Low vision impacts on Quality of Life (QoL). Thus, low vision services are essential to enhance the QoL of people with functional low vision. However, of the estimated 70 out of the 124 million people with low vision who require services, approximately 5-10% has access to services. The demands for low vision services will continue to grow due to the emerging global trends in ageing populations and changes in the epidemiology of vision impairment. While critical data and information are available for other forms of vision impairment, there is a paucity of information on the distribution, needs, and priorities for improving low vision service delivery at the national, regional, and global levels. / This thesis addressed the problem by first developing and distributing a survey to Vision 2020 contacts, government, and non government organisations in 195 countries during 2006-2008 to assess the current situation of low vision services globally. The survey was first pilot tested leading to improvements in the length, layout, and content of its form. Specifically, the survey topics included: epidemiology, policies, human resources, service provision, barriers, equipment, and monitoring and evaluation. / The Classification Analysis and Regression Tree (CART), logistic regression methodology and grounded theory analysis were used to present the findings and identify the critical success factors of low vision service coverage. The qualitative component consisted of case studies in three countries (India, Ghana, and Cameroon) during November 2007 and 2008. A total of 101 interviews were carried out. The case studies provided an overview and historical perspective of services, effectiveness, cost, efficiency, acceptability, access, equity, sustainability, and ideal situations as recommended by interviewees. Qualitative findings from the case studies were produced with the assistance of the NVivo software. / The primary results are that the majority (80%) of countries have poor (≤10%) coverage. Key issues pertinent to the current situation of service coverage are: human resources (number and combination of disciplines), funding (sustainability and arrangements), type of services provided (comprehensive and multidisciplinary) and its locations (NGOs or government facilities), and the sociodemographic and economic barriers (costs, awareness, and rural areas) to accessing services. / The critical success factors found in this research are represented by the ‘FRAME’: Funding (sustainable source, public and private mix), Rehabilitation workers (e.g., adequate numbers of multidisciplinary personnel), Access to low vision devices, Multidisciplinary services; and External contextual influences in which low vision services operate in. The case studies identified seven major themes that further build on the FRAME: sustainability, governance, advocacy, human resources, access, awareness, and service delivery. / The conclusion of the thesis is that a global picture of the current situation of low vision services was acquired and it is now known which countries have poor (≤10%) and better (>10%) coverage. It also found the critical success factors that will assist the WHO Low Vision Working Group and Vision 2020 to improve the current models of service delivery, future planning, training curriculum development, and priorities setting. Specifically, these need to be achieved through three areas of action: human resources development, sustainability, and advocacy.

Esta tese de doutorado é um estudo de caso sobre uma família com um bebê com deficiência visual e a efetividade de uma intervenção precoce, dividindo-se em quatro artigos. O primeiro objetivou revisar a produção científica sobre intervenção precoce na área da deficiência visual. O segundo artigo investigou o duplo impacto da prematuridade e da deficiência visual, examinando as reações emocionais dos pais de um bebê nesse contexto e seu impacto na parentalidade. O terceiro artigo investigou a efetividade de uma intervenção precoce com foco na sensibilidade materna – e paterna, analisando o pré e o pós-intervenção. O último estudo trata-se de um relato de experiência que examina o processo da intervenção. As discussões sobre o impacto da prematuridade junto à deficiência visual lançam bases para o trabalho de intervenção na interação pais-bebê. As análises sugerem ser a intervenção precoce efetiva em termos de promoção de mudanças na interação parental com o bebê e de expressão de emoções. / This doctoral thesis is a single case study of a family with a baby that has vision impairment and the effectiveness of an early intervention, which is divided in four articles. The first aims to review the scientific literature in the field of early intervention in the area of visual impairment. The second article investigated the double impact of the both prematurity and the vision impairment on parenthood, examining the parents emotional reactions in that context. The third article investigates the effectiveness of an early intervention focusing on maternal and paternal sensibility, by analysing the pre- and the post intervention. The last study is a narrative of the experience of the intervention process. Discussions involving the impact of prematurity on vision impairment promote the basis for the intervention in the parent-baby interaction. The results suggest that early intervention may be effective by promotion changes in the parental interaction with baby and by allowing the expresssion of parents emotions.

Esta tese de doutorado é um estudo de caso sobre uma família com um bebê com deficiência visual e a efetividade de uma intervenção precoce, dividindo-se em quatro artigos. O primeiro objetivou revisar a produção científica sobre intervenção precoce na área da deficiência visual. O segundo artigo investigou o duplo impacto da prematuridade e da deficiência visual, examinando as reações emocionais dos pais de um bebê nesse contexto e seu impacto na parentalidade. O terceiro artigo investigou a efetividade de uma intervenção precoce com foco na sensibilidade materna – e paterna, analisando o pré e o pós-intervenção. O último estudo trata-se de um relato de experiência que examina o processo da intervenção. As discussões sobre o impacto da prematuridade junto à deficiência visual lançam bases para o trabalho de intervenção na interação pais-bebê. As análises sugerem ser a intervenção precoce efetiva em termos de promoção de mudanças na interação parental com o bebê e de expressão de emoções. / This doctoral thesis is a single case study of a family with a baby that has vision impairment and the effectiveness of an early intervention, which is divided in four articles. The first aims to review the scientific literature in the field of early intervention in the area of visual impairment. The second article investigated the double impact of the both prematurity and the vision impairment on parenthood, examining the parents emotional reactions in that context. The third article investigates the effectiveness of an early intervention focusing on maternal and paternal sensibility, by analysing the pre- and the post intervention. The last study is a narrative of the experience of the intervention process. Discussions involving the impact of prematurity on vision impairment promote the basis for the intervention in the parent-baby interaction. The results suggest that early intervention may be effective by promotion changes in the parental interaction with baby and by allowing the expresssion of parents emotions.

Esta tese de doutorado é um estudo de caso sobre uma família com um bebê com deficiência visual e a efetividade de uma intervenção precoce, dividindo-se em quatro artigos. O primeiro objetivou revisar a produção científica sobre intervenção precoce na área da deficiência visual. O segundo artigo investigou o duplo impacto da prematuridade e da deficiência visual, examinando as reações emocionais dos pais de um bebê nesse contexto e seu impacto na parentalidade. O terceiro artigo investigou a efetividade de uma intervenção precoce com foco na sensibilidade materna – e paterna, analisando o pré e o pós-intervenção. O último estudo trata-se de um relato de experiência que examina o processo da intervenção. As discussões sobre o impacto da prematuridade junto à deficiência visual lançam bases para o trabalho de intervenção na interação pais-bebê. As análises sugerem ser a intervenção precoce efetiva em termos de promoção de mudanças na interação parental com o bebê e de expressão de emoções. / This doctoral thesis is a single case study of a family with a baby that has vision impairment and the effectiveness of an early intervention, which is divided in four articles. The first aims to review the scientific literature in the field of early intervention in the area of visual impairment. The second article investigated the double impact of the both prematurity and the vision impairment on parenthood, examining the parents emotional reactions in that context. The third article investigates the effectiveness of an early intervention focusing on maternal and paternal sensibility, by analysing the pre- and the post intervention. The last study is a narrative of the experience of the intervention process. Discussions involving the impact of prematurity on vision impairment promote the basis for the intervention in the parent-baby interaction. The results suggest that early intervention may be effective by promotion changes in the parental interaction with baby and by allowing the expresssion of parents emotions.

The older adult population in the United States is rapidly expanding both because of longer life expectancies as well as the aging of the baby boomers. While vision impairment is a growing concern among older adults, there have been few, mostly small studies, of the impact of vision impairment on this population. The present study uses a national data set, the Second Supplement on Aging (1994 -1996) from the National Health Interview Survey, in a cross-sectional study of 9,447 civilian non-institutionalized persons, aged 70 years and over at the time of their interview. The SOA II has been studied in the context of a social theory of aging that emphasizes interdependence through the life course using a stress process model that has been refined into a disability model. Disability is understood as a social construction outcome rather than as a medical outcome. Vision impairment is the stressor which is mediated by health (falls, functioning and self-health report), financial resources (education, income and having only public health insurance) and social support (marital, living along, having no living children, social activities in number and intensity). Depression is a possible, but not a necessary result of vision impairment. Disability may result when a medical pathology leads to an impairment which results in a functional limitation and finally a social disability. This secondary analysis used a multinomial logistic regression for both the whole sample as well as separately for each gender. For the whole sample the results indicate that a typical profile of a vision-impaired older adult depressed some/all of the time, would be a younger-old White woman (aged 70-74 years old) who has fallen in the past 12 months, has difficult with one or more Activities of Daily Living or with both one or more Activities of Daily Living and Instrumental Activities of Daily Living, has a poor to fair self-heath report, a family income under $20,000, a high school or less education, lives alone, has a living child and lacks social activities in number and intensity. In the gender samples, only the female sample at the some/all of the time depression category is significant. Older vision-impaired adults, especially older women who have more social supports are less likely to be depressed and so disabled. There is a need for social policies that will educate, encourage and support older vision-impaired adults as they seek to compensate for the loss of vision, often late in life.

Myndigheten för delaktighet har fått i uppdrag av regeringen att se till att funktionshinderspolitiken efterlevs och stöttar kommuner, stat och regioner i arbetet för att delaktiggöra personer med funktionsnedsättningar i samhället. Att stötta och sprida information gäller även för studie- och yrkesvägledare som är verksamma inom skolvärlden. De möter elever med olika behov och förutsättningar, samt elever som står inför eftergymnasiala övergångar. Studiens syfte är att undersöka hur studie- och yrkesvägledare arbetar med synskadadeelever. I Studien ställs två forskningsfrågor: 1) Vilka utmaningar upplever studie- och yrkesvägledare i vägledningssituationer med synskadade vid övergången till eftergymnasiala studier och ut på arbetsmarknaden? 2) Hur ser studie - och yrkesvägledare på synskadades möjligheter att etablera sig arbetsmarknaden efter genomförd utbildning. En kvalitativ metod med semistrukturerad intervjuguide användes under intervjun. Analysen utgår från Careership teorin. Resultaten pekar på att synskadade elever har större behov av vägledning och i behov av tidigare vägledningsinsatser än sina normalseende jämnåriga. Det behövs flersamverkansresurser för en trygg och smidig övergång till eftergymnasiala studier, vilke tkräver både mer tid, planering och resurser i anspråk. Synskadade möter även i högre grad fler utmaningar i övergångar till eftergymnasiala studier än elever med normal syn, och dessa finns både inbyggda i samhällsstrukturen och i den sociala omgivningen och inte minst inom den synskadade individen själv.

Yes / Purpose: Two binocular sources of information serve motion-in-depth (MID) perception: changes in disparity over time (CD), and interocular velocity differences (IOVD). While CD requires the computation of small spatial disparities, IOVD could be computed from a much lower-resolution signal. IOVD signals therefore might still be available under conditions of binocular vision impairment (BVI) with limited or no stereopsis, e.g. amblyopia. Methods: Sensitivity to CD and IOVD was measured in adults who had undergone therapy to correct optical misalignment or amblyopia in childhood (n=16), as well as normal vision controls with good stereoacuity (n=8). Observers discriminated the interval containing a smoothly-oscillating MID “test” stimulus from a “control” stimulus in a two-interval forced choice (2IFC) paradigm. Results: Of the BVI observers with no static stereoacuity (n=9), one displayed evidence for sensitivity to IOVD only, while there was otherwise no sensitivity for either CD or IOVD in the group. Generally, BVI observers with measurable stereoacuity (n=7) displayed a pattern resembling the control group: showing a similar sensitivity for both cues. A neutral-density (ND) filter placed in front of the fixing eye in a subset of BVI observers did not improve performance. Conclusions: In one BVI observer there was preserved sensitivity to IOVD but not CD, though overall only those BVI observers with at least gross stereopsis were able to detect disparity-based or velocity-based cues to MID. The results imply that these logically distinct information sources are somehow coupled, and in some cases BVI observers with no stereopsis may still retain sensitivity to IOVD. / UK Biotechnology and Biological 498 Sciences Research Council (BBSRC): BB/M002543/1 (Alex R. Wade) BB/M001660/1 (Julie 499 M. Harris) and BB/M001210/1 (Marina Bloj)

Det ingår i ögonsjuksköterskans arbetsuppgifter att mäta synfunktioner och att informera om undersökningsresultat. Det kan kännas svårt att lämna information om att patientens syn inte uppfyller gällande synkrav för körkort, då informationen kan påverka patientens livskvalité negativt. Syftet med studien var att undersöka ögonsjuksköterskans erfarenheter av att informera patienten om att synkraven för körkort inte uppnås. En intervjustudie genomfördes där nio ögonsjuksköterskor medverkade. En kvalitativ innehållsanalys utfördes sedan på insamlad data. Tre kategorier framkom: personcentrering vid informationstillfället, patientreaktioner påverkar informationstillfället samt omständigheter påverkar informationstillfället. Resultatet visade att ögonsjuksköterskorna var djupt involverade i körkortsärenden och de flesta kände ansvar att informera patienten när synkraven för körkort inte uppnåddes. Genom ett personcentrerat förhållningsätt försökte ögonsjuksköterskorna skapa de bästa förutsättningarna för att göra patienten delaktig. Informationstillfället påverkades av patientens reaktioner samt andra omständigheter så som vilken diagnos patienten hade och vilka konsekvenser informationen skulle kunna innebära för patienten. Det visade sig vara av betydelse att ögonsjuksköterskorna hade goda kunskaper i handhavande och bedömningar i körkortsfrågor varför sådan utbildning rekommenderas. Oftalmologiska verksamheter bör avsätta tillräckligt med tid till dessa patientbesök då även detta visade sig vara viktigt. För att ytterligare förbättra den oftalmologiska omvårdnaden är det angeläget att i kommande studier belysa patientens upplevelse av informationstillfället. / It is part of the ophthalmic nurse’s duties to measure functions relating to sight and to report outcomes of such examinations. It can feel difficult to deliver information about sight no longer being sufficient to fulfil the requirements for a drivers’ licence, as such information may negatively impact quality of life. The purpose of this study was to examine the experiences of ophthalmic nurses in informing the patients that their vision no longer fulfils the requirements for holding a drivers’ license. The study comprised interviews in which nine nurses participated. A qualitative content analysis of the collected data was conducted. Three categories emerged: person-centering the delivery of information, reactions of patient affect the delivery of information and circumstances affect the delivery of information. The results show that ophthalmic nurses were deeply involved in drivers’ licence cases, and most of them felt a responsibility to inform patients when their sight fell short of requirements for drivers’ license. By means of a person-centred approach, nurses attempted to create the best conditions in which to involve patients. The time of information delivery was impacted by the reactions of patients, as well as other circumstances such as the type of patient diagnosis and the consequences this information might have for the patient. It was deemed significant that ophthalmic nurses had good knowledge of process and judgment in matters of drivers’ licenses, why such education is recommended. Sufficient time for those meetings was shown to be important. In order to further improve ophthalmic caring, it is important to also highlight the patients’ experience at the time of information.

INTRODUCCIÓN. Los problemas de visión afectan a la autonomía y limitan las oportunidades educativas, laborales y sociales, impactando negativamente en la calidad de vida de las personas afectadas, en sus familias y en la comunidad. La prevalencia de la ceguera y discapacidad visual en el mundo no se distribuye homogéneamente si no que se concentra en determinados grupos de población y regiones en situación de mayor vulnerabilidad. El 90 % de la discapacidad visual podría evitarse si se facilita el acceso universal a los servicios de salud visual. Dado el beneficio social y económico de las intervenciones para resolver estos problemas, el desarrollo los recursos y servicios de salud visual en atención primaria es considerado una prioridad en la agenda de salud pública global y en los planes nacionales de salud. JUSTIFICACIÓN Y OBJETIVOS. La región de Apurímac, en Perú, presenta condiciones geográficas y socioeconómicas que favorecen los problemas de visión mientras que la accesibilidad a los servicios de salud visual está seriamente comprometida por falta de profesionales y servicios especializados. Sin embargo, la red de educación es extensa y alcanza al 90% de la población infantil en la región. El Objetivo General es desarrollar estrategias efectivas desde el ámbito comunitario para abordar los problemas de salud visual y las desigualdades de acceso a los servicios sanitarios en poblaciones de difícil acceso. Para ello se contemplan los siguientes Objetivos Específicos: (1) Analizar la utilidad del cribado visual en el entorno escolar a través de la capacitación de maestros, así como contribuir a una mejor estimación de la prevalencia de errores de refracción en la población infantil en la región; (2) Presentar el proceso de implementación y ampliación de la intervención dirigida a la mejora de la salud visual en población escolar en la Región de Apurímac en Perú. METODOS. La investigación está compuesta por un estudio piloto sobre el cribado visual infantil realizado por maestros y un estudio observacional descriptivo donde se analiza la implementación y ampliación y del programa llevado a cabo en colaboración con la Dirección Regional de Educación en Apurímac. Se analiza la pertinencia de la intervención y la validez del procedimiento, la capacidad de los docentes a identificar a escolares con problemas de visión, y los factores que afectan a la efectividad y la equidad de acceso a los servicios. Se definieron propuestas de mejora consensuadas en grupos de discusión con los participantes. Se presentan de manera descriptiva los resultados y procesos relacionados con la implementación y ampliación del programa y las acciones adaptativas encaminadas a mejorar el alcance y su efectividad. RESULTADOS Y DISCUSIÓN. La prevalencia de errores refractivos no corregidos en población infantil en la región es significativa (>9%), y el docente es capaz de identificar problemas de visión en población escolar, una vez que recibe formación y recursos adecuados para ello (especificidad >93%). Tras la aplicación de acciones adaptativas, la tasa de asistencia a examen de niñas y niños referidos ha aumentado en un 39% (del 66% al 92%) con respecto al estudio piloto. La revisión y adaptación de los materiales formativos, y el apoyo a los docentes y a las familias referidas, ha permitido aumentar la accesibilidad y cobertura del programa. Las campañas externas llevadas a cabo por los equipos de salud y el apoyo recibido por parte de las autoridades municipales han contribuido a que la intervención se extienda entre las familias sin recursos y con mayores dificultades de acceso a estos servicios. Pese a que la capacitación de docentes fue efectiva y bien valorada por los participantes, factores contextuales afectaron a la cobertura e impacto del programa. Tales como el hecho de que las escuelas de preescolar y primaria en el entorno rural son conducidas con frecuencia por un único docente, donde la red eléctrica y de comunicaciones –telefónica e internet- es limitada o inexistente. La concurrencia de la intervención con una huelga general por cuestiones medioambientales afectó a la actividad escolar y a la ejecución del programa. Las recomendaciones de cara el futuro pasan por fortalecer los servicios de atención primaria y la colaboración entre los grupos de interés, centrada en la prevención y el conocimiento de las necesidades visuales en la infancia, la integración de la discapacidad visual en el entorno escolar, la identificación de niñas y niños no escolarizados por problemas de visión y la reducción de costes en la prestación de servicios de calidad, que facilite la equidad en el acceso y la sostenibilidad económica del programa. La incorporación de organizaciones no gubernamentales que trabajan en el ámbito de la salud visual y la atención a la discapacidad a nivel internacional ha permitido mejorar la evaluación del proceso e incorporar nuevas acciones para aumentar el alcance e impacto de la intervención.

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