Changing patterns of visual impairment.
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Causes of childhood blindness in Malaysia: results from a national study of blind school students.
A national study was conducted in children attending six schools for the blind in Malaysia to identify the anatomical site and underlying causes of blindness (BL) and severe visual impairment (SVI), with a view to determine the potentially preventable and treatable causes so that appropriate control measures can be implemented in the future. The standardized clinical examination of eyes was performed and the findings were recorded on the WHO Prevention of Blindness Programme eye examination record form for children with blindness and low vision. A total of 358 children aged between 7 and 17 years were examined, of whom 332 (92.7%) were blind or severely visually impaired. The results relate to these 332 children. Lens was the major anatomical site (22.3%) of visual loss followed by retina (20.8%), whole globe (17.2%), cornea (15.1%), optic nerve (8.7%) and uvea (5.1%). Glaucoma was responsible for BL/SVI in 7.2% and others in 3.6% of cases. Hereditary diseases were responsible for visual loss in 29.5%, intrauterine factors in 4.5%, perinatal factors in 9% and childhood factors in 7.8% of cases. However, the aetiology was unknown in 49.1% of cases which included congenital anomalies of the globe. Childhood cataract and corneal scarring are major treatable causes of BL/SVI that can benefit from future intervention strategies. Perinatal screening for intrauterine factors and hereditary eye diseases, and appropriate interventional therapy will help in reducing the prevalence of childhood blindness.
Adolescent↗
The impact of visual impairment and use of eye services on health-related quality of life among the elderly in Taiwan: the Shihpai Eye Study.
To evaluate the effect of impaired vision on health-related quality of life (HRQoL), the authors administered the Medical Outcomes Survey Short-Form 36 (SF-36) to the elderly in a metropolitan Taiwanese community and assessed their visual impairment status. A structured questionnaire was used for door-to-door data collection. Interviewers also collected information on demographics, medical history, and HRQoL. Those who were interviewed were invited to the study hospital for a detailed eye examination. An eye examination, including presenting visual acuity and best-corrected visual acuity, was conducted by ophthalmologists. Presenting visual acuity and best-corrected visual acuity were measured in the better eye. Impaired vision was defined as presenting visual acuity in the better-seeing eye worse than 6/12 (or 20/40) and was used to evaluate the correlation to HRQoL. A total of 1361 subjects at least 65 years of age participated in both the interview and eye examination. Internal-consistency and test-retest reliability of the eight scales were high. Based on the separate multiple regression model, after controlling for all other covariates, subjects in contact with vision services offered by an ophthalmologist had more positive scores on general health perceptions (beta = 4.29; p < 0.001), vitality/energy (beta = 2.73; p < 0.001), and mental health (beta = 2.06; p = 0.01). Impaired vision was associated with significantly lower scores in physical functioning (beta = -3.62; p < 0.001) and social functioning scales (beta = -3.25; p = 0.015). The findings suggest that visual impairment is associated with lower quality of life and use of eye care services is associated with higher quality of life.
Aged↗
[Project for supporting visually handicapped aged persons: developing a guide for the community of Münster].
In this paper we wish to outline both the function and the role of projects as part of a course in "Nursing Education" (Pflegepädagogik) at the Fachhochschule Münster, as well as to present a specific project which has enabled the students to gain experience in project management and qualitative research. The project target group were visually handicapped old people for whom a guide was produced as a health promotion strategy within the framework of governmental health objectives in the state of Northrhine-Westfalia.
Aged↗
Visual Ability Score -- a new method to analyze ability in visually impaired children.
PURPOSE: We analyzed the correlation between the Preferential Looking (PL) acuities and the Visual Ability Scores (VAS) of 600 patients (many with severe retinopathy of prematurity) to determine their ability to perform various activities within the daily environment. METHODS: Visual acuity was measured by PL. Sixteen visual activities within the environment were analyzed. The VAS (range, 1-16) were calculated from the results of each activity and correlated with PL acuity. RESULTS: The PL acuities of the 600 patients ranged from 20/20 (1.0) to <20/3200 (0.006) [mean, 20/337(006)]. The VAS ranged from 1 to 16 points (mean, 10.65; SD, +/-4.80) and showed a high correlation with the PL acuities (r=0.917, p=0.0001). CONCLUSIONS: In addition to PL vision testing, analyzing the environmental visual behavior of young, severely visually impaired patients is important to accurately evaluate visual abilities. We found the VAS to be an important aid for low-vision specialists, especially for those with no access to a vision evaluation system such as PL.
Activities of Daily Living↗
Visually impaired Swedish children. Longitudinal comparisons 1980-1999.
PURPOSE: To produce the background to a pilot-study of the visual and social outcome of visually impaired children. A study, originally including 219 individuals, done in 1980 in the county of Malmöhus in southern Sweden, was revisited. METHODS: A revision according to current WHO classification led to a cohort of 128 individuals. This was compared to the corresponding group, comprising 2048 individuals, of the total Swedish registration of visually impaired children of today. RESULTS AND CONCLUSION: The two groups were mostly similar as regards male/ female distribution, additional impairments, etiological factors and diagnoses. The prevalence of visual impairment due to peri-/neonatal influence had increased (p=0.038; odds ratio (OR): 1.61, 95% confidence interval (CI): 1.04-2.61), while visual impairment due to prenatal infections had decreased (p = 0.0001; OR: 0.26, 95%CI: 0.15-0.49). Regarding diagnoses we saw a significant decrease in chorioretinitis, as well as in microphthalmus and Stargardt's disease, while hypoplasia of the optic nerve increased. In all these, except chorioretinitis, the changes are probably due to altered diagnostic classification.
Adolescent↗
Visually impaired Swedish children. The 1980 cohort study--a 19-year ophthalmological follow-up.
PURPOSE: To assess the ophthalmological outcome in a cohort of visually impaired children in a geographically defined area. METHODS: A 19-year follow-up of medical records, interview and, if needed, re-examination of the initial 128 patients, born 1962-1976. RESULTS AND CONCLUSION: Follow-up was possible in 123 patients (96%); 76 (59%) were still visually impaired, 17 (13%) were deceased, while 30 (23%) had acquired a visual function > or = 0.3. The chances of gaining a visual function outside the WHO limits for visual impairment was significantly higher for patients without additional impairments (p=0.0023). The initial ophthalmologic diagnosis remained unchanged in 88%. The diagnoses with improved visual development included albinism and congenital nystagmus, while retinal diseases showed poorer results. An increase in visual function could be seen even in the initially older age-groups, indicating a maturation of visual function beyond what is usually considered the limit of plasticity of the visual system.
Adolescent↗
Visually impaired Swedish children. The 1980 cohort study--aspects on mortality.
PURPOSE: Assessment of the burden of mortality in a cohort of visually impaired children in a geographically defined area. METHODS: A 19-year follow-up of medical records and death certificates. RESULTS AND CONCLUSIONS: Of the initial 128 patients, born 1962-76, 17 (13%) had died, giving a highly significant increase in mortality compared to the equivalent age-specific Swedish population (p-value <0.000001). All deceased had additional impairments. Respiratory causes of death were found in 12/17 cases. The primary ophthalmological diagnosis was cerebral visual impairment in 8 cases, optic atrophy in 6 cases, one each of congenital cataract, microphthalmus and chorioretinitis. A more pronounced level of visual impairment gave an increased risk of mortality. A significantly higher mortality rate among multiply impaired was seen in the combined group with 'childhood blindness' (visual acuity <0.05) and 'visual impairment, undetermined or unknown' opposed to the group with 'low vision' (visual acuity 0.05-<0.3) (p=0.047).
Adolescent↗
Association between visual impairment and functional and morphological cerebral abnormalities in full-term children.
PURPOSE: To characterise the nature and degree of ocular disorders and cerebral morphological and functional abnormalities in a population-based group of visually impaired full-term pre-school children. METHODS: Forty-five children who were born at full-term between 1989 and 1995 in Värmland, Sweden, were reported as being visually impaired. An ophthalmological examination was performed and clinical data regarding mental development and neurological disease were obtained for all children. Cerebral imaging was performed in 35 children. RESULTS: Twenty-six per cent of the children were found to have ocular disorders only. Forty-two per cent had cerebral morphological abnormalities, verified by cerebral imaging, and 65% had signs of cerebral functional abnormalities. In total, 74% were found to have cerebral morphological and/or cerebral functional abnormalities. CONCLUSION: The majority of children with visual impairment, including children with ocular disorders, were found to have cerebral morphological and/or cerebral functional abnormalities. We suggest that any child with visual impairment should therefore undergo cerebral imaging and be examined by a paediatrician in order to establish the correct diagnosis.
Brain↗
The frequency of amblyopia among visually impaired persons.
PURPOSE: To investigate the frequency of amblyopia among visually handicapped patients. METHODS: The study is a retrospective investigation of all living patients registered in four Visual Rehabilitation Centres in a region in southern Sweden. The area's total population numbered 865,612 persons of whom 11,365 were registered as visually handicapped (with visual acuity < or = 0.3 in the better eye). RESULTS: Amblyopia was the main cause of decreased visual acuity in one eye in 1.72% (195 of 11,365) of the patients. The average age of the patients with amblyopia was 69 years (9-95 years) and 28.2% of these patients were less than 65 years old (the age for retirement in Sweden). The median visual acuity in the amblyopic eye among these patients was 0.1. The median visual acuity in the nonamblyopic eye was 0.2. The most common cause of decreased vision in the nonamblyopic eye was macular degeneration (39.5%). Bilateral amblyopia was present in 13 (6.7%) of the amblyopic patients. By comparing this study with earlier studies, we can calculate that about 1.2% of the persons with amblyopia 0.3 or lower will eventually become visually handicapped. CONCLUSION: A small but considerable number of patients who attend the Visual Rehabilitation Centres have amblyopia as a cause of their visual impairment. Since amblyopia can be treated if detected in childhood, later visual rehabilitation of these patients can be avoided or delayed, thereby reducing rehabilitation costs for society.
Adolescent↗
Optic nerve hypoplasia: Risk factors and epidemiology.
OBJECTIVES: To study the epidemiology of optic nerve hypoplasia. DESIGN AND METHODS: Children with optic nerve hypoplasia and visual impairment were identified through the Swedish Register of Visually Impaired Children. Pre- and perinatal characteristics were obtained from the Medical Birth Registry and by scrutinizing pregnancy and delivery records. Clinical characteristics of children with optic nerve hypoplasia are described. The following risk factors were studied: maternal age, parity, maternal smoking, gestational duration, birth weight, delivery method, Apgar score, maternal disease during pregnancy, drugs used in early pregnancy. RESULTS: Young maternal age, first parity, maternal smoking, preterm birth and factors associated with preterm birth were risk factors for optic nerve hypoplasia. There was an indicated association with the use of fertility drugs and antidepressant drugs. CONCLUSIONS: Optic nerve hypoplasia is apparently associated not only with other anomolies, notably of the central nervous system, but also with signs of general disturbance in fetal development.
Adolescent↗
A small number of older type 2 diabetic patients end up visually impaired despite regular photographic screening and laser treatment for diabetic retinopathy.
PURPOSE: The present study describes the prevalence of visual impairment and blindness in a geographically defined population 8 years after the introduction of a screening programme in 1987 for early detection of sight-threatening diabetic retinopathy. METHODS: Of 374 patients with diabetes, comprising 2.6% of the population in the study community, 72% were examined with fundus photography or biomicroscopy during 1994-95. These patients form the basis of this study. The screening programme was fulfilled by 93% of subjects, all of whom underwent ophthalmic examinations at least every other year. A total of 79 eyes in 52 patients received photocoagulation for macular oedema alone or in combination with severe non-proliferative or proliferative retinopathy. RESULTS: Eight years after the implementation of the programme, only three patients, all with type 2 diabetes (diabetes diagnosed at or after 30 years of age), had visual acuity < or = 0.1. The total number of eyes with visual acuity < or = 0.5 was higher in insulin-treated type 2 diabetic patients (n = 20) than in those on oral treatment (n = 5) or diet treatment only (n = 1) (p = 0.006 in both cases). The only independent risk factor for visual impairment in eyes with sight-threatening retinopathy was age. CONCLUSION: A small number of older type 2 diabetic patients end up with visual impairment due to unsuccessful photocoagulation of macular oedema.
Adolescent↗
Screening for diabetic retinopathy by non-ophthalmologists: an effective public health tool.
PURPOSE: To investigate and report the reliability of detection and grading of diabetic retinopathy by direct ophthalmoscopy through a dilated pupil by general physicians (non-ophthalmologists) and optometrists who have undergone a short period of training. METHODS: A total of 400 eyes of 200 diabetes patients were examined by two non-ophthalmologists. Their observations were compared with an ophthalmologist's diagnoses for the same patients. RESULTS: The diagnoses made by the general physician (kappa = 0.8381, SE = 0.041) and the optometrist (kappa = 0.7186, SE = 0.051) showed good rates of agreement with the ophthalmologist's diagnoses. CONCLUSIONS: The provision of appropriate screening protocols and follow-up parameters can enable primary care physicians and support personnel to reliably screen individuals for retinopathy in diabetes. This will reduce the workload of tertiary hospitals, and provide optimal services to the huge majority of the Indian population that has limited access to eye care services.
Adult↗
Visually impaired children with posterior ocular malformations: pre- and neonatal data and visual functions.
AIM: To analyse pre- and neonatal data and ocular findings in children with visual impairment caused by posterior ocular malformations. METHODS: Medical records were scrutinized, dried blood spot cards were analysed for virus DNA and ophthalmological assessments were performed in 28 children with optic nerve hypoplasia (ONH) and 10 with optic/chorio-retinal coloboma. RESULTS: Prenatal exposure to possible teratogens was documented in 5/28, herpes simplex virus type 1 DNA was identified in the dried blood spot cards of 1/26 children and neonatal hypoglycaemia in 12/28 children with ONH. The time delay from ocular to endocrinological diagnosis and treatment was 3 years. Children with ONH and severe visual impairment had endocrinopathy more often (11/13) than ONH children with better visual functions (5/15). Prenatal exposure to teratogens or neonatal hypoglycaemia was not identified in any of the children with coloboma. CONCLUSION: Neonatal hypoglycaemia was common in children with ONH. Severe visual impairment predicted endocrinopathy. Analysis of dried blood spot cards could serve as an additional diagnostic tool in children with ocular malformations.
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ECHO-DETECTION ABILITY OF THE BLIND: SIZE AND DISTANCE FACTORS.
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Blindness↗
The validity of judgments based on blind Rorschach records.
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Blindness↗
Electrical stimulation of the visual cortex as the conditioned stimulus in peripherally blind rats.
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Animals↗
Manifest anxiety and test taking distortion of the blind.
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Anxiety↗