Vision Services Research Articles

An Innovative Interprofessional Course in Ophthalmology and Low Vision for Occupational Therapy Students

Introduction: There is an increasing need for occupational therapists with the skills to provide low vision services, however, there is a lack of standardized training of low vision occupational therapy services. The purpose of this study is to design and evaluate a course for occupational therapy students to improve their skills and knowledge about ophthalmology and low vision. Methods: A multifaceted, 15-week curriculum using didactic learning, clinical experience, and reflective writing was created to instruct second-year occupational therapy students in ophthalmology and low vision. Participants included 19 occupational therapy students from Thomas Jefferson University. Each trainee participated in the course modules and then submitted their course evaluations and reflective writings for review. Participants evaluated their satisfaction with the course using a Likert-scale and open-ended comments. Reflective writing from each participant was reviewed by occupational therapy faculty authors (AB, AL). Results: Nineteen students participated in the course, with 19 (100%) of participants reporting being “satisfied” or “highly satisfied” with the course. Analysis of the reflective writings revealed three main themes: the impact of eye-related medical conditions on daily life, insight into the provider-patient interaction and relationship, and the potential role of the occupational therapist on the vision team as an agent to maximize patient adjustment and function. Discussion: This collaborative, multimodal interprofessional educational model can assist in training and sensitizing occupational therapy students in the areas of ophthalmology and low vision. Implications for Practitioners: This report provides a model for medical educators to utilize in the training of occupational therapy students.

Dynamic and Effect-Driven Output Service Selection for IoT Environments Using Deep Reinforcement Learning

In the context of the recent emergence of the Internet of Things (IoT), human users and IoT-based services are interacting via physical effects, such as light and sound. Therefore, it is necessary to consider the quality of the delivery of physical effects to users by IoT devices for selecting services in IoT environments. However, traditional service-selection algorithms focus primarily on the network-level Quality of Service (QoS), such as latency and throughput. In this study, we improve on the visual-service effectiveness metric developed in our previous work to measure the effectiveness of the personalized delivery of physical effects of visual services to users by considering user- and application-specific factors. We evaluate the metric by conducting a user study, and the results show that the metric reflects users’ perceived effectiveness with high accuracy. We also investigate the use of virtual reality (VR) to imitate physical environments for efficient evaluation of the metric. Based on this metric, we develop a dynamic effect-driven output-service selection agent (DEOSA) that selects output services dynamically by considering the effectiveness of service-effect delivery. By adopting a state-of-the-art reinforcement-learning algorithm, DEOSA can learn the optimal policy for selecting output services that can be generalized to various environments. We evaluate DEOSA in simulated IoT environments and show that it can learn the optimal policy successfully; it generally performs better than traditional greedy algorithms in terms of the visual service effectiveness metric and the replacement overhead in randomly generated test environments.

TFormer: A Transmission-Friendly ViT Model for IoT Devices

Deploying high-performance vision transformer (ViT) models on ubiquitous Internet of Things (IoT) devices to provide high-quality vision services will revolutionize the way we live, work, and interact with the world. Due to the contradiction between the limited resources of IoT devices and resource-intensive ViT models, the use of cloud servers to assist ViT model training has become mainstream. However, due to the larger number of parameters and floating-point operations (FLOPs) of the existing ViT models, the model parameters transmitted by cloud servers are large and difficult to run on resource-constrained IoT devices. To this end, this article proposes a transmission-friendly ViT model, TFormer, for deployment on resource-constrained IoT devices with the assistance of a cloud server. The high performance and small number of model parameters and FLOPs of TFormer are attributed to the proposed hybrid layer and the proposed partially connected feed-forward network (PCS-FFN). The hybrid layer consists of nonlearnable modules and a pointwise convolution, which can obtain multitype and multiscale features with only a few parameters and FLOPs to improve the TFormer performance. The PCS-FFN adopts group convolution to reduce the number of parameters. The key idea of this article is to propose TFormer with few model parameters and FLOPs to facilitate applications running on resource-constrained IoT devices to benefit from the high performance of the ViT models. Experimental results on the ImageNet-1K, MS COCO, and ADE20K datasets for image classification, object detection, and semantic segmentation tasks demonstrate that the proposed model outperforms other state-of-the-art models. Specifically, TFormer-S achieves 5% higher accuracy on ImageNet-1K than ResNet18 with 1.4× fewer parameters and FLOPs.

Barriers and facilitators in the referral pathways to low vision services from the perspective of patients and professionals: a qualitative study

BackgroundUnderutilization of and lack of access to low vision services (LVS) has been reported internationally. The purpose of this study was to identify barriers and facilitators in LVS referral procedures and service delivery from both the perspective of people with visual impairment and professionals from different eye care providers in the Netherlands.MethodsA qualitative study in the Netherlands was conducted. Barriers and facilitators were explored through semi structured interviews with older adults with macular degeneration, diabetic retinopathy and/or glaucoma (n = 14), and healthcare professionals including ophthalmologists and LVS professionals (n = 16). Framework analysis was used for analyzing the interviews with Atlas.ti software.ResultsAccording to both patients and professionals, facilitators in LVS access and utilization are having motivation, self-advocacy, high participation needs and social support, as well as being negatively impacted by the impairment. Both samples found having good communication skills and informing patients about LVS as a healthcare provider to facilitate access. A long patient-provider relationship and the Dutch healthcare system were also mentioned as facilitators. Professionals additionally found long disease duration and the presence of low vision optometric services in the ophthalmic practice to promote access.Barriers that were reported by patients and professionals are lack of motivation, self-advocacy and acceptance of the impairment in patients. In addition, having low participation needs as a patient, lack of information provision by providers and time constraints in the ophthalmic practice were mentioned as barriers. Professionals also reported lack of social support, short disease duration of patients, a short patient-provider relationship and lack of coordination of care in the ophthalmic practice to hinder access.ConclusionsFindings suggest that providers’ lack of information provision about LVS, especially to patients who are less assertive, hamper referral to LVS. Providers should have attention for patients’ LVS needs and actively inform them and their social network about LVS to facilitate access. Educating and training providers about how and when to address LVS may help to reduce barriers in the referral pathways. In addition, referral procedures may benefit from tools that make providers more aware of LVS.

Vision rehabilitation in glaucoma patients.

Vision rehabilitation services are important but underutilized resources for patients with glaucoma. Glaucoma and its impact on vision can affect patients' abilities to read and drive, two activities of daily living that are associated with quality of life and functional independence. In this review, we provide an overview of low vision, discuss barriers to vision rehabilitation, and outline various strategies and interventions to optimize visual function and quality of life in patients with glaucoma. Studies have shown that glaucoma negatively impacts reading, driving and overall quality of life. Decreased visual acuity, visual field loss and reduced contrast sensitivity play a role. Low vision services and interventions can help patients maximize visual function and improve their quality of life. Barriers to receiving these services exist at multiple levels and an increased awareness and integration into routine ophthalmic care are needed to deliver comprehensive care. Glaucoma is one of the leading causes of low vision. Ophthalmologists who treat glaucoma often tend to focus on objective measures to monitor progression and disease severity, but the functional impact of glaucoma should also be addressed. Low vision services can benefit patients, particularly for reading and driving, and should be considered as an essential component of patient care.

A community-based cross-sectional study of eye care service utilization among the adult population in southern Ethiopia.

Visual impairment, which is related to many eye diseases, is a major public health problem. If detected and treated early, it can be prevented; therefore, regular use of vision services is very important. This study aimed to assess the proportion of utilization of eye care services and associated factors among the rural community population in southern Ethiopia. A community-based cross-sectional study design with a two-stage cluster random sampling technique was conducted to collect data from adults aged 40 years and above using interviewer-administered questionnaires. Kebeles were randomly selected by the lottery method, and systematic random sampling with proportional distribution was used to select the households. An adult individual was randomly selected from a household when there was more than one adult available. A binary logistic regression model was used to establish the association between eye care service utilization and the variables that might affect it. Of the 551 study population, 510 responded to this study, and the response rate was 92.6%. The mean age of the respondents was 52.2 years. The rate of eye care service utilization was 29% (95% confidence interval (0.25, 0.33)). The study shows that older participants, aged 65 and above (adjusted odds ratio: 4.04; 95% confidence interval (2.20, 7.43)), having previous eye problems (adjusted odds ratio: 10.04; 95% confidence interval (5.81, 17.33)), the presence of systemic illness (adjusted odds ratio: 2.52; 95% confidence interval (1.21, 5.21)), and having awareness about regular checkups (adjusted odds ratio: 11.75; 95% confidence interval (6.62, 20.84)) were found to be the predictors of eye care service utilization. In this study, utilization of eye care services was low. Older age, previous eye problems, systemic illness, and awareness about checkups were found to be predictors of eye care service utilization. Hence, there is a need to increase the absorption of existing ophthalmic services and create awareness of the use of ophthalmology services to reduce preventive blindness.

Barriers and facilitators to implement e-mental health for depression and anxiety in patients with macular oedema: a qualitative interview study among stakeholders

Purpose: Mental health problems are common in patients with macular oedema, who receive repeated intravitreal injections with anti-vascular endothelial growth factor. A guided internet-based self-help intervention, called E-PsEYE, was developed to reduce these problems. Patients were referred by their ophthalmologist to follow E-PsEYE individually at home, guided by a social worker from low vision services. Since e-mental health is new in this setting and professionals were collaborating in a novel way, barriers and facilitators during implementation and for future scale-up were evaluated. Methods: Semi-structured interviews were performed with patients (n=8), ophthalmologists (n=4), heads of ophthalmology departments (n=2), doctor’s assistants (n=3), social workers (n=6) and managers from low vision services (n=2), and representatives from a health insurer (n=2). Data were analyzed using a thematic approach. Results: Both patients and professionals were satisfied with the potential efficiency and added value of the intervention. They indicated that sufficient digital skills in patients and social workers, information technology (IT) support and adding personalized face-to-face contacts, could facilitate implementation. However, a high workload within the different settings (i.e., hospital and low vision services) and the reluctance of both patients and professionals in focusing on mental health problems could hinder implementation. Moreover, evidence on cost-effectiveness and incorporation in current guidelines were expected to be important for reimbursement and scale-up. Conclusions: Both on the individual level and in the interaction between stakeholders and their context, different important barriers and facilitators were expressed. To facilitate the use of E-PsEYE in practice, strategies that focus on these aspects could be implemented, e.g. healthcare providers could discuss and normalize mental health complaints and their digital skills could be supported.

Prevalence of low vision and barriers to uptake of low vision services in an adult population of Southwest Nigeria

Aim: To determine the prevalence of functional low vision and barriers to uptake of low vision services in Oluyole Local Government Area, Oyo State with a view to obtaining data for proper planning of low vision services. Methods: A population-based cross-sectional study. Multistage random sampling technique with probability proportion to size was used to select respondents from the L.G.A. The study involved the administration of questionnaires to elicit basic demographic data, ocular history, and barriers to uptake of low vision services as well as ocular examination to determine the causes of low vision. Results: A total of 419 respondents participated in the study, 303 were females with male-to-female ratio of 1:2.6 and a mean age of 49.38 (± 13.17) years. Fourteen (3.3%) respondents were found to have functional low vision. The main causes of functional low vision were glaucoma (32%) and age-related macular degeneration (ARMD) (16%). Functional low vision was strongly associated with older age (p = 0.019) and the main barriers to utilization of low vision services were lack of awareness of the services and financial constraints. Conclusion: A significant burden of functional low vision was found in Oluyole Local Government Area of Oyo State. There is need for regular community-based surveys in other parts of the country to aid proper planning of low vision services in the host communities and the country as a whole. Also, more awareness needs to be created about common ocular diseases and facilities for appropriate treatment of these diseases.

Low Vision Service Reimbursement Plan for Each Canadian Province

The increasing low vision patients in the world encounter several barriers that prevent them seeking treatment. In Canada, such barriers stem from patients’ circumstances, stigma in the community or from factors that discourage eye care professionals from providing low vision services. Remuneration plans for low vision services are inconsistent and insufficient between provinces or territories. One method for our health care systems to enhance accessibility and equity of low vision services would be by providing adequate reimbursements to eye care professionals who spend extra time and care to conduct such crucial service.

Assessment of Low Vision Referrals before and after Establishment of a Low Vision Program at an Academic Medical Center.

We assessed the number of referrals for low vision (LV) services to determine if establishing an LV program at a large academic medical center impacted referral rates. Visual acuity (VA), referral outcome, location, and specialty were examined as factors that could impact referrals. This study aimed to identify gaps in the referral process to LV services. Electronic medical records of patients were reviewed to ascertain the referral rate among those who qualified for services, both before (2014 to 2016) and after (2017 to 2019) the establishment of an LV program. The medical records were further subdivided into two categories based on VA in the better-seeing eye: 20/70 to 20/200 and 20/200 to worse vision. A total of 2014 patient records with VA qualifying for LV services were reviewed. The proportion of patients who had a VA of 20/70 to 20/200 inclusive in their better eye was 91.7%. A majority (89.8%) of patients with VA of 20/70 to 20/200 and 74.4% of patients with VA worse than 20/200 were never referred. Before establishing an LV program, only 2.2% of patients with VA of 20/70 to 20/200 were referred for services on their first visit, which improved to 8% after the program was established (odds ratio [OR], 3.88; 95% confidence interval [CI], 2.37 to 6.33; P < .001). Also, before the program's establishment, 12.5% of patients with VA worse than 20/200 were referred on their first visit, which increased to 31.9% after the program's establishment (OR, 3.29; 95% CI, 1.50 to 7.19; P = .002). Patients with VA worse than 20/200 were more likely to be referred (before: OR, 6.34 [95% CI, 3.03 to 13.28; P < .001]; after: OR, 5.38 [95% CI, 3.09 to 9.37; P < .001]). Our data also showed that 10.3% of patients in this study declined referral to LV services. Referral rates to LV services are low among patients who qualify. The establishment of an LV program at the medical center significantly increased referral rates. However, more improvement is necessary to connect patients to LV services.

School-Based Delivery of Vision Care in Chicago Public Schools.

In 2012, Chicago Public Schools and the Chicago Department of Public Health partnered together to create the Chicago School-Based Vision Program (CSBVP). This ongoing, city-wide program provides school-based vision services (eye examinations, eyeglasses provision, and eye care referrals) to students with limited access. Descriptive analysis of the program operations from 2012 to 2020, including number of students served and exam findings during 2017-2020, as well as lessons learned and recommendations for reproducing the successes of the CSBVP in other contexts. During its first 8 years, the CSBVP provided eye examinations to over 350,000 students. During the years 2017-2020, this included 126,238 eye exams and provision of eyeglasses to 73,751 students. The CSBVP is built upon strong community and school relationships. The program offers vision services, equitably, to all students across the district. The lessons learned through the implementation of the CSBVP may provide guidance for future district-wide vision programs.

Robust watermarking based on blur‐guided JND model for macrophotography images

Macrophotography Images (MPIs) have recently emerged as an active topic due to the development of mobile phone camera technology. A large number of MPIs have been rapidly increasing in many rich visual services, such as smartphones or high-definition monitors. MPIs are often composed of sharp macroimage and blur background, which exhibit different perceptual properties that often lead to different just noticeable difference (JND) estimation. Inspired by this, we formulate the blur concealment (BC) as another factor to determine the total masking effect: the interaction is relatively straightforward with a limited masking effect in the sharp regions, and is complicated with a strong masking effect in the blur parts. Furthermore, texture and orientation adaption and color information weighting are separately incorporated into the contrast masking and color masking. Finally, considering both BC and masking effects, a novel robust watermarking framework based on the proposed blur-guided JND model for MPIs, targeting at further improving the MPIs copyright protection performance. Extensive experiments on MP2020 and Blur Detection data sets show that the applicability of the proposed JND model in the scenario of perceptually MPIs watermarking, and our proposed scheme can outperform the state-of-the-art watermarking schemes by providing better robustness performance at the uniform visual quality.

Low Vision Referral Patterns in Intermediate Age-Related Macular Degeneration

Purpose Sparse data exist regarding low vision (LV) services referral patterns. We retrospectively examined our institution’s intermediate age-related macular degeneration (iAMD) patients to determine factors influencing referral. Methods We compared visual acuity (VA) and Visual Function Questionnaire (VFQ-25) composite and subscale scores for referred and non-referred iAMD patients. VA was collected at time of referral or most recent visit, and VFQ-25 was taken upon enrollment into the registry. Results Thirty-six (15.5%) of the 232 iAMD patients were referred to LV. Referred patients were more likely to have older age, worse VA in both eyes, and lower VFQ-25 scores. Univariate analysis of VFQ-25 subscales demonstrated worse scores in general vision, near, distance, mental health, role limitations, dependency, and driving. Multivariable analysis revealed lower scores in general health, general vision, and driving. Forty-eight percent of non-referred patients had VA or VFQ-25 composite scores at least as poor as the median for referred patients. Two-thirds of patients who were not referred had no discernable obstacle to referral. Conclusions Our institution refers patients with worse objective and functioning vision, but more patients may benefit from referral. Future studies should identify metrics to prompt referral and evaluate this approach.

Impact of Teacher Incentive Intervention on Students' Vision Healthcare Uptake: A Cluster-Randomized Controlled Trial.

Less than one-third of rural Chinese children with refractive error own or wear eyeglasses. To study the effect of teacher incentives on the acceptance of vision care offered to rural students with uncorrected refractive error, we conducted a cluster-randomized controlled trial in 18 townships in one county in Shaanxi Province. Primary and junior high schools within each township were assigned to either intervention (all teachers received an incentive) or control (no teacher incentives were offered) groups. A total of 42 schools were assigned to either the intervention group (13 schools) or the control group (29 schools). Teachers in the intervention group could elect to receive high-value (sunglasses worth USD 148), moderate-value (eyeglasses worth USD 89), or cash incentives (USD 35) if ≥70% of eligible students (uncorrected visual acuity (VA) ≤ 6/12 in both eyes and corrected VA ≤ 6/9.5 in both eyes) in the teacher’s class visited a program-affiliated vision center (VC) within 60 days after their vision screening. Among 8238 students, 3401 (41.2%, of which 53.0% were girls with a mean age of 12 (SD 1.75)) met the enrollment criteria and were randomly allocated to the intervention (n = 1645, 49.0%) and control groups (n = 1579, 51.0%). Among these, 3224 (94.8%) completed the study and underwent analysis. Nearly equal numbers of students had classroom teachers selecting the high-value (n = 524, 31.9%), moderate-value (n = 582, 35.4%), and cash incentives (n = 539, 32.8%). The rate of the acceptance of offered vision care was significantly higher in the intervention group (382/1645 = 23.2%) compared to the control group (172/1579 = 10.9%, 95% confidence interval for observed difference 12.3%, p < 0.001). Teacher incentives appeared effective in improving Chinese rural school-aged children’s uptake rate of vision services provided by county hospital-based VCs.

Comparative analysis of the Cycles and Eevee graphics engines on the example of rendering 3D models of archaeological artifacts

The purpose of the article is to control the comparative analysis of the two that take place in the Blender application. These are the Eevee and Cycles engines. The analysis will include elements such as: applicable-possible tools, measurement possibilities and the provision of visual services. Perform research prepared research in the form of a desktop computer with a clean system.

Increased quantity and diversity of patient referrals following the introduction of a novel vision rehabilitation model

Despite effective vision rehabilitation (VR) interventions, no gold standard model of care delivery has been established. The institution of the South East Ontario Vision Rehabilitation Service (SOVRS) introduced a centralized intake, an occupational therapist as a systems navigator, and improved communication pathways between low vision services in order to optimize regional VR care. The aim of this study is to compare the SOVRS model of VR to a traditional, hospital-based pre-SOVRS-implementation model using referral data. A single-site (Vision Rehabilitation Clinic at Kingston Health Sciences Center), retrospective medical chart review was performed. Data were gathered from the electronic medical records of patients who received a low vision assessment at the pre-SOVRS-implementation clinic (2017) and the SOVRS clinics (2019). A total of 245 charts were reviewed over the two study periods. There were no significant differences in the age, gender, or diagnoses causing vision loss between 2017 and 2019. One hundred nine incoming referrals were received in 2017, with 136 in 2019, representing a 25% increase in incoming referrals ( p &lt; .001). The proportion of incoming referrals from non-ophthalmologists rose from 3.7% in 2017 to 31.9% in 2019 ( p &lt; .001). The number of outgoing referrals also increased significantly, from 113 outgoing referrals in 2017 to 259 in 2019 ( p &lt; .001), equivalent to a mean of 1.04 ± 0.68 (± standard deviation) outgoing referrals per incoming referral in 2017 and 1.90 ± 0.97 outgoing referrals per incoming referral in 2019. Outgoing service referrals also diversified significantly in 2019 ( p &lt; .001), with more referrals to services such as VR health service organizations and community services. The SOVRS model was able to increase both the quantity and diversity of incoming and outgoing referrals by adopting several key strategies during its development. By expanding referrals, SOVRS increased the services available to patients and enabled a larger population to receive VR care.

Vision characteristics of Special Olympics athletes seen at the United States National Games 2010-2018.

Special Olympics International (SOI) has provided eye assessments at no cost to athletes participating in competitions through the Special Olympics Lions Clubs International Foundation Opening Eyes (OE) programme. Access to vision services is crucial given the high rates of eye abnormalities found in studies collected at OE programmes in other countries. As of 2022, no studies covering vision data have been published on SOI athletes specifically from the USA. Therefore, this multiple cross-sectional study hopes to investigate the vision profile of US athletes over three national games, detecting any changes in vision and ocular health outcomes over an 8-year period. Vision assessments were conducted in the US national games of 2010, 2014 and 2018. Demographic and clinical data from 1427 vision assessments were used in this study. Prevalence of vision and ocular health abnormalities were compared across national games. In our cohort of 1427 assessments with athletes' mean age±SD of 29.8±11.5years, 85.3% (n=1170) had an abnormal vision result with at least one of the following findings: decreased visual acuity of 20/40 or worse (31.0%, n=442), refractive error including myopia (52.8%, n=754), hypermetropia (15.7%, n=224), and astigmatism (35.0%, n=499), ocular misalignment distant (16.2%, n=224) or near (17.2%, n=239), or ocular abnormality (19.1%, n=273). This study demonstrates the burden of vision defects and ocular disease in US SOI athletes over the past decade. While continued effort must be made to train eye providers in caring for patients with ID to increase eyecare accessibility outside of SOI, vision assessments at national games can continue providing opportunities for improved ocular health in children and adults with ID.

VIRTUAL TOUR: A MEDIA TO TEACH ENGLISH FOR TOURISM

This study aims at explaining the use of virtual tours in learning English for tourism in the English for Tourism course at the Department of English Education, Sultan Ageng Tirtayasa University. Technology is an alternative that is used as a human response. In the field of education, innovation was born through technological developments, namely virtual tour services which became a learning platform equipped with visual, audiovisual and interactive learning resources. Studying at home can be boring for both students and teachers due to the confined environment in the room. It is hoped that the visual service organized by the virtual tour application in Indonesia can provide educational, inspirational and recreational value as well as in learning English for tourism which is carried out online

Music Recommendation System Using Facial Expression Recognition Using Machine Learning

Abstract: “MUSIC RECOMMENDATION SYSTEM USING FACIAL EXPRESSION RECOGNITION USING MACHINE LEARNING" is the title of this project. The study of human emotional responses to visual stimuli such as photos and films, known as visual sentiment analysis, has proven a fascinating and difficult problem. It attempts to comprehend the high-level information of visual data. The development of strong algorithms from computer vision is responsible for the present models' success. The majority of existing models attempt to overcome the problem by recommending either robust features or more sophisticated models. Visual elements from the entire image or video are the key proposed inputs in particular. Local areas have received less attention, which we believe is important to the emotional reaction of humans to the entire image. Image recognition is used to locate people in photos, analyse their emotions, and play emotion-related tunes based on their feelings. This repo accomplishes this goal by utilising the Google platform's Vision services. Given an image, it would look for faces, identify them, draw a rectangle around them, and describe the emotion it discovered

Intersectionality and access to visual rehabilitation services: Experiences of people with low vision, a qualitative study

Low vision is a condition of visual impairment, generated by an underlying pathology that affects visual functioning and the development of daily activities. In the field of visual impairment, the developments in the analysis of access to rehabilitation services are scarce and incipient. The study approaches the understanding of the experiences of people with low vision in Medellín, Colombia, in their search for visual rehabilitation services. Ethnographic collective case study was conducted. Intersectionality was adopted to explore people’s experiences with low vision management health services. Five women and four men with low vision who attended the healthcare center participated in the study. Twenty-nine interviews and 16 participant observation exercises were carried out. Three categories emerged in the study: (1) I had never heard of low vision services; (2) Interaction with the health system: A path of struggles; and (3) Barriers that are exacerbated by the intersection of multiple identities and systems of oppression. The Colombian health system acts as an axis of structural oppression that interacts with the economic condition, educational level, and geographical location to generate greater difficulties for the identification of low vision management options, which also interact with the multiple and dynamic identities of each subject.