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PubMedDate not supplied

Computer and World Wide Web accessibility by visually disabled patients: problems and solutions.

Rapid advances in information technology have dramatically transformed the world during the past several decades. Access to computers and the World Wide Web is increasingly required for education and employment, as well as for many activities of daily living. Although these changes have improved society in many respects, they present an obstacle for visually disabled patients who may have significant difficulty processing the visual cues presented by modern graphical user interfaces. This article reviews the specific barriers to computer and Web access faced by visually disabled patients, describes clinical evaluation methods, summarizes traditional low vision methods as well as newer assistive computer technologies for universal accessibility, and discusses emerging technologies and future directions in this area.

Access to Information↗
PubMed2003

Associations between glaucomatous visual field loss and participation in activities of daily living.

PURPOSE: This study investigated the association between visual field loss and participation in daily activities in individuals with glaucoma. METHODS: Seventy-nine patients were recruited from the Royal Victorian Eye and Ear Hospital. Visual fields were assessed using the Esterman binocular visual field tests and participation in daily activities was assessed using the Impact of Vision Impairment (IVI) questionnaire. Visual acuity and contrast sensitivity were also measured. RESULTS: There was no independent relationship between visual field loss and IVI score (r = -0.20; P = 0.09), except for the mobility domain (r = 0.25; P = 0.03). Mobility was the most affected domain of the IVI (mean = 1.2). Over a quarter of the patients reported experiencing moderate to severe restriction with mobility activities despite relatively minor binocular field loss. CONCLUSION: Mobility is the area in which glaucoma patients encounter difficulties even when the visual field and visual acuity are relatively good. Questions related to mobility could be asked to identify those patients who need rehabilitation.

Activities of Daily Living↗
PubMed2004

Adjustable typography: an approach to enhancing low vision text accessibility.

Millions of people have low vision, a disability condition caused by uncorrectable or partially correctable disorders of the eye. The primary goal of low vision rehabilitation is increasing access to printed material. This paper describes how adjustable typography, a computer graphic approach to enhancing text accessibility, can play a role in this process, by allowing visually-impaired users to customize fonts to maximize legibility according to their own visual needs. Prototype software and initial testing of the concept is described. The results show that visually-impaired users tend to produce a variety of very distinct fonts, and that the adjustment process results in greatly enhanced legibility. But this initial testing has not yet demonstrated increases in legibility over and above the legibility of highly legible standard fonts such as Times New Roman.

Adult↗
PubMed2005

Further validation of the Daily Living Tasks Dependent on Vision: identification of domains.

AIM: To examine the Daily Living Tasks Dependent on Vision (DLTV), a visual function questionnaire for domain structure, and redundancy. METHOD: 235 subjects underwent full ophthalmic assessment and completed the DLTV questionnaire by interview. Principal component analysis with varimax rotation and item response theory (IRT) were used to assign the items to domains. The internal consistency of each domain was examined using Cronbach's alpha. Redundancy was assessed by regressing each item in a domain against the remainder of items in that domain. RESULTS: Four domains were identified. Domain 1 was formed by nine items, which after applying IRT were seen to be among the most difficult questions in the instrument. Domain 2 contained eight items, all of which fell in the easier half of the instrument on applying IRT. Domain 3 contained only three items, all of which were among the easier questions and appear to deal with peripheral vision function. Domain 4 consisted of two items dealing with adaptation to light and dark conditions. Cronbach's alpha for each domain was 0.96, 0.93, 0.73, 0.66. Redundancy was found to be present in domain 1, which was therefore reduced by two items, with little effect on internal consistency. CONCLUSIONS: The authors believe using the domains identified in this report will optimise the information provided by patients on their ability to function on visually demanding tasks.

Activities of Daily Living↗
PubMed2005

[Referral for rehabilitation in case of permanent visual handicap; guideline of the Dutch Society of Ophthalmology].

The Dutch Society of Ophthalmology (NOG) has developed an evidence-based guideline for the referral of visually impaired people for rehabilitation and support. Referral for rehabilitation and support must be preceded by diagnosis and treatment. Consultation of an ophthalmologist is essential. Information about the disease should be given to the patient orally as well as in writing. The ophthalmologist brings up the possibility of rehabilitation in the presence of a visual acuity < 0.5 and/or visual field of < 30 degrees in the better eye and a well-defined request for help. Visually impaired patients with a relatively simple request for help are referred to a specialised optometrist whenever possible. Visually impaired patients with more complex requests for help are referred to a multidisciplinary (regional or national) rehabilitation centre for people with a visual handicap. Visually impaired and blind patients are informed about the existence of patient organisations. Referral for rehabilitation is done by means of a structured letter with all relevant information. A copy of this letter should be sent to the family physician and all other attending physicians.

Disability Evaluation↗
PubMed2002

From visual function deficiency to handicap: measuring visual handicap in Mali.

BACKGROUND/AIMS: Blindness is a major public health problem in developing countries, even though most could be prevented by relatively simple hygienic and medical interventions. Relatively few patients use the quality health care services available, despite their low cost, due to problems of access or socio-cultural barriers. This health services research project stressed the need for measurement of subjective self-perceived health. The objectives of this study were twofold: a) To translate, adapt and integrate the cultural context found in Mali and validate two instruments for measuring, respectively, perceived vision and quality of life. b) To study the relationship between these variables and visual deficiencies by gender. METHODS: The perceived vision and quality of life questionnaires were based on a translation of the Aravind questionnaire, adapted to Mali. The resulting perceived vision questionnaire comprises 13 questions, grouped according to five subscales (global vision, visual perception, sensory adaptation, visual field and depth perception). Furthermore, the 13 questions on quality of life were grouped into four subscales (personal care, mobility, social life and psychological). For both questionnaires, a global score could be computed. These two questionnaires were administered to a representative sample of 203 subjects with impaired vision, aged over 40, in a rural area in Mali. RESULTS: The acceptability of the questionnaires was good (1% missing data). The convergent validity was adequate for all but one subscale (psychological). The discriminate validity is acceptable for three of the six subscales where measurement can be made (visual perception, personal care, mobility). The Cronbach alpha coefficients indicate good reliability for the global scores. CONCLUSIONS: Analysis of mean results confirms the validity of the International Classification of Disease (ICD) definition of blindness (seeing less than 0.05 results in a steep decrease in quality of life). Moreover, blindness affects the quality of life of women more severely than that of men; this may be related to the availability of social support.

Adult↗
PubMed1998

An instrument for assessment of subjective visual disability in cataract patients.

AIMS/BACKGROUND: The construction and validation of an instrument for the assessment of subjective visual disability in the cataract patient is described. This instrument is specifically designed for measuring the outcome of cataract surgery with respect to visual disability. METHODS: Visually related activities thought to be affected by cataract were considered for the questionnaire. These were reduced by pilot study and principal components analysis to 18 items. A patient's assessment of his/her ability to perform each task was scored on a four point scale. Scores were averaged to create an overall index of visual disability, as well as subscale indices for mobility related disability, distance/lighting/reading related disability, and near and related tasks visual disability. The questionnaire, administered verbally is entitled "The Visual Disability Assessment (VDA)". Reliability testing included test-retest reliability, interobserver reliability (p, the intraclass correlation coefficient), and internal consistency reliability (Cronbach's alpha). Construct validation, the process for proving that a test measures what it is supposed to measure, included consideration of content validity, comparison with the established Activities of Daily Vision Scale (ADVS) and empirical support with factor analysis. RESULTS: For the four indices, interobserver reliability varied from 0.92 to 0.94, test-retest reliability varied from 0.96 to 0.98, and internal consistency reliability varied from 0.80 to 0.93. The VDA compared favourably with the ADVS by correlation, but Bland-Altman analysis demonstrated that the two instruments were not clinically interchangeable. Factor analysis suggests that all test items measure a common theme, and the subgroupings reflect common themes. CONCLUSIONS: The VDA is easy to administer because it has a short test time and scoring is straightforward. It has excellent interobserver, test-retest, and internal consistency reliability, and compares favourably with the ADVS, another test of visual disability. Factor analysis demonstrated that the 18 items measure a related theme, which can be assumed to be visual disability. The VDA is a valid instrument which provides a comprehensive assessment of visual disability in cataract patients and is designed to detect changes within a patient over time.

Activities of Daily Living↗
PubMedDate not supplied

Prevalence of remediable disability due to low vision among institutionalised elderly people.

BACKGROUND: Prevalence of remediable visual disability among institutionalised elderly people, resulting from inappropriate use or non-use of low-vision aids, is reported to be high, but largely rests on anecdotal evidence. OBJECTIVE: To estimate the prevalence of binocular low vision and underlying eye diseases among institutionalised elderly people in a Dutch urban population and the size of remediable visual disability as the result of inappropriately corrected low vision. METHODS: The design was a cross-sectional survey of 284 subjects with low vision (corrected binocular vision <0.4) in nursing homes and homes for the elderly in the Netherlands. RESULTS: 284 of 610 eligible residents were examined. The prevalence of binocular low vision was 31.3%. Among elderly residents with low vision, prevalence of cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy was 77.9, 37.7, 5.2 and 5.2%, respectively. In 32 residents (41.6%), (non)-use of low-vision aids was considered inappropriate. In 50 residents (64.9%), visual disability was considered at least partially remediable, either through better use of low-vision aids, or through cataract extraction. Residents who were not optimally corrected for low vision were significantly more functionally impaired compared with their peers who were optimally corrected. CONCLUSION: Low vision is likely to be highly prevalent among institutionalised elderly. A significant amount of the associated visual disability may be remediable.

Aged↗
PubMed2006

Cortical visual impairment in children.

PURPOSE OF REVIEW: Cortical visual impairment is rapidly becoming a leading cause of visual loss in children in developed countries predominately because of the improved survival rates of premature infants over the past decade. RECENT FINDINGS: Most cases of cortical visual impairment arise from hypoxic ischemic injury to watershed areas of the brain. In the preterm infant the watershed areas are in the subcortex around the ventricles, while in the term infant the watershed areas are between the major arteries with injury to the subcortex and cortex. Therefore, preterm and term injury will manifest different ocular and visual system abnormalities as a result of this damage. Cognitive visual dysfunction, a type of cortical visual impairment, may occur in cases of damage to the peristriate cortex (association areas of the brain). The anterior visual pathways may also be damaged in a retrograde, transsynaptic fashion in cases of cortical visual impairment. SUMMARY: Cortical visual impairment is a prevalent cause of visual loss in children. It encompasses a wide range of visual disabilities from no light reception to normal visual acuity with cognitive visual dysfunction.

Blindness, Cortical↗
PubMed2004

Causes and prevalence of visual impairment among adults in the United States.

OBJECTIVES: To estimate the cause-specific prevalence and distribution of blindness and low vision in the United States by age, race/ethnicity, and gender, and to estimate the change in these prevalence figures over the next 20 years. METHODS: Summary prevalence estimates of blindness (both according to the US definition of < or =6/60 [< or =20/200] best-corrected visual acuity in the better-seeing eye and the World Health Organization standard of < 6/120 [< 20/400]) and low vision (< 6/12 [< 20/40] best-corrected vision in the better-seeing eye) were prepared separately for black, Hispanic, and white persons in 5-year age intervals starting at 40 years. The estimated prevalences were based on recent population-based studies in the United States, Australia, and Europe. These estimates were applied to 2000 US Census data, and to projected US population figures for 2020, to estimate the number of Americans with visual impairment. Cause-specific prevalences of blindness and low vision were also estimated for the different racial/ethnic groups. RESULTS: Based on demographics from the 2000 US Census, an estimated 937 000 (0.78%) Americans older than 40 years were blind (US definition). An additional 2.4 million Americans (1.98%) had low vision. The leading cause of blindness among white persons was age-related macular degeneration (54.4% of the cases), while among black persons, cataract and glaucoma accounted for more than 60% of blindness. Cataract was the leading cause of low vision, responsible for approximately 50% of bilateral vision worse than 6/12 (20/40) among white, black, and Hispanic persons. The number of blind persons in the US is projected to increase by 70% to 1.6 million by 2020, with a similar rise projected for low vision. CONCLUSIONS: Blindness or low vision affects approximately 1 in 28 Americans older than 40 years. The specific causes of visual impairment, and especially blindness, vary greatly by race/ethnicity. The prevalence of visual disabilities will increase markedly during the next 20 years, owing largely to the aging of the US population.

Adult↗
PubMed2001

The association of multiple visual impairments with self-reported visual disability: SEE project.

PURPOSE: This report examines the relationship between psychophysical measures of visual impairment and self-reported difficulty with everyday visual tasks in a population-based sample of individuals 65 years of age and older. METHODS: Community-dwelling residents (n = 2520) of Salisbury, MD, between the ages of 65 and 84 were recruited for the study. Visual acuity under normal and low luminance, contrast and glare sensitivity, stereoacuity, and visual fields were measured. Subjective physical disability was assessed with the Activities of Daily Vision Scale (ADVS). RESULTS: In multiple regression analyses adjusted for demographic factors, cognitive status, depression, and number of comorbid medical conditions, each of the vision tests except low luminance acuity was independently associated with lower ADVS scores. The analyses indicate that a factor of 2 reduction in visual acuity or contrast sensitivity, comparable with that observed in mild to moderate lens opacity, was associated with a three- to fivefold odds of reporting difficulty with daily tasks. Although age alone was a significant risk factor for disability, it was not associated with overall ADVS score, once visual impairment and other chronic medical conditions were taken into account. CONCLUSIONS: Visual acuity, contrast and glare sensitivity, stereoacuity, and visual fields are significant independent risk factors for self-reported visual disability in an older population. Visual impairment defined by acuity alone is not the only dimension of the association with subjective disability. Additional vision measures are required to understand the impact of vision loss on everyday life.

Activities of Daily Living↗
PubMed2006

Prevalence of visual impairment in relation to the number of ophthalmologists in a given area: a nationwide approach.

BACKGROUND: Sociological and economic risk factors of visual impairment have never been described in France at a national level as the association between the number of ophthalmologists per inhabitant and visual impairment prevalence. METHODS: Two national surveys were pooled. First, 2075 institutions were selected at random from the French Health Ministry files. Second, a random, stratified sample of 356,208 citizens living in the community was selected. Blindness and low vision (LV) prevalence rates were estimated by age and gender. Geographical equities were estimated by logistic regression adjusted on age and occupational category. The association between ophthalmologist density and visual impairment prevalence rate was estimated per region. Interviews were completed with 14,603 (94.9%) of 15,403 randomly selected subjects in institutions, and 16,945 (77.8%) of 21,760 randomly selected subjects in the community. Three groups were defined from the interviews: low vision, blind, and control. RESULTS: Prevalence rates were LV 2.08% and blindness 0.12%. Both rates increased exponentially with age. No major difference was found with gender. Injury was the declared reason for both LV (12%) and blindness (12%). Large regional differences in prevalence persisted for LV after adjustment on age and occupation (ORs: 0.35 to 2.10), but not for blindness. Regions with ophthalmologists below the national per capita average were usually those with higher LV prevalence. CONCLUSION: An inverse correlation was found between ophthalmologist number and LV prevalence rates for subjects of similar age and socio-professional category. This denoted possible inequity in the provision of healthcare.

Activities of Daily Living↗
PubMedDate not supplied

Attitudes of dentists, working in Riyadh, toward people with a sensory impairment.

This study was conducted to determine the attitudes of dentists, working in Riyadh, toward people with a sensory impairment (SI), according to the Scale of Attitude Towards Disabled Persons (SADP). The SADP scale was modified to focus solely upon sensory impairment. The modified scale was pre-tested and then incorporated into a self-administered questionnaire. This was then administered to 600 dentists (response rate, 73.7%) working in the city of Riyadh, Saudi Arabia. The modified scale showed itself to be reliable, with a Chronbach's coefficient alpha 0.616 and four-factor analysis, which accounted for 38.5% of the variance. Ninety-four percent of the dentists were generally positive toward SI in the society. There were, however, significant variations in attitudes, with a more positive score for dentists who had worked for 30 years or more (p < 0.005), were specialists (p < 0.005), received little or no undergraduate training in this subject (p < 0.05), and who received their undergraduate training in Europe/North America (p < 0.001). However, in a stepwise regression model, all these variables were significant except for the years of practice. The modified SADP showed dentists, working in Saudi Arabia, having a positive attitude toward people with SI.

Adult↗
PubMed1998

Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire: results from focus groups with visually impaired persons.

OBJECTIVE: To identify the content area for a questionnaire designed to measure vision-targeted health-related quality of life and to determine whether problems with vision-related functioning are qualitatively similar across different common eye diseases. DESIGN: Twenty-six condition-specific focus groups were conducted with 246 patients from 5 geographic regions to identify the content area for a questionnaire for use among persons with diabetic retinopathy, glaucoma, macular degeneration, cytomegalovirus retinitis, and cataract. A standard protocol was used to structure each focus group discussion. Sessions were audiotaped, transcribed, and coded in preparation for a content analysis. SETTINGS: Five university-based ophthalmology practices and 1 nonprofit eye care foundation. PARTICIPANTS: Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. All eligible persons were older than 21 years, spoke English, and had sufficient cognitive function to provide informed consent. RESULTS: Among the 246 participants, 2623 problems with vision-related functioning were mentioned. The mean number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for persons with glaucoma. For the sample overall, reading problems were mentioned most frequently, followed by driving, general problems with seeing clearly, and mental health complaints caused by vision. Although the proportion of persons who reported each problem varied by condition, at least some persons with each eye disease reported each problem. The 3 most common descriptors associated with each problem were difficulty or ease of performance (13%), psychological distress associated with performance of the activity (11%), and complete inability to participate in a visual activity (11%). CONCLUSION: An item-generation strategy for a new questionnaire using a standardized focus group method identified content areas and aspects of visual disability that are not included in currently available vision-specific instruments that assess the impact of common eye diseases on visual functioning in every-day life. Although participants mentioned problems that were unique to their disease, across conditions the problems mentioned were similar. These findings provide empirical evidence of content validity for a vision-targeted, health-related quality-of-life survey designed for use across conditions.

Adult↗