Blindness Research Articles

Accessibility of assistive technologies among primary school learners with visual impairments in Tanzania

This study examined the accessibility of Assistive Technologies (ATs) for Learners with Visual Impairments (LwVI) in primary schools in Tanzania. The primary aim was to scrutinize the availability of both high-tech and low-tech ATs, as well as the enabling infrastructure used to enhance the use of ATs in teaching and learning for LwVI. This study employed an exploratory case design within a qualitative approach, in which data were collected through observations and semi-structured interviews and analyzed using thematic data analysis procedures. Data was gathered from five teachers, the Deputy Head Teacher, five LwVI from one primary school, and the District Special Needs Education Officer in the district where the school is located. The study revealed that despite government efforts to promote equitable quality education within an inclusive framework, LwVI in primary schools remain marginalized due to the inadequacy of both low-tech and high-tech ATs, as well as insufficient enabling infrastructure necessary to support their use. This finding is inconsistent with the modern world's emphasis on digitizing education, particularly in ensuring equitable quality education for persons with disabilities. Therefore, a comprehensive approach is needed, including earmarking resources for AT procurement, fostering robust partnerships among stakeholders—including the government and non-governmental organizations—for the acquisition and maintenance of ATs, and upgrading the enabling infrastructure to support their sustainable use. Additionally, there is a need to develop a comprehensive framework for evaluating AT availability and a database for tracking the resources available in schools. These two components should inform policymaking practices and stakeholder decisions.

Digital Assessment of Cognitive Health in Outpatient Primary Care: Usability Study

Background Screening for cognitive impairment in primary care is important, yet primary care physicians (PCPs) report conducting routine cognitive assessments for less than half of patients older than 60 years of age. Linus Health’s Core Cognitive Evaluation (CCE), a tablet-based digital cognitive assessment, has been used for the detection of cognitive impairment, but its application in primary care is not yet studied. Objective This study aimed to explore the integration of CCE implementation in a primary care setting. Methods A cohort of participants was recruited from the upcoming schedules of participating PCPs at UMass Memorial Medical Center. Eligibility criteria included individuals aged ≥65 years; ability to read, write, and speak in English or Spanish; no previous diagnosis of cognitive impairment; and no known untreated hearing or vision impairment. Research coordinators collected consent from participants and facilitated the screening process. PCPs reviewed reports in real time, immediately before the scheduled visits, and shared results at their discretion. A report was uploaded to each participant’s REDCap (Research Electronic Data Capture; Vanderbilt University) record and linked to the encounter in the electronic health record. Feedback from patients and their caregivers (if applicable) was collected by a tablet-based survey in the clinic before and after screening. Participating PCPs were interviewed following the completion of the study. Results The screened cohort included 150 patients with a mean age of 74 (SD 7) years, of whom 65% (97/150) were female. The CCE identified 40 patients as borderline and 7 as positive for cognitive impairment. A total of 84 orders were placed for select laboratory tests or referrals to neurology and neuropsychology within 20 days of CCE administration. Before the assessment, 95% (143/150) of patients and all 15 caregivers expressed a desire to know if their or their loved one’s brain health was declining. All except one patient also completed the postassessment survey. Among them, 96% (143/149) of patients reported finding the CCE easy to complete, and 70% (105/149) felt that the experience was beneficial. In addition, 87% (130/149) of patients agreed or strongly agreed that they wanted to know their CCE results. Among the 7 participating PCPs, 6 stated that the CCE results influenced their patient care management, and all 7 indicated they would continue using the CCE if it were made available after the study. Conclusions We explored the integration of the CCE into primary care visits, which showed minimal disruption to the practice workflow. Future studies will be warranted to further validate the implementation of digital cognitive impairment screening tools within primary care settings in the real world.

ACESSO AO MERCADO DE TRABALHO AOS PORTADORES DE DEFICIÊNCIA VISUAL NA CIDADE DE MAPUTO

Access to work for visually impaired people in the City of MAputo is a topic that reveals significant challenges and gaps that prevent the inclusion of visually impaired people in the job market. The research aims to analyze such challenges, using a qualitative approach, based on interviews with the main actors involved and a bibliographic analysis. The results indicated that, although there are standards that guarantee rights, there is a lack of specific regulations that address the needs of people with visual impairments, such as reasonable adaptations in the work environment and targeted training programs. Furthermore, prejudice and discrimination persist as relevant barriers in the workplace, reflecting an ableist view that still permeates city residents in Maputo. Employers often have limited perceptions of these people's capabilities, which creates resistance to hiring them. The main challenges faced include the lack of awareness about the rights of people with disabilities and the insufficiency of effective public policies to ensure their inclusion. The conclusions indicate that there is a need to strengthen existing policies and implement training programs for both workers with disabilities and employers, aiming to raise awareness about the importance of inclusion. It is also recommended to create awareness campaigns that promote inclusion and respect for the rights of people with visual impairments. These actions are essential to ensure a more inclusive and accessible environment, allowing visually impaired people to contribute to society and the job market in the City of Maputo.

ORTHOGRAPHIC ERROR ANALYSIS IN WRITING AT-TARBIYAH ISLAMIC BOARDING SCHOOL SUKABUMI

Understanding and addressing writing errors is crucial for Arabic language teachers to enhance students' proficiency. This study focuses on analyzing orthographic writing errors made by seventh-grade students at the At-Tarbiyah Islamic Boarding School Sukabumi. Employing a qualitative descriptive approach, data on orthographic errors were collected through students’ responses to essay tests in Arabic language and Tajweed subjects. Additionally, interviews with Arabic and Tajweed teachers were conducted to identify the causes of these errors and propose solutions. The findings reveal that despite being in a linguistic environment, seventh-grade students frequently make orthographic errors due to several factors: the absence of a writing-focused subject in the curriculum, mishearing vocabulary, reliance on auditory input without verification, failure to review vocabulary, incorrect assumptions about word equivalencies, and visual impairments. To address these issues, the study recommends implementing targeted strategies, including increasing writing practice, training students to listen accurately to Arabic words, improving pronunciation skills, consistently reviewing previously learned vocabulary, utilizing dictionaries, and incorporating supportive teaching aids. These interventions aim to reduce orthographic errors and foster better writing skills among students. The study underscores the importance of systematic error analysis in identifying challenges and enhancing Arabic language education.

Low Vision Services Are Underutilized by Patients with Vision Loss from Corneal Disease.

This study evaluated the rate at which patients with visual impairment primarily from corneal disease were referred for low vision (LV) services and assessed the visual outcomes from completed evaluations. This 1-year retrospective, cross-sectional study included patients with corneal disease limiting best-corrected visual acuity (BCVA) to ≤ 20/40. Outcome measures included the change in BCVA achieved after distance refraction by a LV specialist. Incremental costs per quality-adjusted life years (QALY) gained were calculated upon the better-seeing eye, by using a willingness-to-pay threshold of USD 50,000/QALY. Of 3230 patients, 143 (4.4%) had visual impairment from corneal disease. The median age of those patients was 80 years (IQR: 66-88 years) and 64.3% were male. Just over half were referred for LV evaluations (53.2%), and most completed appointments (96.1%). Patients more likely to be referred had better vision in their worse-seeing eye (0.961 logMAR vs. 1.451 logMAR, P = 0.002) and were more frequently diagnosed with corneal dystrophies, degenerations, or ectatic disease (51.3% vs. 26.9%, P = 0.003) compared with other corneal conditions, but they were less likely to have immunologic conditions (2.6% vs. 13.4%, P = 0.016). In total, two-thirds of patients achieved improved BCVA for their better-seeing eye, with 32% gaining ≥ 2 lines. This translated into an average gain of 0.04 QALYs/patient at a cost of USD 3128/QALY. The estimated net monetary benefit was USD 1923/LV evaluation completed. Referring patients with corneal disease to LV services resulted in significant improvements in visual function at a reasonable cost.

Influence of Surface Chemistry and Nanomechanical Properties of Methacrylate-Based Copolymer Thin Films on Keratocyte Cell Adhesion.

Keratoprosthesis is an alternative treatment for visual impairment caused by corneal diseases. However, due to the recognized postoperative complications in available Kpros, there is an exigency to explore potential alternative skirt materials for corneal implants. This study aims to investigate the suitability of poly(2-methoxyethyl methacrylate-co-2-hydroxyethyl methacrylate) (15% MEMA: 85% HEMA), and poly(2-phenoxyethyl methacrylate-co-2-hydroxyethyl methacrylate) (15% PhEMA: 85% HEMA) copolymers as a corneal implant material by evaluating their ability to adhere human keratocytes. The effect of chemical and mechanical properties of copolymers on the keratocyte cell adhesion was investigated. These copolymers are thermally stable with a glass transition temperature between 75 and 80 °C, and thermogravimetric analysis showed that the copolymers do not degrade until 190 °C. Sum frequency generation spectroscopy (SFG) and atomic force microscopy (AFM) were employed to evaluate the surface chemical and mechanical properties of the polymer thin films. SFG spectra showed the contributions of methylene (CH2) and α-methyl (α-CH3) functional groups at the air/polymer interface. Moreover, the signature vibrational modes of methoxy (-OCH3) and phenoxy (-OPh) groups were detected at the 15% MEMA: 85% HEMA and 15% PhEMA: 85% HEMA copolymer surfaces that contribute to chemical composition surface analysis. Meanwhile, the analysis of the AFM topographical images showed that the 15% MEMA: 85% HEMA copolymer is relatively rougher with a root-mean-square value of 56 nm but was found to be more elastic than the 15% PhEMA: 85% HEMA copolymer with a Young's modulus value of 0.39 GPa. Fluorescence microscopy images showed visible F-actin filaments on stiffer substrates, demonstrating the ability to regulate cell adhesion and migration behavior based on the nanomechanical characteristics of implants. The results show that substrate stiffness can regulate keratocyte cell adhesion as keratocytes preferred to adhere on a stiffer 15% PhEMA: 85% HEMA copolymer surface than the 15% MEMA: 85% HEMA copolymer surface.

Advances in the Study of Age-Related Macular Degeneration Based on Cell or Cell-Biomaterial Scaffolds

Age-related macular degeneration (AMD), a progressive neurodegenerative disorder affecting the central retina, is pathologically defined by the irreversible degeneration of photoreceptors and retinal pigment epithelium (RPE), coupled with extracellular drusen deposition and choroidal neovascularization (CNV), and AMD constitutes the predominant etiological factor for irreversible vision impairment in adults aged ≥60 years. Cell-based or cell-biomaterial scaffold-based approaches have been popular in recent years as a major research direction for AMD; monotherapy with cell-based approaches typically involves subretinal injection of progenitor-derived or stem cell-derived RPE cells to restore retinal homeostasis. Meanwhile, cell-biomaterial scaffolds delivered to the lesion site by vector transplantation have been widely developed, and the implanted cell-biomaterial scaffolds can promote the reintegration of cells at the lesion site and solve the problems of translocation and discrete cellular structure produced by cell injection. While these therapeutic strategies demonstrate preliminary efficacy, rigorous preclinical validation and clinical trials remain imperative to validate their long-term safety, functional durability, and therapeutic consistency. This review synthesizes current advancements and translational challenges in cell-based and cell-biomaterial scaffold approaches for AMD, aiming to inform future development of targeted interventions for AMD pathogenesis and management.

Classification, diagnosis, and management of orbital venous-lymphatic malformations: Current state-of-the-art

Abstract Orbital venous-lymphatic malformations (VLMs) are complex vascular anomalies that pose significant challenges to ophthalmologists due to their diverse clinical manifestations and the difficulties inherent in their therapeutic management, particularly given their proximity to critical orbital structures. This narrative review synthesizes the current knowledge on the classification, pathology, molecular mechanisms, imaging characteristics, and therapeutic strategies for VLMs. Historically misclassified as orbital lymphangiomas, VLMs are now recognized as complex malformations comprising interconnected venous and lymphatic components, with the potential for significant complications, including proptosis, visual impairment, and esthetic disturbances. Recent molecular insights have revealed critical pathogenetic mechanisms, particularly mutations in the PIK3CA gene that activate the phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin transduction network, alongside the upregulation of vascular endothelial growth factor (VEGF)-mediated signaling. These aberrations not only illuminate the disease etiology but also present promising therapeutic targets. Contemporary management strategies emphasize a multidisciplinary approach, with sclerotherapy emerging as a particularly promising intervention. Sclerosing agents such as bleomycin and pingyangmycin typically yield effective treatment outcomes with relatively favorable safety profiles. Surgical excision is reserved for accessible lesions but often requires adjunctive therapies due to the infiltrative nature of VLMs. Emerging treatments targeting molecular pathways, including PI3K inhibitors and anti-VEGF therapies, show promise in refractory cases. As our understanding deepens, clinicians can now offer more personalized interventions that consider factors such as lesion location, extent, architecture, and hemodynamic characteristics, thereby minimizing morbidity and optimizing clinical and aesthetic outcomes.

Whole-exome sequencing reveals sex difference in the genetic architecture of high myopia

BackgroundHigh myopia (HM) is one of the leading causes of visual impairment and blindness worldwide. To understand the sex difference in the genetic architecture of HM, which may contribute to...

The Uneven Effect of Rare Diseases on Functional Status and Work Capacity

Background: Rare diseases are defined as clinical conditions that affect only a small number of persons in a population, considered fewer than 1 per 2000 in the European Union or fewer than 1 per 1600 in the United States They are serious, often chronic and progressive conditions, characterized by a pronounced clinical polymorphism that crosses all medical specialties. Multiple areas of life beyond just physical health are affected with significant impact on patients, families, and healthcare systems. Objective: To analyze the socio-demographic, medical, and vocational characteristics that correlate with functional status and work disability as a measure of quality of life in rare diseases. Methods: An observational retrospective study of adults with rare diseases evaluated for eligibility for social insurance rights in the National Institute of Medical Assessment and Work Capacity Rehabilitation Bucharest (INEMRCM, the Romanian abbreviation) over a 5-year period was made. Descriptive analysis was used to present sample characteristics. Means and standard deviations (SD) were calculated to describe numerical variables, frequencies were used to describe categorical variables, and logistic regression analysis was conducted to evaluate potential predictors of work capacity. All statistical analyses were performed by PSPP.3 software. p < 0.05 was the cut-off for statistical significance with a 95% confidence interval. Results: 90 consecutive persons were included in the survey. The mean age of the group was 44.5 years ± SD 10.61 years, with a female/male ratio of 48/42 persons. The mean disease duration was 10.61 years ± SD 9.76 years. Men had more severe disease (73.81%); p = 0.018 and significantly younger retirement age, M/F = 39.10 ± 12.26/43.06 ± 9.32; p = 0.037. Less disabling diseases were predominant autoimmune conditions (85.71% of cases); genetic conditions had a more severe functional impact in 63.75% of cases; p = 0.037. People with multisystem diseases but with specific or targeted treatment can work more frequently (76.19%); those with visual impairment have more severe impairments (73.77%); p < 0.001. All individuals who received specific therapy had a better functional status, unlike only 37.21% of those who received symptomatic treatment or treatment for complications; p = 0.023. Logistic regression analysis indicated that the type of impairment and the availability of specific treatments could serve as predictors of a reduced likelihood of employment in rare disease cases. Education level and occupation were not correlated with functional impairment and work disability (NS). Conclusions: Several factors, including some that are modifiable, were associated with better outcomes, such as reduced disability and an increased potential for work participation. Sex, disease etiology, type of impairment, and treatment were all significantly linked to functional capacity. Among these, the type of impairment and the availability of specific treatments might be predictors of employment. Addressing these parameters requires a multidisciplinary team, involving specialized care and comprehensive support services to improve the overall quality of life of individuals affected by rare diseases.

Treatment approaches for refractory full-thickness macular holes.

Full-thickness macular holes (FTMH) can result in significant visual impairment if untreated. Although conventional treatment achieves high closure rates, FTMH can persist or reopen in some cases. This review examines recent advances in surgical approaches for managing refractory FTMH and highlights their effectiveness and limitations. Approaches to refractory FTMH aim to relieve traction, encourage glial cell proliferation, improve RPE pump efficiency, increase retinal compliance, and/or provide replacement tissue. A variety of techniques targeting these mechanisms, including various autologous or allogeneic transplants such as internal limiting membrane (ILM) or human amniotic membrane grafts, or surgical manipulations such as macular detachment or relaxing retinotomies, have been proposed. These techniques are reviewed here. Multiple techniques have shown promise for refractory FTMH. Choice of technique should be guided by characteristics of the FTMH, including size and chronicity, availability of desired tissue or instrumentation, and surgeon familiarity.

Capillary leakage leading to bilateral visual impairment: a diagnostic journey.

Capillary leakage leading to bilateral visual impairment: a diagnostic journey.

Monocular reading performance measured by MNREAD-P acuity chart in normo-readers schoolchildren.

This study aimed to determine and establish values for reading performance in normo-readers schoolchildren. Literate students aged 8 to 18 years old without visual impairments were recruited. The MNREAD-P chart was used to assess monocular reading acuity (RA in logMAR), critical print size (CPS in logMAR), and maximum reading speed (MRS in words per minute - wpm). Participants were grouped into three education levels: Elementary School I (3rd to 5th grade), Elementary School II (6 to 9th), and High School (10 to 12th). Lower and upper normal limits were determined using a 95% confidence interval around the mean. The association of RA, MRS, and CPS with sex, heterophoria, and education level was analyzed with a significance level of p ≤ 0.05. The final sample included 184 eyes from 92 participants (65% female) with a mean age of 12.8 ± 2.9 years. The normative lower limits were: (a) RA of 0.1 logMAR for Elementary I and II and 0.0 logMAR for High School; (b) CPS of 0.3 logMAR for all education levels; (c) MSR of 116 wpm for Elementary I, 159 wpm for Elementary II and 192 wpm for High School. Higher education level was significantly associated with improvement in RA (p = 0.017) and MRS (p < 0.001).

Long-Term Experiences of Health Care Providers Using Iris Scanning as an Identification Tool in a Vaccine Trial in the Democratic Republic of the Congo: Qualitative Study.

Iris scanning has increasingly been used for biometric identification over the past decade, with continuous advancements and expanding applications. To better understand the acceptability of this technology, we report the long-term experiences of health care providers and frontline worker participants with iris scanning as an identification tool in the EBL2007 Ebola vaccine trial conducted in the Democratic Republic of the Congo. This study aims to document the long-term experiences of using iris scanning for identity verification throughout the vaccine trial. Two years after the start of the EBL2007 vaccine trial (February to March 2022), 69 trial participants-including nurses, first aid workers, midwives, and community health workers-were interviewed through focus group discussions. Additionally, 13 in-depth individual interviews were conducted with physicians involved in the trial, iris scan operators, trial staff physicians, and trial participants who declined iris scanning. Qualitative content analysis was used to identify key themes. Initially, interviewees widely accepted the iris scan and viewed it as a distinctive tool for identifying participants in the EBL2007 vaccine trial. However, over time, perceptions became less favorable. Some participants expressed concerns that their vision had diminished shortly after using the tool and continued to decline until the end of the study. Others reported experiencing perceived vision loss long after the trial had concluded. However, no vision impairment was reported as an adverse event or assessed in the trial as being linked to the iris scan, which uses a previously certified safe infrared light for scanning. Our findings highlight the sustained acceptability and perceived high accuracy of the iris scan tool for uniquely identifying adult participants in a vaccine trial over time. Continued efforts to systematically disseminate and reinforce information about the function and safety of this technology are essential. Clearly presenting iris scanning as a safe procedure could help dispel misconceptions, concerns, and perceived risks among potential users in vaccine trials.

Cataract surgery in sub-Saharan Africa-Possibilities and limits

The importance of cataract surgery for the treatment of visual impairment and blindness is as uncontroversial as the cost-effectiveness of the procedure. In terms of quality, there are almost no published case series of cataract operations in sub-Saharan Africa that meet the World Health Organization (WHO) guidelines for postoperative visual acuity. The results after cataract surgery at apublicly accessible tertiary care eye clinic in Rwanda are presented and compared with standardized results from an eye clinic in Germany (AKW). Data from 100 consecutive eyes (manual small incision cataract surgery, MSICS-Rwanda, Phaco-Rwanda, Phaco-AKW) were retrospectively evaluated. The results were compared with each other and with WHO guidelines. The number of patients with significantly reduced preoperative visual acuity (visual acuity > 1.3 logMAR) was highest in the MSICS group (MSICS 92%, Phaco-Rwanda 13%, Phaco-AKW 1%). Uncorrected postoperative visual acuity was similar in the Phako-Rwanda and Phako-AKW groups (0.22/0.21 logMAR) and better than MSICS Rwanda (0.33 logMAR). The best corrected postoperative visual acuity was significantly better in the Phako-Rwanda group (0.07 logMAR) than in the two comparison groups Phako-AKW (0.1 logMAR) and MSICS Rwanda (0.15 logMAR). The results of all three groups fulfilled the WHO criteria for postoperative visual acuity. Despite poor initial visual acuity, high quality results can be achieved in cataract surgery in aclinical setting in sub-Saharan Africa that are within WHO expectations. Acoexistence of MSICS technique and phaco seems reasonable to avoid complications and achieve the best possible results.

Assessment of Syphilitic Optic Neuropathy: A Prospective Cross-Sectional Study.

To evaluate the clinical features of syphilis optic neuropathy (SON) and explore its underlying pathogenesis by measuring the peripapillary retinal nerve fiber layer (pRNFL). This was a prospective cross-sectional study. Syphilitics, regardless of ocular complaints, in the ophthalmology department in 2020 were screened for SON, which was defined as isolated optic neuropathy without overt signs of syphilitic uveitis. We analyzed the demographic and clinical information, including ultra-wide-field fundus photographs, fundus fluorescein angiography (FFA), and pRNFL thickness measured by spectral-domain-OCT (SD-OCT). Of 577 cases with syphilis, 25 patients (4.3% ± 0.8%) presented with optic disc edema and 7 patients (1.2% ± 0.5%) with optic atrophy. Of the eyes with optic disc edema, (35 eyes, 40% biocular), 40% had no ocular symptoms, and 45.7% had visual acuity (VA) better than 20/25, whereas 100% showed optic disc leakage in FFA. Of the eyes with optic atrophy (14 eyes, 100% biocular), 100% were male and presented severe vision impairment (VA worse than 20/70), but no optic disc leakage in FFA. A higher rapid plasma reagin (RPR) level was more frequently observed in patients with SON (p = 0.009). Additionally, the pRNFL thickness in non-ocular syphilis was not related to the RPR level or the syphilis duration (all p > 0.05). The SONs could manifest as asymptomatic optic disc edema or blinding optic atrophy, which were independent episodic reactions from ocular or cerebral syphilis, respectively. Our data highlighted the need for ophthalmic screening and prompt neurosyphilis treatment.

A Rare Vitreoretinal Degenerative Disorder: Goldmann–Favre Syndrome Complicated with Choroidal Neovascularization in a Pediatric Patient

Goldmann–Favre syndrome (GFS) is a rare vitreoretinal degenerative disorder caused by mutations in the NR2E3 gene located on the short arm of chromosome 15. This condition, inherited in an autosomal recessive manner, was first described by Favre in two siblings, with Ricci later confirming its hereditary pattern. In GFS, rod photoreceptors are essentially replaced by S-cone photoreceptors. Enhanced S-Cone Syndrome (ESCS) and Goldmann–Favre syndrome are two distinct entities within the spectrum of retinal degenerative diseases, both caused by mutations in the NR2E3 gene. Despite sharing a common genetic basis, these conditions exhibit significantly different clinical phenotypes. ESCS is characterized by an excessive number of S-cones (blue-sensitive cones) with degeneration of rods and L-/M-cones, leading to increased sensitivity to blue light and early-onset night blindness. In contrast, GFS is considered a more severe form of ESCS, involving additional features such as retinal schisis, vitreous degeneration, and more pronounced visual impairment. GFS typically manifests in the first decade of life as night blindness (nyctalopia) and progressive visual acuity impairment. The clinical features include degenerative vitreous changes such as liquefaction, strands, and bands, along with macular and peripheral retinoschisis, posterior subcapsular cataract, atypical pigmentary dystrophy, and markedly abnormal or nondetectable electroretinograms (ERGs). Although peripheral retinoschisis is more common in GFS, central retinoschisis may also occur. Despite the consistent genetic basis, the phenotype of GFS can vary significantly among individuals. The differential diagnosis should consider diseases within the retinal degenerative spectrum, including retinitis pigmentosa, congenital retinoschisis, and secondary pigmentary retinopathy.

"Good vision in care facilities" : Qualitative evaluation study from the perspective of the vision officers

Visual impairment increases with age and can adversely affect the quality of life of older people. Ophthalmological care in nursing homes is often inadequate, leading to poor detection and treatment of visual problems. The prevention program "Good vision in care facilities" ("Gutes Sehen in Pflegeeinrichtungen") of the Institute for the Blind Foundation (Blindeninstitutsstiftung) aims to promote the eye health of residents through targeted measures and the training of qualified vision officers. The aim was to evaluate the prevention program from the perspective of the vision officers, focusing on their role, the performance of vision assessments, the improvement of the living environment and the qualification measures. Aqualitative evaluation study was conducted through guideline-based interviews with eight vision officers from seven nursing homes. The data were analyzed using Mayring's structured content analysis. Vision officers consider their role to be important but the success of implementation depends on the available resources. The performance of vision assessment varies due to cognitive impairment and motivation of the residents. Barriers to accessibility were primarily addressed when minimal effort was required. Face to face training sessions contribute significantly to awareness due to their practical content and interaction. The sustainable implementation of the prevention program requires resource allocation by nursing home management. The qualification of several vision officers in each facility could increase the success of the program. Alternative methods of vision assessment for cognitively impaired residents should be developed.

Astaxanthin ameliorates benzalkonium chloride-induced dry eye disease through suppressing inflammation and oxidative stress via Keap1-Nrf2/HO-1 signaling pathways.

Dry eye disease (DED) predominantly results from elevated tear film osmolarity, which can not only cause ocular inconvenience but may lead to visual impairments, severely compromising patient well-being and exerting substantial economic burdens as well. Astaxanthin (AST), a member of the xanthophylls and recognized for its robust abilities to combat inflammation and oxidation, is a common dietary supplement. Nonetheless, the precise molecular pathways through which AST influences DED are still poorly understood. Therapeutic targets for AST were identified using data from the GeneCards, PharmMapper, and Swiss Target Prediction databases, and STITCH datasets. Similarly, targets for dry eye disease (DED) were delineated leveraging resources such as the Therapeutic Target Database (TTD), DisGeNET, GeneCards, and OMIM databases, and DrugBank datasets. Interactions among shared targets were charted and displayed using CytoScape 3.9.0. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were conducted to elucidate the functions of pivotal targets within the protein-protein interaction network. Molecular interactions between AST and key targets were confirmed through molecular docking using AutoDock and PyMOL. Molecular dynamics simulations were performed using GROMACS 2022.3. Viability of human corneal epithelial cells (hCEC) was assessed across varying concentrations of AST. A mouse model of experimental DED was developed using 0.1% benzalkonium chloride (BAC), and the animals were administered 100 mg/kg/day of AST orally for 7 days. The efficacy of the treatments was assessed through a series of diagnostic tests to evaluate the condition of the ocular surface after the interventions. The levels of inflammation and oxidative stress were quantitatively assessed using methods such as reverse transcription-polymerase chain reaction (RT-PCR), Western blot, and immunofluorescence staining. Network pharmacology suggests that AST may alleviate DED by influencing oxidation-reduction signaling pathways and reducing oxidative stress provoked by BAC. Invivo experiments demonstrated an improved overall condition in AST-administered mice in contrast to the control group. Immunofluorescence staining analyses indicated a decrease in Keap1 protein in the corneal tissues of AST-treated mice and a significant increase in Nrf2 and HO-1 protein. Invitro studies demonstrated that AST significantly enhanced cell viability and suppressed reactive oxygen species expression under hyperosmotic (HS) conditions, thereby protecting the human corneal epithelium. AST is capable of shielding mice from BAC-induced DED, decelerating the progression of DED, and mitigating oxidative stress damage under HS conditions in hCEC cells. The protective impact of AST on DED may operate through stimulating the Keap1-Nrf2/HO-1 signaling pathway. Our research findings indicate that AST may be a promising treatment for DED, offering new insights into DED treatment.

Adaptation and validation of the modified Egyptian Arabic version of Addenbrooke’s Cognitive Examination III (VI-ACE-III) for assessing cognitive impairment in visually impaired elderly

BackgroundVision impairment affects the accuracy of cognitive test outcomes, emphasizing the need for developing cognitive screening tools designed for visually impaired individuals, especially considering global aging trends. This study aimed to develop a modified, validated version of the Vision-Impairment version of Addenbrooke's Cognitive Examination III (VI-ACE-III) for Arabic-speaking elderly individuals with vision impairment in Egypt. In addition, the study aimed to assess the accuracy of VI-ACE-III in diagnosing dementia and mild cognitive impairment (MCI).MethodsThe VI-ACE-III was developed using large printed formats and verbal substitution of the vision-dependent items. One hundred and eighty participants aged ≥ 60, with varying degrees of vision impairment (including moderate, severe, and blindness), were divided into three equal groups: 60 individuals with MCI, 60 with mild to moderate dementia, and 60 with cognitively intact controls. Receiver operating characteristics (ROC) curves were plotted to assess the accuracy of the test screening.ResultsROC analysis for dementia established an optimal cut-off point of 84 out of 115, demonstrating 100.0% sensitivity, 98.3% specificity, and an area under the curve (AUC) of 0.983, based on the comparison between the dementia and MCI groups. The analysis for MCI determined an optimal cut-off point of 94 out of 115, with 95.0% sensitivity, 96.7% specificity, and an AUC of 0.983 compared to controls. The VI-ACE-III demonstrated significant Cronbach's alpha values (α = 0.866, α = 0.771), indicating strong internal consistency within the dementia and MCI groups.ConclusionsThe VI-ACE-III showed good sensitivity and specificity for assessing dementia and MCI in Arabic-speaking elderly individuals with visual impairment (VI) in Egypt. Regular screening and interventions are crucial for managing and preventing the deterioration of cognitive dysfunction and vision impairment in the elderly population.