Vision Services Research Articles

Knowledge, Attitudes, and Practices of Optometrists Regarding Low Vision Services in Saudi Arabia

Purpose: To address the human resources challenge for the provision of low vision services in Saudi Arabia, this study sought to investigate the knowledge, attitudes, and practices of optometrists in Saudi Arabia regarding low vision services. The knowledge and attitudes to low vision services can influence the provision of low vision services by optometrists. Methods: A prospective cross-sectional survey of optometrists practicing in Saudi Arabia was undertaken using an online questionnaire designed to elicit the opinions of respondents. The online questionnaire was sent out to optometrists on the official mailing list of registered optometrists and those on the mailing list of the Saudi Society of Optometry. Results: Only 26.5% of the respondents correctly indicated the correct designation of low vision in terms of visual acuity. Although 95.8% indicated that optical low vision devices could help people with low vision, 81.6% reported that low vision devices were expensive, and 42.9% felt low vision practice was not profitable. Only 10.4% of respondents provide low vision services in their practice. Insufficient training in low vision care was the main barrier militating against the provision of low vision services. Conclusion: The pertinent finding in this study is that about a quarter of the respondents could correctly designate low vision in terms of visual acuity using the World Health Organization (WHO) definition. The study concluded that there was poor knowledge, attitudes, and practices of optometrists in Saudi Arabia regarding low vision, which has implications for the provision of low vision services by optometrists.

What can we learn from a service evaluation in a hospital low vision clinic?

Cirta Tooth discusses an analysis of the activities of a Scottish hospital low vision service and reflects on what lessons might be learned regarding the best approach to managing people with vision loss.

Developing consensus-based referral criteria for low vision services in Australia.

To develop expert consensus on referral criteria for low vision services in Australia. In a modified online Delphi process, a panel of 38 Australian experts in low vision (including ophthalmologists, optometrists, orthoptists, occupational therapists, orientation and mobility professionals, researchers and managers) participated in three rounds of consensus building over a period of 5months commencing in 2019. Initially, 90statements were developed, addressing what should be included in best-practice low vision referral criteria, currently used criteria, timing of referral and responsibility for referral. By the third round, these had been reduced and refined to a total of four statements. In three Delphi rounds, the expert panel produced three key recommendations for low vision referral: (1) that low vision referral should be based mainly on the impact of uncorrectable vision impairment on function and well-being; (2) clinical measures of visual acuity and visual field might be a secondary consideration and (3) it is important to fully inform a person about low vision services at an early stage of vision loss and to involve them in decision making about referral. There was consensus on the need for clear referral pathways and that both ophthalmologists and optometrists have primary responsibility to refer for low vision services. Although recommendations and guidelines should not replace sound individual clinical judgement, promotion and adoption of these consensus recommendations could assist health care professionals in providing appropriate and timely referral for low vision services to the benefit of people with vision impairment.

Barriers to Low Vision Services Among Optometrists in Saudi Arabia

Introduction: This study identifies the barriers and challenges to the provision of low vision services among practicing optometrists in Saudi Arabia. Methods: In this study, a self-administered online structured survey for practicing optometrists was used. Responses were collected to understand the number and percentage of low vision service providers, level of awareness, and barriers to the provision of low vision services. Results: This study included 154 (79 females and 75 males) practicing optometrists. They were from the five regions of Saudi Arabia (23 cities). The age of the practitioners ranged from 22 to 54 years. They had Bachelor’s, Master’s, and Doctor of Philosophy degrees. Forty-four participants (30%) provided low vision services. The major barriers reported were lack of training (87%), lack of awareness about low vision services (76%), lack of availability of low vision devices (70%), lack of motivation (65%), low vision services being time-consuming (55%), being busy in providing general optometry (65%), and lack of financial sources (31%). Conclusion: Building an efficient model for low vision rehabilitation in Saudi Arabia is needed. Moreover, encouraging more optometrists to be involved in low vision rehabilitation is necessary. There is also a need for more low vision education, national health coverage of patients with low vision, and better collaboration between low vision service providers.

Report on the International Symposium on Low Vision

The International Symposium on Low Vision held at the School of Optometry, University of Waterloo, June 25th to 27th was a major event in Canadian Optome­try. It was the first of its type ever held but, no doubt, it will not be the last. The rapidly rising demand for low vision services will ensure that.

Software for generation of video files metadata

In today’s world, information is one of the most important resources. Its large turnover in the media makes companies look for ways to automate processes related to labeling and storage of data. But often these processes are left on the shoulders of archive workers who have to review the footage in real-time and create metadata based on what they see, which will be transferred into the archive. This process is often very time-consuming. As a result of the analysis of approaches to video data processing, comparative analysis of the efficiency and availability of computer vision services, a software for searching faces, and forming metadata in the video archive of the VGTRK company was designed and implemented.

Coverage of Dental, Vision, and Hearing Services in Medicare

This Viewpoint discusses how consumer need, policy solutions, and the legislative environment around Medicare expansion to include dental, vision, and hearing services offer a rare window of opportunity for policy change.

Clinical Profile of Low Vision in Children

Introduction: Visual impairment in children is more common in developing countries like Nepal. A low vision service has been found to be effective in significantly improving their overall development and quality of life. The main aim of this study was to determine the causes of low vision in pediatric population along with their refractive error distribution and visual functions. Methods: A descriptive cross sectional study was carried out in Tribhuvan University, BP Koirala Lions Center for Ophthalmic Studies. A total of 50 low vision children were under went detail low vision examination. They were selected through purposive sampling. Data was analyzed by using the descriptive and inferential statistics with SPSS version 19.0. Results: The study findings showed, most common cause of visual impairment in low vision children was refractive error (20%), followed by congenital cataract (18%) and macular dystrophy (16%). The most commonly prescribed low vision device for distance was telescope and for near was spectacle magnifier. There was average acuity improvement of five lines in distance visual acuity with low vision devices. Conclusion: The study concluded that refractive error and congenital cataract being the commonest cause of low vision in children, which reflect poor accessibility of care service among Nepalese children. Refractive error, the major cause of visual impairment could have been managed even in primary eye care center in Nepal. Children with impairment have potential visual acuity that can be improved with low vision services.

Eye health profile of affordable eye care service users

ABSTRACT Clinical relevance Knowledge of the typical eye health profile of patients experiencing social or economic disadvantage is useful for health care modelling. Background The aim of this work is to profile the ocular health and sociodemographic characteristics of Australian College of Optometry service users of all ages and to explore the relationships between key sociodemographic characteristics and eye health. Methods For 3093 eye examinations, best-corrected distance visual acuity and mean spherical equivalent refractive error were tested non-parametrically by clinic category, remoteness area, number of co-morbidities, gender and indigenous status, also correlated against age and socioeconomic advantage/disadvantage. Covariates of interest were entered into linear mixed models of visual acuity and mean spherical equivalent refractive error, controlling for age. Risk estimates are reported for visual impairment (defined as ≤6/12 best-corrected distance visual acuity in one or both eyes) and ocular diagnoses. Results Visual impairment is more prevalent amongst service users examined in domiciliary settings. Increasing co-morbidities were associated with poorer best-corrected distance visual acuity. Aboriginal and Torres Strait Islander service users had lower visual impairment prevalence overall but proportionally fewer aged ≥50 years attended for eye care, compared to non-indigenous. Conclusions Domiciliary eye examinations detect remediable visual impairment. Federal public health interventions delivered by the Australian College of Optometry for Aboriginal and Torres Strait Islander eye care appear effective but may not reach all aged ≥ 50 years; further research is required. Identification of multiple co-morbidities should prompt optometrists to tailor public health messages and signpost to low vision services earlier.

Barriers and facilitators to recognize and discuss depression and anxiety experienced by adults with vision impairment or blindness: a qualitative study

BackgroundDepression and anxiety are highly prevalent, but often unrecognized in adults with vision impairment (VI) or blindness. The purpose of this study was to explore visually impaired and blind adults’ views on facilitators and barriers in recognizing and discussing mental health problems.MethodsSemi-structured interviews, based on the Integrated Model for Change, were conducted with 16 visually impaired or blind adults receiving support from three Dutch low vision service organizations. Interview data was analyzed using the framework approach.ResultsParticipants perceived their focus on practical support with regard to their VI, lack of mental health literacy, and misattribution of symptoms of depression or anxiety as barriers for recognizing mental health problems. With regard to discussing mental health problems, they perceived difficulties in acknowledging their VI and mental health problems due to feelings of vulnerability and inequality. Participants mentioned that their social support system and healthcare providers (could) facilitate them in recognizing and discussing mental health problems. However, participants thought that healthcare providers currently often lacked the knowledge, skills and attitude to recognize and discuss this topic with their clients.ConclusionOur findings suggest that visually impaired and blind adults may experience several barriers to recognize, acknowledge and discuss mental health. Healthcare providers and social support systems seem essential for them in reducing these barriers. However, there might be a mismatch between the needs of visually impaired and blind adults and healthcare providers’ knowledge, skills and attitude. Training healthcare providers may improve detection of depression and anxiety in adults with VI or blindness, and enhance clinician-patient communication on mental health.

Design and Research of Digital Painting Online Learning and Communication System Based on Visual Semantics

This paper mainly describes the design and implementation of digital painting online learning and communication system. Based on the research results of publishing and matching mechanism of visual services and the needs of service resource management, this paper designs a publishing and matching model of visual services, and implements a prototype system by using technology, which enables users to conveniently publish, query, manage and share visual service resources, and the prototype system has good scalability and is easy to upgrade. And the overall operation flow of the system and the data flow diagram of the three user function modules, i.e. administrator, teacher and student, are designed in detail. Finally, each information data table of the background database of the digital digital painting online learning and communication system is designed.

Estimated Prevalence of Keratoconus in the United States From a Large Vision Insurance Database.

To estimate the prevalence of keratoconus in the United States using a large vision insurance database. We used data from the 2016 vision service plan (VSP) Global claims database to estimate the prevalence of keratoconus among enrollees by state. The VSP Global database includes cross-sectional de-identified claims data summarized by state of residence in predefined age and gender groups. Crude values of prevalence of keratoconus are provided in the VSP Global database. The open-source software package qGIS version 3.12 was used as the geographic information system for geospatial analysis. The prevalence of keratoconus among VSP enrollees in the United States was estimated to be 0.15% with 95% confidence interval (CI) (0.15%, 0.15%). The prevalence of keratoconus was highest in Western states and among male population. The highest prevalence of keratoconus was in Colorado (0.51%; 95% CI 0.49%-0.52%), with particularly high prevalence for men in the age groups 18 to 39 years (0.90%; 95% CI 0.84%-0.95%) and 40 to 64 years (0.90%; 95% CI 0.85%-0.95%). The average prevalence of keratoconus in the United States in 2016 may be higher than previously reported. Living in Western states and male sex were associated with high prevalence.

Sight for All United: Five Year Impact of a Vision Foundation on its Community

Background: In 2016, Sight for All United (SFAU) was founded in the Mahoning Valley of Ohio with the mission of improving access to care and maximizing the visual potential of the underserved. Methods: A retrospective chart review was conducted on patients served by SFAU from January 2016 through August 2020. Socioeconomic information, type of service, cost, and dollar amount paid were collected for patients. The data were analyzed with descriptive statistics and mapped with Esri ArcGIS. Results: A total of 1327 patients received assistance through the medical assistance and school vision programs. In the medical assistance program, 222 patients (mean age 50 years, 57% female) completed applications and 37% (83 patients) were in a household of 3 or more people. Median yearly income was $18 504, 134% above the federal poverty level by household size. The most common surgical services were cataract surgery (101) and vitreoretinal care (17). The most common medical services were eye exams (79) and spectacles (76). Estimated value of medical services provided was $367 249; actual cost was $93 746. The school vision program provided 1105 eye exams, 1514 pairs of spectacles, and 1 cataract surgery with an estimated value of $133 692. Conclusion: Sight for All United provided $500 941 of vision services to its patients since 2016 while dispersing less than $100 000 of donated dollars through collaboration with eye care providers, community resources, and national foun-dations. This study demonstrates the impact vision foundations managed by local eye care providers can have on the needs in their community in a cost-effective and efficient way.

Low vision: Knowledge, attitude, and practice among optometrists in India

In a developing country like India, affordable eye care services are limited and less developed. Moreover, a general lack of awareness about proper vision care leads to a rise in the number of individuals with visual impairment. In developing countries like India, the low vision services are still growing. Hence, it becomes necessary to understand the knowledge and practice patterns among optometrists regarding low vision services. This was a cross-sectional study carried out from May 2020 to July 2020 among optometrists across India. The questionnaire was constructed using the information from the already existing literature, and content validity was done through experts in this field. Furthermore, this survey was circulated to 1374 optometrists in the form of Google survey. The participants were able to participate in the survey only after a written informed consent. Analysis was carried out using Statistical Package for the Social Sciences, Version 20.0 (SPSS, Inc., IBM), to report the knowledge, attitude, and practice of the low vision services in India. In total, 280 individuals participated in this survey, and the mean age of the participants was 28 ± 8 years. There were 156 (55.7%) females and 124 (44.3%) males with a response rate of 20.37%. Out of 280 participants, 184 (65.7%) were involved in clinical practice, whereas 96 (34.3%) in optical practice. Lack of accessibility and time were found to be the two major barriers to enhance knowledge in low vision; however, accessibility, lack of awareness, and cost were the hindering factors to practise low vision services among these participants. This study reports that accessibility to the low vision services and awareness about the services are the barriers to uptake of low vision services. Besides this awareness, training programmes and public awareness would effectively contribute to enhance low vision services.

PMS11 Explaining the Excess Healthcare Expenditures Associated with Chronic Pain among Adults with Osteoarthritis: An Application of Cost Decomposition Analysis

Osteoarthritis (OA) is one of the leading causes of chronic pain that interferes with normal daily activities. Pain Interference with Activity (PIA) and OA are associated with high healthcare expenditures. There is a lack of studies on the evaluation of excess healthcare expenditures of PIA in adults with OA. This study estimated the extent to which differences in characteristics among adults experiencing PIA explain excess expenditures associated with OA. This study adopted a cross-sectional design using 2015 data from the Medical Expenditure Panel Survey (MEPS). Adults 21 years or older who were alive during the calendar year and did not have missing information on PIA status were included in the study (N = 1,849; weighted N = 25.43 million). Total healthcare expenditures included inpatient, outpatient, prescription drugs, dental, vision, home healthcare, and other services. The Blinder-Oaxaca post-linear decomposition on log-transformed total health expenditures was used. All analyses accounted for the complex survey design of MEPS. OA adults with PIA had higher average expenditures ($18,902 vs $8,277, p<0.001; 8.84 vs 7.99 in log-transformed expenditures) compared to those without PIA. Based on pooled regression weights, 60% of excess expenditures were explained by differences in characteristics between the two groups. Number of co-occurring chronic health conditions (diabetes, asthma, chronic obstructive pulmonary disease, anxiety, depression and heart diseases) and prescription medications (NSAIDs, opioids, and polypharmacy) were the main drivers of excess healthcare expenditures of PIA. Our findings suggest that primary, secondary, and tertiary prevention of co-occurring chronic health conditions may be a pathway to reducing excess healthcare expenditures associated with chronic pain in adults with OA.

Availability of low vision services and barriers to their provision and uptake in Ghana: practitioners' perspectives.

Provision and uptake of low vision services are essential. To assess the availability of low vision services and barriers to their provision and uptake in the Ashanti and Brong Ahafo regions of Ghana from the perspective of eye care practitioners. A descriptive, quantitative, cross-sectional study design using semi-structured questionnaires was used to collect information from eye care practitioners selected from 58 eye care facilities in the Ashanti and Brong Ahafo regions of Ghana. Forty-four eye care practitioners from Ashanti region and 10 from Brong Ahafo region responded to the questionnaire. Seventeen (34%) of the 50 eye care facilities who reported having patients seeking low vision services in their facilities provided such services. Lack of low vision devices (94.4%) and equipment (87%) were reported to be the main barriers to the provision of low vision services. Major barriers to low vision services uptake were lack of awareness (88.7%), high cost (70.4%) and social unacceptability of low vision assistive devices (59.3%). Lack of adequate low vision services and barriers to their provision and uptake impact negatively on efforts to prevent visual impairment and blindness in Ghana.

Personalized Telerehabilitation for a Head-mounted Low Vision Aid: A Randomized Feasibility Study.

A recent trend in low vision rehabilitation has been the use of portable head-mounted displays to enhance residual vision. Our study confirms the feasibility of telerehabilitation and informs the development of evidence-based recommendations to improve telerehabilitation interventions to reduce device abandonment. To develop evidence-based recommendations for telerehabilitation, we conducted a feasibility study in preparation for a future randomized trial on the use of head-mounted displays. We recruited novice eSight Eyewear users, randomized 1:1: the experimental group received telerehabilitation by a low vision therapist using video conferencing; the control group completed at home self-training provided by the device manufacturer. The primary feasibility outcomes were whether the recruitment goal of 60 participants (30/group) was attainable within 1 year and how participants judged the accessibility and acceptability of the telerehabilitation. An exploratory outcome was the impact of telerehabilitation on eSight Eyewear use behavior. Among 333 eSight users, 57 participants were enrolled, of which 35% withdrew from the study, whereas the remainder completed the 6-month follow-up. The withdrawal rate was higher in the control group but did not differ significantly from the experimental group. High accessibility (93% of participants accessed the platform) and global acceptability (100% overall satisfaction) were reported among those who completed the telerehabilitation protocol. The therapist had no difficulty judging the participants' reading performances qualitatively while participants used their device to read their eSkills and VisExc guides. Most participants improved their daily activities, based on qualitative reports of the attained goals. Seventy-nine percent of individuals declined to participate, whereas 16% of participants decided not to use eSight Eyewear anymore. The data demonstrated the feasibility of a randomized controlled telerehabilitation study for people with low vision using a head-mounted display. Positive feedback from the participants and the therapist suggests the potential value of this modality for low vision services.

Lessons from COVID-19, challenges of remote learning for childhood cancer survivors.

10054 Background: More than half of childhood cancer survivors (survivors) will have neurocognitive deficits that impact schooling, most commonly reflecting attention and executive dysfunction. Schools are legally bound (IDEA, 2004) to support eligible students with Individualized Education Program (IEP) informed instruction and related services (e.g. assistive technology, speech-language, physical, or occupational therapy) to foster academic success. However, these service provision were not designed under the constraints of remote learning. The COVID19 shift to remote learning is likely to extend beyond the pandemic especially for medically fragile students. This quality improvement project describes challenges for survivors during remote learning and recently developed related patient education materials. Methods: Interviews with families were used to identify themes around challenges during remote learning, which informed development of a 29-question survey disseminated via flyer in local oncology clinics and social media posts by local childhood cancer organizations in Fall 2020. Results: The survey was completed by 67 parents describing their affected child (mean age= 8.6 years; 60% male; 78% White, 12% Black, 95% non-Hispanic). Most children (74%) had completed therapy (43% for leukemia, 18% for brain tumor; 39% other). The majority (86%) attended public school and 37% received special education or related services: speech-language (26%), occupational (23%), and physical (14%) therapies, and vision services (3%). Fully remote learning was reported for 73%, in-person 4%, and hybrid learning for 14%. The majority (57%) reported observing greater difficulty with attention and focus during RL, indicating difficulty occurred about half of the time during related services therapies, class and/or small group video instruction. Technology-related challenges included difficulty navigating online instruction/equipment (28%), reading difficulty (16%), and difficulty seeing materials/lack of vision supports (18%). Findings did not differ based on treatment or IEP status (p&gt;0.50). Few (14%) reported their school team discussed assistive technology options for online learning. Parents indicated the most helpful supports for addressing challenges included speech-to-text tools, screen readers, and audio books. Parents reported their oncology team was helpful in making referrals to neuropsychology and therapies and completing documentation necessary to secure supports. Conclusions: Childhood cancer survivors, irrespective of diagnosis or IEP status, report challenges with remote learning. Families find a lack of information or special accommodations as roadblocks to success. Oncology providers were identified as valued resources, so educational materials ( https://tinyurl.com/nxbhj5or ) were developed for oncology teams to share with families.

Indoor positioning: “an image-based crowdsource machine learning approach”

Various technologies have been utilized today for recognizing client or user in the indoor areas. These technologies incorporate RSSI, Bluetooth Low Energy Beacons, Ultrasound waves, Vision-based advances, for example, fixed camera recordings QR codes, remote gadgets, etc. RSSI fingerprinting technique requires more effort and it is also expensive to be used for indoor localization frameworks working in real-time. In this research, indoor localization based on images is investigated as an option in contrast to other indoor positioning techniques using these days. Image-based indoor positioning is more affordable than RSSI based technologies being utilized. A mobile phone camera is utilized to take the pictures of area inside the building to find the user inside the building. Sensor data from various sensors isn’t required or no extra framework is required to find the client in the building utilizing indoor positioning based on an image. Microsoft Azure Custom Vision Services are utilized to locate the client; MS Azure classifies the pictures in one of the labels made. Strategy’s attainability is demonstrated by various investigations and accomplished accuracy and review is recorded above 90%. The average precision of the trained model is recorded above 95%.

Autonomous Marine Robot Based on AI Recognition for Permanent Surveillance in Marine Protected Areas.

The world’s oceans are one of the most valuable sources of biodiversity and resources on the planet, although there are areas where the marine ecosystem is threatened by human activities. Marine protected areas (MPAs) are distinctive spaces protected by law due to their unique characteristics, such as being the habitat of endangered marine species. Even with this protection, there are still illegal activities such as poaching or anchoring that threaten the survival of different marine species. In this context, we propose an autonomous surface vehicle (ASV) model system for the surveillance of marine areas by detecting and recognizing vessels through artificial intelligence (AI)-based image recognition services, in search of those carrying out illegal activities. Cloud and edge AI computing technologies were used for computer vision. These technologies have proven to be accurate and reliable in detecting shapes and objects for which they have been trained. Azure edge and cloud vision services offer the best option in terms of accuracy for this task. Due to the lack of 4G and 5G coverage in offshore marine environments, it is necessary to use radio links with a coastal base station to ensure communications, which may result in a high response time due to the high latency involved. The analysis of on-board images may not be sufficiently accurate; therefore, we proposed a smart algorithm for autonomy optimization by selecting the proper AI technology according to the current scenario (SAAO) capable of selecting the best AI source for the current scenario in real time, according to the required recognition accuracy or low latency. The SAAO optimizes the execution, efficiency, risk reduction, and results of each stage of the surveillance mission, taking appropriate decisions by selecting either cloud or edge vision models without human intervention.