Thesis (Ph.D.)--University of Melbourne, Centre for Eye Research Australia, Dept. of Opthalmology 2010. / Typescript. Includes bibliographical references (p. 251-274)

This research was designed to address important issues for the effective prescription of, and training in the use of, magnifiers for reading patients with visual impairment. The emphasis was on the development of simple methods of assessment and training that could be easily implemented, at no great cost, by low vision practitioners in clinical practice. To ensure that the results would be widely applicable, the research focused on subjects with age-related macular degeneration (AMD) using stand magnifiers (being the most common cause of low vision and the most commonly prescribed magnifiers respectively). From this research, modifications to the current methods of reading rehabilitation are suggested to more effectively improve low vision reading for the millions of people with low vision around the world. The magnification and reading performance achieved with the magnifier determined by the fixed acuity reserve method was as valid as that achieved with the magnifier determined by the individual acuity reserve method. The fixed acuity reserve is a simpler method to calculate the required magnification, as it requires only near visual acuity and the patient's goal reading task. This method was primarily used to select the appropriate illuminated stand magnifiers for the subjects participating in the subsequent studies and is recommended for use as the starting point in clinical low vision practice. The main study of this thesis was a longitudinal investigation of the benefit of large print reading practice on reading performance with stand magnifiers. Instead of the intensive training programs on magnifier use which have been suggested by previous studies, this study aimed to investigate the effect of simple large print reading practice, under either full or restricted field of view (the latter simulated by a practice stand), on reading rate with stand magnifiers for subjects with AMD. The experimental hypothesis was that reading practice prior to the prescription of stand magnifiers would improve reading performance with the stand magnifiers for subjects with AMD. As previous studies have shown, reading rate reduced when a stand magnifier was first introduced. One week of reading practice on large print, with or without a reduced field of view, gave an improvement in reading rate with the stand magnifier for passages of text (such that the reading rates with and without magnifiers were not significantly different). There was a suggestion that this practice may give a more rapid improvement in reading rate than that achieved by the control subjects who did not do any large print reading practice, but this did not reach statistical significance. Even very brief reading with the stand magnifiers by the control subjects gave some improvement in reading rate. Therefore, home or in-office reading practice on large print or with magnifiers is recommended for patients with AMD before magnifiers are prescribed. Subjects who had neither reading practice nor exposure to the magnifier prior to its prescription required two weeks practice using their stand magnifiers to achieve their maximum reading rate. This suggests that home practice in using stand magnifiers is beneficial and a follow up visit is recommended two weeks after the provision of a magnifier to assess any change in reading rate. If no improvement in the magnifier reading rate is found or the rate is less than the reading rate on large print without a magnifier, further investigations of the patients' vision and/or their magnifier manipulation strategy are necessary. In the last study, a simple method aimed at alleviating difficulties with magnifier manipulation and navigation, the attachment of a line guide to the base of the stand magnifier, was investigated using both objective methods (recording magnifier movements and reading rate measures) and subjective methods (simple questionnaire). Although there was no improvement in the objective measures of reading or navigation performance with the line guide, more than half of the subjects with low vision preferred to have the line guide on their stand magnifiers. This suggests that the objective measures might not be sensitive enough to predict the subjective response, or that other factors that were not measured in this study influenced subjects' preferences in selecting the line guide (e.g., psychological support provided by the line guide in reading orientation). Clinically, the subjective response of patients to the use of low vision aids as well as their motivation are important criteria for success in low vision rehabilitation. There was a tendency for less experienced users to prefer the line guide to assist their use of the stand magnifier for reading. Therefore, a line guide could be offered as a preliminary training aid when stand magnifiers are first prescribed for AMD patients. Possible improvements to the design of the line guide were identified. Further research is required to assess the benefits of this or similar devices for new magnifier users and to understand the difficulties that people with visual impairment have with page navigation in order to determine improved methods of training navigation strategies. The unique contribution of this study to the field of low vision rehabilitation is that the benefit of short-term reading practice, on large print or with magnifiers, as simple, cheap methods of enhancing reading performance with stand magnifiers was demonstrated. The results of this study have led to the development of recommendations for assessing and training AMD patients who are prescribed stand magnifiers.

Purpose: The prevalence of age-related visual impairment is projected to increase as the Canadian population ages. As a result, the demand for low vision service is also projected to increase. However, there is a lack of healthcare planning regarding vision rehabilitation in Canada. The current study is the first study that describes optometric low vision services across Canada. The primary purposes of this study were to determine the provision of low vision services by optometrists in Canada, the barriers to providing low vision services and the pattern and perception of referrals to specialised low vision services. The secondary purposes of this study were to examine regional differences in low vision practice and referral patterns, and to identify predictive factors associated with the extent of optometric low vision care. Methods: Practising optometrists across Canada (n=1839 or 40.5% of the Canadian optometric population) were randomly sampled so as to obtain approximately equal responses from the Western Provinces, Ontario, Quebec and the Eastern provinces. Between October 2010 to January 2011, optometrists were invited to participate in a 30-item questionnaire that included questions on personal profile, primary practice profile, types of patients seen, levels of low vision services offered, patterns of referral and barriers to provision of low vision care. Descriptive statistics were used to describe the current landscape of optometric low vision care. Chi-square analyses were used to identify any regional differences in pattern of low vision provision and/or referrals. Multivariate logistic regression was used to determine the predictive factors associated with the extent of optometric low vision care. Written comments on low vision education and provision of low vision services were first coded to represent relevant categories of information emerging from the written data. Then the patterns of coding were grouped into common themes. Results: A total of 459 optometrists responded (24.8%). Optometrists estimated that 1% (range 0-100%) of their patients were patients with low vision, yet also estimated that 10% of their patients had a best corrected visual acuity of ???6/12. Almost three-quarters of respondents would manage a hypothetical patient with minimal visual disabilities and simple visual goals with high-powered additions and lighting; however, the proportion of those who would manage with the same patient with magnifiers and filter lenses dropped to 43%. The most frequently cited barriers to providing more extensive low vision services were found to be related to financial non-viability, lack of affordability by the patient and the time-consuming nature of conducting a low vision assessment. The percentage of respondents who cited no interest in low vision was 33.5%. Many respondents would like to see more continuing education on low vision, preferably through a hands-on approach. The most frequent site of referral was CNIB (81.9%), although most of the respondents (57.1%) rarely (0-5% of the time) or almost never (0-25% of the time) received a written report from the low vision service providers. Chi-square analyses revealed that optometrists in Quebec tended to refer eligible patients to government-sponsored vision rehabilitation centres, while optometrists in Eastern provinces tended to manage patients on their own. The predictive factors associated with the extent of optometric low vision care were advanced years of practice (16+ years), having local low vision optometrists/ophthalmologists within one-day???s travel, working in a practice within a population of less than 50,000 and working in a non-solo practice. Conclusions: This study documents that optometrists may be undertaking more low vision (LV) in patients with relatively good vision than they tend to label as LV. Vision rehabilitation is of interest to a large portion of optometrists across Canada. To translate the interest into practice, barriers identified by the current study must be addressed.

No description available.

The number of individuals facing vision loss as adults is increasing, and the need for these adults to have access to training and skills to aid in their adjustment process is prevalent. Guided by the tenets of connectivism, this phenomenological study examined current trends in social networking and the possibilities that are available to adults adjusting to low vision by using technology as a means for continued learning, social interaction, and professional connections. The main research question focused on the participants' perception of the adjustment process and their ability to learn and use technology. Data were collected through semi-structured interviews of 10 adults who had low vision and had attended some form of intervention. The experiences were recorded through the use of reflection that included memoing and inductive coding where themes emerged during the field process. NVivo software was utilized to clarify and present details about themes and patterns presented during the interview discussions. These themes detailed the participants' feelings of confidence and self expressed level of skills needed to use technology; the barriers to using technology, such as cost and time; and benefits of staying connected with technology. The findings from this study suggested that the ability to stay connected and to access information outweighed the barriers, although the participants expressed frustration with technological issues. The study contributed to an area of research that supports the benefits of continued training for adults adjusting to low vision. A process of training could be implemented that would involve general technology as well as assistive technology assisting individuals with continued success in their daily lives.

This study evaluated whether cortical reorganization occurs in response to macular degeneration (MD), a progressive disorder of the retina that results in central vision loss. Past research has observed the ability of V1 to adapt to retinal damage, demonstrating that deafferented cortex is activated by the stimulation of intact retinal areas. It is still unclear, however, if and to what degree cortical reorganization is associated with specific forms of macular degeneration. This study evaluated the retinal health of MD participants (both age-related and juvenile) as well age-matched controls with computerized microperimetry. Contrast-reversing stimuli were then presented to different parts of the visual field while participants were scanned with functional magnetic resonance imaging (fMRI). For MD participants, stimulation of peripheral retinal areas elicited activation in deafferented cortex. This activation occurred for retinal areas adapted for eccentric viewing (preferred retinal locations), but not in preserved retina at the same eccentricity. These findings add to the scientific knowledge of plasticity in sensory systems by supporting an experience driven understanding of cortical reorganization. They could also have a meaningful impact on how macular degeneration is treated by informing the design of therapeutic training regimes.

No description available.

The purpose of this study was to describe the prevalence of self-reported visual and neck/shoulder complaints among individuals with a low vision diagnosis. The study also aimed to examine whether there was an association between the degree of self-rated visual and the neck/shoulder complaints. There was a questionnaire survey that was conducted on patients that visits an eye center in a county in central Sweden. There were a total of 18 people participated in the survey, between 17-92 years old. The questionnaire contained 22 questions and was analyzed with SPSS. The results showed how the distributions of answers were to the questions about the respondents’ vision respectively of respondents’ musculoskeletal problems. Results also showed that there was an association between the degree of self- rated visual difficulties and the degree of self- rated neck/shoulder disorder. The results in this study support the hypothesis that a relationship exists between visual and musculoskeletal problems. / Syftet med denna studie varatt beskriva förekomsten av självskattade syn och nacke/skuldra besvär hospersoner med ögonsjukdomar. Studien syftade också till att undersöka om det fannsett samband mellan graden av självskattade synbesvär och självskattade besvär inacke/skuldra. Enkätundersökning genomfördes på patienter som besökte ensyncentral i ett län i mellersta Sverige. Totalt 18 personer deltog iundersökningen, inom ålderskategorin 17-92 år gamla. Enkäten innehöll 22 frågorinklusive bakgrundsfrågor om kön och livsfaktorer som sedan analyserades medhjälp av databasen SPSS. Resultaten visade hur fördelningarna av svaren påfrågorna om respondenternas syn respektive muskuloskeletala problem. Resultatetvisade också att det fanns ett statistiskt signifikant samband mellan graden avsjälvbeskattade synbesvär och graden av självbeskattade nacke/skuldra besvär.Resultaten ger stöd för hypotesen att det finns en relation mellan öga-nacke/skuldrabesvär hos synsvaga individer.

Background: Social exclusion of people with vision impairments is an ongoing issue. Since social inclusion emphasizes social and emotional aspects as distinct from academic ones and the aspects concerning opportunities, the focus is turned on the domain of social interactions and friendships. Adolescence is the time point when youth feels mostly the need to ‘fit in’ in social circles and groups and the social life and friendships are important aspects of young people’s well-being and development. Aim: The aim of this study is to review the existing literature on the social interactions and friendships of adolescents with visual impairments from their own perspective and investigate the interventions designed to improve their social interactions and friendships. Method: A literature search on the databases of ERIC, CINAHL and PsycINFO and a hand search on the reference lists of the relevant articles was conducted. The search was limited to recent peer reviewed studies published in English, reporting perspectives of adolescents (13-18 years old) with visual impairments on their social interactions and friendships and intervention studies aimed to support them in the aforementioned domain. Results: In the 18 included studies, adolescents with vision impairments engaged more in passive activities that were not highly interactive. They reported being satisfied with their networks and friends, however contradictions existed in the perceived quality of friendships and the feeling of loneliness. The context of school was presented often as problematic compared to other contexts, and friendships in schools were rare. According to adolescents’ voices, friendships helped to cope with the impairment, friends had a meaningful role in their life and they made school life more enjoyable. In comparison to their sighted peers, adolescents with vision impairments had smaller networks and less friends with whom they had different type of relationships. Lastly even though several barriers and facilitators were identified, which belong to domains of Body functions and structures and Physical, Attitudinal and Social environment, there was a lack of interventions aiming to support the social interactions and friendships of adolescents with vision impairments. Conclusions: Considering the importance of social interactions and friendships in adolescents’ life for them to learn, develop and enjoy, more interventions with social focus need to be designed in respect to the challenges that exist. A plethora of barriers and facilitators impacting the social interactions and friendships of adolescents with vision impairments were identified that need to be taken into consideration for future research and interventions since the existing literature provided so far is limited. Adolescents need to be engaged in this process so that their interests, preferences and their views are prioritized.

Não raro, situações difíceis de se lidar na Educação são presenciadas no cotidiano escolar, como a questão da inclusão de alunos com deficiência na escola regular, que, muitas vezes, não tem estrutura física adequada, nem pessoal qualificado para trabalhar com esses alunos e proporcionar-lhes o desenvolvimento e a aprendizagem esperados. Por conhecer a importância que a visão tem no processo escolar e na vida sócio-cultural da criança, e por saber que a Deficiência Visual (DV) atinge boa parte da população brasileira, optou-se, nesta pesquisa, por estudar crianças com graves limitações visuais matriculadas em escolas regulares. Assim, objetiva-se verificar como a comunidade escolar percebe a criança com DV; como é a percepção da própria criança com DV em relação à sua participação na escola regular e quais os procedimentos adotados pelas escolas para trabalhar com alunos com essas características. Para tal, fez-se necessário o estudo de caso, utilizando-se, como instrumentos, a observação e a análise documental de três crianças uma menina e dois meninos entre 6 e 8 anos de idade, com baixa visão congênita, que frequentavam diferentes escolas regulares de Ensino Infantil e Fundamental do Município de Juiz de Fora, MG, além de uma entrevista semiestruturada com as crianças e suas comunidades escolares. O estudo pautou-se por uma abordagem qualitativa de pesquisa, cujos resultados apontaram para uma escassez de conhecimento por parte dos profissionais que atuavam nas escolas observadas, tanto sobre a DV quanto a respeito dos casos específicos das crianças pesquisadas. Além disso, constatouse que a baixa visão não é vista por muitas pessoas como DV, sendo menos conhecida do que a cegueira, e, talvez, por isso, alguns indivíduos a consideram como sendo menos grave do que a ausência total de visão. Em relação à percepção das comunidades escolares no que tange a seus alunos com baixa visão, de um modo geral, as três crianças eram percebidas como alunos normais e iguais aos outros, apesar de ainda não estarem totalmente incluídos nas escolas. Os métodos e as adaptações disponibilizados nas aulas eram insuficientes para lhes permitirem atingir seu potencial cognitivo e motor, apesar de terem ocorrido desenvolvimentos e avanços. Para os próprios alunos observados, a baixa visão era um detalhe ou mais uma de suas várias características, o que permite que eles se percebam crianças como as outras que têm diferenças comuns a todos os indivíduos, não se sentindo diferentes ou discriminados em razão da DV. Com a realização e o término desta pesquisa, percebe-se que a teoria inclusiva ainda está distante da prática e do cotidiano escolar. Argumentos são apresentados na tentativa de encobrir as falhas, e as responsabilidades comumente são lançadas para outras pessoas. Entretanto, um sistema educacional será verdadeiramente produtivo se todas as suas partes se conscientizarem de suas funções, combinando suas responsabilidades e almejando, sempre, o melhor para os educandos. / Not rarely difficult situations to deal with concerning Education are seen in the school enviroment, like including disabled pupils in regular schools, which, normally, don\'t have suitable structures or qualified professionals to work with those ones and also to provide them with the expected development and teaching. Being aware of the importance of vision in the school process and in the children\'s social and cultural lives as well as the fact that Visual Disability (VD) is a reality for part of the Brazilian people, this research is aimed to study children with serious visual limitations registered in regular schools. Being so, the main aim is to verify how the school community see the children with VD, how disabled children see themselves and their participation in the regular school and what procedures are adopted by schools to cope with children with the characteristic mentioned beforehand. To make it possible it\'s necessary a case study having as tools the observation and documental analysis of three children - a girl and two boys between 6 and 8 years old with low congenit vision who attended different regular primary and elementary school in Juiz de Fora, MG, besides an interview semi-structured with children and their school communities. The study follows a qualitative approach whose results point to a lack of knowledge from professionals who worked in the schools researched, both about VD and the specific case of the three children observed. Besides that, it was noted that low vision is not taken as VD, being less known than blindness and may be, because of that, some people consider it less serious than total visual absence. In relation to the perception of school communities about children with low vision, in general, the three children were taken as normal pupils and exactly like the others, although they weren\'t totally included in the schools. The methods and adaptations avaiable in the classes weren\'t enough to permit them to reach their cognitive and motor potencial, however, there was development and improvement. For the observed children, low vision was one more detail or one of their many characteristics, what made them see themselves as the other children who have differences like everybody individually, not feeling different or discriminated for being visual disabled. During the process and ending this research, it was noticed that the inclusive theory is far from practice in the school routine. Points are made to try to cover fails as well as responsabilities are given to other people. However, an educational system will be truly productive if all the parts are conscious of their functions, matching responsabilities and hoping for the best for the pupils.