Glaucoma is a degenerative disease that contributes greatly to vision loss and blindness worldwide. There are several treatments that focus on alleviating its symptoms, but few address the underlying pathophysiology, the blockage of aqueous outflow, and the onset of neuroretinal damage. Novel drugs under investigation have aimed to address this deficiency. Two of these Rho kinase inhibitors have been approved by national health agencies, and several are in clinical trials. This work investigates the promise of inhibitors of the Rho kinase signaling pathway to treat primary open-angle glaucoma.

Yes / Importance: Myopia is a leading cause of untreatable visual impairment and is increasing in prevalence worldwide. Interventions for slowing childhood myopia progression have shown success in randomized clinical trials; hence, there is a need to identify which children would benefit most from treatment intervention. Objectives: To examine whether genetic information alone can identify children at risk of myopia development and whether including a child’s genetic predisposition to educational attainment is associated with improved genetic prediction of the risk of myopia. Design, Setting, and Participants: Meta-analysis of 3 genome-wide association studies (GWAS) including a total of 711 984 individuals. These were a published GWAS for educational attainment and 2 GWAS for refractive error in the UK Biobank, which is a multisite cohort study that recruited participants between January 2006 and October 2010. A polygenic risk score was applied in a population-based validation sample examined between September 1998 and September 2000 (Avon Longitudinal Study of Parents and Children [ALSPAC] mothers). Data analysis was performed from February 2018 to May 2019. Main Outcomes and Measures: The primary outcome was the area under the receiver operating characteristic curve (AUROC) in analyses for predicting myopia, using noncycloplegic autorefraction measurements for myopia severity levels of less than or equal to −0.75 diopter (D) (any), less than or equal to -3.00 D (moderate), or less than or equal to −5.00 D (high). The predictor variable was a polygenic risk score (PRS) derived from genome-wide association study data for refractive error (n = 95 619), age of onset of spectacle wear (n = 287 448), and educational attainment (n = 328 917). Results: A total of 383 067 adults aged 40 to 69 years from the UK Biobank were included in the new GWAS analyses. The PRS was evaluated in 1516 adults aged 24 to 51 years from the ALSPAC mothers cohort. The PRS had an AUROC of 0.67 (95% CI, 0.65-0.70) for myopia, 0.75 (95% CI, 0.70-0.79) for moderate myopia, and 0.73 (95% CI, 0.66-0.80) for high myopia. Inclusion in the PRS of information associated with genetic predisposition to educational attainment marginally improved the AUROC for myopia (AUROC, 0.674 vs 0.668; P = .02), but not those for moderate and high myopia. Individuals with a PRS in the top 10% were at 6.1-fold higher risk (95% CI, 3.4–10.9) of high myopia. Conclusions and Relevance: A personalized medicine approach may be feasible for detecting very young children at risk of myopia. However, accuracy must improve further to merit uptake in clinical practice; currently, cycloplegic autorefraction remains a better indicator of myopia risk (AUROC, 0.87). / PhD studentship grant from the College of Optometrists (Drs Guggenheim and Williams; supporting Mr Mojarrad) entitled Genetic prediction of individuals at-risk for myopia development) and National Institute for Health Research (NIHR) Senior Research Fellowship award SRF-2015-08-005 (Dr Williams). The UK Medical Research Council and Wellcome grant 102215/2/13/2 and the University of Bristol provide core support for the Avon Longitudinal Study of Parents and Children (ALSPAC). A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). This research was conducted using the UK Biobank Resource (application 17351). The UK Biobank was established by the Wellcome Trust, the UK Medical Research Council, the Department for Health (London, England), the Scottish government (Edinburgh, Scotland), and the Northwest Regional Development Agency (Warrington, England). It also received funding from the Welsh Assembly Government (Cardiff, Wales), the British Heart Foundation, and Diabetes UK.

Yes / Unlike many other sports, Rugby Union has not permitted players to wear spectacles or eye protection. With an industrial partner, World Rugby developed goggles suitable for use while playing rugby for the purposes of growing participation amongst those that need to wear corrective lenses. This study reports on the profile and experiences of goggle wearers. 387 players received the goggles. Data were obtained from 188 (49 %) using an online, 75-item questionnaire. 87 % “strongly agreed/agreed” that goggles are beneficial and 75 % are happy with goggle performance. Common problems reported by 49.7 and 32.6 % of respondents were issues with fogging-up and getting dirty. 15 (8 %) players stopped wearing the goggles because of fogging-up, limits to peripheral vision and poor comfort/fit. Injuries were reported in 3 % of respondents. In none of these cases did the player stop wearing the goggles. From the positive experience of players in the trial, the goggles were adopted into the Laws of the game on July 1, 2019. As the need to correct vision with spectacles is common, and contact lenses are not worn by 80 % + of spectacle wearers, the new Rugby goggles will widen participation for those that need to wear refractive correction, or have an existing/increased risk of uniocular visual impairment.

No / PURPOSE. To determine the influence of cataractous and refractive blur on postural stability and limb-load asymmetry (LLA) and to establish how postural stability changes with the spatial frequency and contrast of the visual stimulus. METHODS. Thirteen elderly subjects (mean age, 70.76 ± 4.14 [SD] years) with no history of falls and normal vision were recruited. Postural stability was determined as the root mean square [RMS] of the center of pressure (COP) signal in the anterior¿posterior (A-P) and medial¿lateral directions and LLA was determined as the ratio of the average body weight placed on the more-loaded limb to the less-loaded limb, recorded during a 30-second period. Data were collected under normal standing conditions and with somatosensory system input disrupted. Measurements were repeated with four visual targets with high (8 cyc/deg) or low (2 cyc/deg) spatial frequency and high (Weber contrast, ¿95%) or low (Weber contrast, ¿25%) contrast. Postural stability was measured under conditions of binocular refractive blur of 0, 1, 2, 4, and 8 D and with cataract simulation. The data were analyzed in a population-averaged linear model. RESULTS. The cataract simulation caused significant increases in postural instability equivalent to that caused by 8-D blur conditions, and its effect was greater when the input from the somatosensory system was disrupted. High spatial frequency targets increased postural instability. Refractive blur, cataract simulation, or eye closure had no effect on LLA. CONCLUSIONS. Findings indicate that cataractous and refractive blur increase postural instability, and show why the elderly, many of whom have poor vision along with musculoskeletal and central nervous system degeneration, are at greater risk of falling. Findings also highlight that changes in contrast sensitivity rather than resolution changes are responsible for increasing postural instability. Providing low spatial frequency information in certain environments may be useful in maintaining postural stability. Correcting visual impairment caused by uncorrected refractive error and cataracts could be a useful intervention strategy to help prevent falls and fall-related injuries in the elderly.

The purpose of this study was to examine differences in early intervention (EI) referral and service frequency for children with blindness or visual impairment (BVI) and gather information about the practices and experiences of vision professionals across the United States. The study focused on obtaining data from certified teachers of students with visual impairment (CTVI) and certified orientation and mobility specialists (COMS) in the United States. Information collected included descriptive statistics and professional information about EI for children with BVI, and information about the referral process and service frequency for children with BVI during EI. Thirty-three states were represented in the collected data. Of these states, 26 had responses from four or more professionals, the criteria for inclusion in the analyses. Participants provided information based on a researcher-developed survey requesting information related to the procedures used to provide EI services for children with BVI. Questions were adapted from established instruments where possible. Across states, there were some statistically significant differences in CTVIs and COMS reports of procedures regarding the role of professional collaboration, parent/caregiver participation in IFSP meetings, strengths/resources utilized by vision professionals, and challenges parents/families encountered when accessing EI services for their child with BVI. No statistically significant differences were identified across states for type of referral method, most commonly initiated by health care professionals, or method by which service frequency was determined. Results will be used to inform future research to further examine EI for children with BVI in the United States.

The submitted thesis deals with ethical aspects of the life of people with severe visual impairment. Since recently, likewise e.g. in medicine, the partner model of cooperation between the social services provider and the receiver is also preferred in the blind and visually impaired rehabilitation, the present state of manners in society was necessarily considered within the ethical deliberation, e.g. the historical development of the interest in people with severe visual impairment, traditional approaches to them, persisting prejudices, the moral field, which in practice project into attitudes and behaviour determining value hierarchy, as well as into the legal field, i.e. into sources and the situation of social legislation relevant for visually impaired people's lives. The theoretical part informs the reader about the fundamental terminology used in special pedagogy, social work and other related branches. Further, it focuses on the theoretical ethical resources applied to the field of the blind and visually impaired rehabilitation, the help of the welfare state embodied in the legislation, and it takes into account the spiritual dimension of the human personality and its significance for the visual impairment acceptance. The practical part contains the quantitative and qualitative research...

The submitted thesis deals with ethical aspects of the life of people with severe visual impairment. Since recently, likewise e.g. in medicine, the partner model of cooperation between the social services provider and the receiver is also preferred in the blind and visually impaired rehabilitation, the present state of manners in society was necessarily considered within the ethical deliberation, e.g. the historical development of the interest in people with severe visual impairment, traditional approaches to them, persisting prejudices, the moral field, which in practice project into attitudes and behaviour determining value hierarchy, as well as into the legal field, i.e. into sources and the situation of social legislation relevant for visually impaired people's lives. The theoretical part informs the reader about the fundamental terminology used in special pedagogy, social work and other related branches. Further, it focuses on the theoretical ethical resources applied to the field of the blind and visually impaired rehabilitation, the help of the welfare state embodied in the legislation, and it takes into account the spiritual dimension of the human personality and its significance for the visual impairment acceptance. The practical part contains the quantitative and qualitative research...

Univerzita Karlova v Praze, Pedagogická fakulta, Katedra speciální pedagogiky, DIPLOMOVÁ PRÁCE Comparing the level of olfactory perception among persons with congenital or acquired severe visual impairment Autor: Tereza Kopsová, Vedoucí práce: Mgr. Pavlína Šumníková, Ph.D., Praha 2010 ANNOTATION: The work deals with identifying the level of olfactory perception among people with severe visual impairment. The aim is to compare the function of olfactory discrimination and olfactory threshold sensitivity among persons with congenital or acquired visual handicap. The theoretical section presents the basic anatomical and physiological characteristics of the olfactory system, the list of disorders of smell and olfactory testing methods in clinical practice, and a brief account of visual impairments. The empirical investigation is carried out using standardized tests, olfactory discrimination function is measured by a test of the University of Pennsylvania Smell Identification Test (UPSIT), olfactory perception threshold using the Smell Threshold Test (STT). The thesis describes in detail both the methods and characteristics of groups of test subjects. In the analytical part it focuses on the comparison of test results among persons with congenital or acquired severe visual impairment.

Barbora Hrušková, Rodičovství osob s těžkým zrakovým postižením Abstract (in English) The diploma thesis researches practical aspects of the parental role of persons with severe visual impairment. Its aim is to describe the experiences of visually impaired parents with preparing for the arrival of a child, with parental role and with childcare during a preschool age. At the same time it aims to chart the social services available to this group and to determine the extent to which they actually use these services, or whether they are missing some services. Due to differences in the availability of services in Prague and in smaller towns, the whole diploma thesis is focused on the territory of Prague. The theoretical part describes a person with severe visual impairment, including its specifics in different areas of life. It also deals with possible different aspects of parenting for people with visual disabilities. It provides a description of compensatory aids and explains their important role in the lives of visually impaired people. Next it acquaints readers with the possibilities of financial support for visually impaired parents primarily by the state. The conclusion of the theoretical part is devoted to listing and description of Prague organizations that provide some services for parents with severe...

Separation anxiety is highly prevalent among intellectually and visually impaired individuals, yet little research has been done into its treatment in this population. Due to delayed cognitive skills, these individuals struggle to develop the abstract concept of person permanence, which is necessary to diminish separation anxiety. The first aim of this study was to investigate whether using technology alone or including caregivers was the most beneficial approach to developing person permanence using technology-assisted therapy. The caregivers received training in advance in an attachment-based protocol about securing attachment relationships with the participant. It was hypothesised that the inclusion of attachment figures in technology-assisted therapy would enhance the acquisition of the person permanence concept. The second aim of this study was to determine whether technology-assisted therapy in tandem with the participation of caregivers consequently decreased separation anxiety and challenging behaviour in an adult with intellectual and visual impairment. It was hypothesised that the subject’s anxiety and challenging behaviour levels would significantly decrease due to the intervention. The final aim was to determine how the caregivers and the participant experienced this intervention. It was hypothesised that they would regard it as a positive experience. This single-subject design used a pre-experimental quantitative approach. It was based on the familiar ABAB design and comprised six phases. Phase A served as baseline, giving the participants time to become acquainted with the technology. Phase B consisted of automated responses to the participant’s messages. In phase C caregivers directed the active reply. The daily messages were discussed when the participant and caregiver reunited, incorporating the attachment-based protocol. Phase B and C were repeated. Phase D followed after the devices were handed in. The technology was a specially adapted touch iPhone with an application comprising coloured emoticons. When the participant was physically separated from the caregiver, he could send happy, sad, angry or scared emoticons, or request help. The caregiver, who had a similar device, responded by sending a pre-determined response such as acknowledging the participant’s “I am angry” message with a “You are angry” message. Due to the association between anxiety and challenging behaviour in this population, standardised instruments were used to measure changes in these behaviours. Repeated measure ANOVA and a non-parametric Friedman test were used to analyse the data, specifically comparing phase B and C. Overall, the results showed that behaviour did significantly change over the course of the intervention. The frequency of the various iPhone messages sent by the participant was recorded daily. ANOVA contracts results demonstrated significantly fewer anxious and angry messages sent during the C phases compared with the B phases. The professional caregivers recorded the frequency and intensity of anxiety and challenging behaviours. The ANOVA contrast results showed a significantly lower frequency and intensity of these behaviours in the C phases compared with the B phases. A questionnaire was developed to evaluate the social validity of the intervention. The independent samples t-test demonstrated a significant difference between the mean scores rated by the caregivers at the beginning and the end of the invention. The participant and caregivers were positive about the intervention. Although the results cannot be generalised, it can be concluded that the inclusion of caregivers in technology-assisted therapy can serve as an invaluable aid to developing the person permanence concept. The findings also indicate that the anxiety and challenging behaviour levels shown by the adult with ID and visual impairment decreased due to technology-assisted therapy applied by caregivers, while responses to the social validity of the intervention were positive. / MSc (Research Psychology), North-West University, Potchefstroom Campus, 2015