Search

Match-related performance analysis in judo Para athletes with visual impairments is important to coaches and staff to identify technical–tactical profiles of their athletes and opponents but also to identify whether there are similar characteristics in each visual class. Thus, this study explores the match-related performance in judo Para athletes and verifies the relationship between performance using the old and new classification systems. The match-derived variables were analyzed using different statistical methods considering a total of 182 matches from the Tokyo 2020 Paralympic Games. The results indicated that performance was affected by sex and degree of impairment. The new classification system seems suitable for grouping Para judo athletes, as it differentiates performance between the two proposed classes (J1 and J2), since athletes from each group compete separately. Furthermore, different variability index measures were correlated with competitive performance, demonstrating a specific performance profile for each sport class in judo. [ABSTRACT FROM AUTHOR]

This study evaluated physical activity interventions designed for individuals with visual impairments and sought to guide health intervention scientists aiming to promote physical activity in this demographic. We delved into the specifics of participants' visual impairments, intervention features, accommodation approaches, and replicability prospects. The search spanned four databases, namely PubMed, CINAHL, SportDiscus, and Scopus, providing a wide scope and diversity of potential studies. There were no restrictions on publication years. We reviewed 13 studies, totaling 15 interventions. A consensus on visual-impairment definitions remains elusive, and the intervention dosages displayed variability. Notably, 66.7% (n = 7) integrated behavior-change techniques to amplify physical activity levels. Multiple studies employed audio descriptions as an accommodation method. While most studies provided adequate information for potential replication, detailed study protocols were frequently absent. It is essential for developed interventions to be persistently evaluated and fine-tuned to optimize results. [ABSTRACT FROM AUTHOR]

In this paper, we analyze the subjective inclusion experiences of visually impaired (VI) adult tennis players from an ableism-critical perspective. The primary focus of this research is the inclusive potential of blind tennis from the perspective of VI individuals. Episodic interviews were conducted to capture subjective perspectives. A qualitative text analysis revealed that the interviewees were confronted with multiple ability assumptions by sighted people in their everyday lives. Deficit notions on the performance of VI people included sports, work, and general activities. Participation in blind tennis helped the interviewees build a "competent identity" and acquire various skills useful for their everyday lives as participation in blind tennis was a pathway for competence in sports. Further research is needed to identify exclusion experiences from the perspective of disabled people to recognize the potential of different sports in reducing barriers to participation. [ABSTRACT FROM AUTHOR]

Being visually impaired or legally blind (having vision that is uncorrectable or cannot be corrected to a legally acceptable level) is inherently uncertain. Although uncertainty can result in positive, negative, or neutral consequences, little is known about how uncertainty is experienced and negotiated in this understudied population. Thus, through in-depth, semi-structured interviews of 24 individuals with a visual impairment, we apply uncertainty management theory (UMT) to examine the communication strategies visually impaired individuals used to manage the personal, vision-related, and social uncertainty they experienced. Many participants appraised the uncertainty negatively and consequently aimed to reduce it by seeking social support and information, using instrumental strategies, and proactively disclosing their visual impairment. Interviewees who preferred to remain uncertain maintained it by avoiding thinking about their visual impairment or worsening vision and/or by concealing their low vision and passing as sighted. Last, some participants, particularly those who were born with low vision or had been visually impaired longer, learned to adapt to the uncertainty through reframing and accepting, self-care, and by turning to God. The study also uncovered that some participants' uncertainty management was limited by ableist constraints, such as inadequate support systems, systemic barriers, and stigma. The study also underscores the universal and fluid nature of uncertainty and uncovers tangible ways individuals with visual impairment can navigate uncertainty within a pervasive cultural biomedical model of disability. [ABSTRACT FROM AUTHOR]

Background: Glaucoma, characterized by a high incidence and significant ocular harm, has been elucidated through various mechanisms. Excessive autophagy leading to the loss of retinal ganglion cells (RGCs) is suggested as one potential cause for visual impairment in glaucoma. Methods: A glaucoma model was established through anterior chamber injection of silicone oil in mice. RTA408 and the positive control tafluprost were administered for intervention. The efficacy was preliminarily assessed by intraocular pressure measurement. HE staining and fluorescent staining were used to assess RGC loss, while fluorescent staining and western blot were employed to evaluate the expression of Nrf2. The role of autophagy in the pathogenesis of glaucoma was investigated by artificially modulating autophagy levels. Results: In glaucomatous mice, RTA408 significantly reduces the apoptosis levels of RGCs and decreases RGC loss. Further investigations reveal a notable upregulation of autophagy levels in glaucomatous mice, with RGC loss being associated with autophagy. RTA408 promotes the expression of Nrf2 and downstream antioxidant molecules, enhancing the antioxidant system while downregulating mitochondrial autophagy levels. This reduces RGC apoptosis and loss, demonstrating a protective effect against glaucoma. Conclusion: Autophagy mediates the occurrence of glaucoma in mice, promoting RGC apoptosis. RTA408 alleviates RGCs damage by inhibiting excessive autophagy in the context of glaucoma. [ABSTRACT FROM AUTHOR]

Moving is an integral part of everyday life and applies to accessing the workplace, attending a health centre or meeting friends. Determination of the source of sound may be important when a visually impaired person is moving around. This allows to navigate, but also provides important information about potential danger. Sound exercises have been prepared to support the ability to recognize the direction of sound and to learn about the problems associated with it. The research version of the app was prepared covering 12 situations related to three static and nine dynamic sources of sounds. All 10 participants in the exercises had a significant degree of visual impairment. An extended dataset obtained from three subjects without disabilities was also included. As a result, six exercises qualified for the final set of sound exercises, which allow to gain benefits from their implementation. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) methods attempt to simulate the behavior and the neural activity of the brain. In particular, Convolutional Neural Networks (CNNs) offer state-of-the-art models of the ventral visual stream. Furthermore, no proposed model estimates the distance between objects as a function of the dorsal stream. In this paper, we present a quantitatively accurate model for the visual system. Specifically, we propose a VeDo-Net model that comprises both ventral and dorsal branches. As in the ventral visual stream, our model recognizes objects. The model also locates and estimates the distance between objects as a spatial relationship task performed by the dorsal stream. One application of the proposed model is in the simulation of visual impairments. In this study, however, we show how the proposed model can simulate the occurrence of dorsal stream impairments such as Autism Spectrum Disorder (ASD) and cerebral visual impairment (CVI). In the end, we explore the impacts of learning on the recovery of the synaptic disruptions of the dorsal visual stream. Results indicated a direct relationship between the positive and negative changes in the weights of the dorsal stream's last layers and the output of the dorsal stream under an allocentric situation. Our results also demonstrate that visual–spatial perception impairments in ASD may be caused by a disturbance in the last layers of the dorsal stream. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies show inconsistent links between hearing/vision impairment and dementia risk. Using multisource data, we investigated how single or combined sensory impairments relate to risks of all-cause and specific types of dementia. Methods: We employed a triangulation approach combining three methodologies. We analyzed 90,893 UK Biobank (UKB) adults to explore single and joint effects of hearing and vision impairments on all-cause and Alzheimer's disease (AD), vascular dementia (VD) and non-AD non-VD (NAVD). A meta-analysis of prospective studies involving 937,908 participants provided stronger evidence. Finally, we conducted Mendelian randomization (MR) analysis using genome-wide association studies from UKB (361,194 participants) and FinnGen (412,181 participants) to validate relationships between sensory impairments and dementia occurrence. Results: In the UKB cohort study, compared to participants with normal hearing, those in the mild and severe hearing impairment groups had progressively and significantly higher risk of all-cause dementia (mild: HR1.52, 95%CI 1.31–1.77; severe: HR1.80, 95%CI 1.36–2.38), AD (mild: HR1.63, 95%CI 1.30–2.04; severe: HR2.18, 95%CI 1.45–3.27), VD (mild: HR1.68, 95%CI 1.19–2.37; severe: HR1.47, 95%CI 1.22–1.78), and NAVD (mild: HR1.47, 95%CI 1.22–1.78; severe: HR1.98, 95%CI 1.43–2.75). Besides, vision impairment was associated with an increased risk of all-cause dementia (HR1.55, 95%CI 1.18–2.04) and NAVD (HR1.51, 95%CI 1.07–2.13). Furthermore, dual sensory impairment was associated with stepwise increased risks of all-cause and cause-specific dementia than single hearing or vision impairment. In the meta-analysis of 31 prospective cohort studies, risks of all-cause dementia and AD were elevated in participants with single hearing impairment (all-cause dementia: HR1.30, 95%CI 1.21–1.40; AD: HR1.30, 95%CI 1.21–1.40) and dual sensory impairment (all-cause dementia: HR1.63, 95%CI1.14–2.12; AD: HR 2.55, 95%CI 1.19–3.91), while single vision impairment only associated with higher risk of all-cause dementia (HR1.43, 95%CI 1.16–1.71) but not AD. Finally, the MR analysis revealed a significant association between hearing impairment and all-cause dementia (OR1.74, 95%CI 1.01–2.99), AD (OR1.56, 95%CI 1.09–2.23), and NAVD (OR1.14, 1.02–1.26), as well as vision impairment and NAVD (OR1.62, 95%CI 1.13–2.33). Conclusions: Our findings showed significant associations between hearing and vision impairments and increased risks of all-cause and cause-specific dementia. Standardized hearing and vision assessment and intervention should be emphasized in dementia prevention strategies. [ABSTRACT FROM AUTHOR]

Elderly and vision-impaired indoor activity monitoring uses sensor technology to monitor interaction and movement in the living area. This system can identify deviations from regular patterns, provide alerts, and ensure safety in case of emergencies or potential risks. These solutions enhance quality of life by promoting independent living while offering peace of mind to loved ones and caregivers. Visual impairments have become the chief part of these problems over the past few years. Usually, visually impaired people seek help from others to keep doing their daily tasks. An automated human activity recognition (HAR) technique could enhance a vision-impaired person’s transaction activity and safe movement. HAR using deep learning (DL) includes training neural networks to automatically detect and classify various activities carried out by humans based on sensor information. By leveraging DL approaches, the HAR system could accurately identify and classify activities, including sitting, standing, walking, or running, from the information captured by sensors or wearable devices. This system is integral to smart home automation, healthcare, and sports analytics. This study develops an Automated Fractal Quantum Salp Swarm Algorithm with Machine Learning based HAR (QSSA-MLHAR) for assisting elderly and visually impaired people. The QSSA-MLHAR technique uses sensory input data to identify human activities in diverse classes. In the QSSA-MLHAR technique, the min–max scalar is primarily used to scale the input data. Besides, the QSSA-MLHAR technique applies a mixed extreme learning machine (M-ELM) model to classify various human actions. The QSSA-based hyperparameter tuning process is used to improve the detection results of the M-ELM system. A wide range of simulations was performed to ensure the better performance of the QSSA-MLHAR method. The comprehensive outcomes assured that the QSSA-MLHAR technique performs well compared to other models. [ABSTRACT FROM AUTHOR]

Objective: High myopia is a significant risk factor for irreversible vision loss and can occur in isolation or as a component of various syndromes. However, the genetic basis of early-onset high myopia remains poorly understood. We aimed to identify the causative genetic variants for high myopia in a cohort of Slovenian children. Methods: The study included children referred to a tertiary paediatric ophthalmology centre at the University Eye Clinic in Ljubljana between 2010 and 2022. The participants met the following inclusion criteria: age ≤ 15 years and high myopia ≤-5.0 D before the age of 10 years. Genetic analysis included exome sequencing and/or molecular karyotyping. Participants were categorized based on clinical presentation: high myopia with systemic involvement, high myopia with ocular involvement, and isolated high myopia. Results: Genetic analysis of 36 probands revealed a genetic cause of high myopia in 22 (61.1%) children. Among those with systemic involvement (50.0%), genetic causes were identified in 13 out of 18 children, with Stickler's and Pitt-Hopkins being the most common syndromes. Among cases of high myopia with ocular involvement (38.9%), a genetic cause was found in 8 out of 14 probands, including (likely) pathogenic variants in genes related to retinal dystrophies (CACNA1F, RPGR, RP2, NDP). The non-syndromic ARR3- associated high myopia was identified in the isolated high myopia group. Conclusions: A genetic cause of high myopia was identified in 61.1% of children tested, demonstrating the value of genetic testing in this population for diagnosis and proactive counseling. [ABSTRACT FROM AUTHOR]

Many studies have attempted to identify the root cause of dyslexia. Different theories of dyslexia have proposed either a phonological, attentional, or visual deficit. While research has used eye‐tracking to study dyslexia, only two previous studies have used the moving‐window paradigm to explore the perceptual span in dyslexic reading, and none have done so in visual search. The present study analysed the perceptual span using both reading and visual search tasks to identify language‐independent attentional impairments in dyslexics. We found equivocal evidence that the perceptual span was impaired in dyslexic reading and no evidence of impairment in visual search. However, dyslexic participants did show deficits in the visual search task, with lower search accuracy and shorter saccades compared with controls. These results lend support for a visual, rather than attentional or phonological, account of dyslexia. [ABSTRACT FROM AUTHOR]

Different studies have tried to establish a relationship between dyslexia and the vestibular system function. Subjective Visual Vertical/Horizontal (SVV and SVH) and Video Head Impulse Test (VHIT) are useful for studying the vestibular system and can be easily performed in children. Our aim was to evaluate the vestibular function in dyslexic children by SVV/SVH and VHIT. We enrolled 18 dyslexic children (10M/8F; mean age 10.7 ± 2.3 years; range 7–14 years) and 18 age‐matched children with typical development of learning abilities. All children performed VHIT, SVV and SVH. We found normal gain and symmetry of vestibulo‐ocular‐reflex both in dyslexic and typically developing children. Fifteen out of 18 dyslexic children (83.3%) showed a difference of at least one amongst SVV or SVH. The mean value of SVV was 2.3° and the mean value of SVH was 2.6°. Statistical analysis showed a significant difference between typically developing and dyslexic children for both SVV and SVH. We confirm a relationship between dyslexia and the alteration of SVV and SVH. Our results could be related to the pathogenetic hypothesis of a visual processing impairment related to a dysfunction of the magnocellular pathway or to a general deficit related to a multimodal cortical network. [ABSTRACT FROM AUTHOR]

Background: Computerised static visual field testing using dedicated machines such as the Humphrey Field Analyzer (HFA) can assess and track changes in visual field sensitivity. The use of retrospective visual field databases is a novel undertaking, with no studies published utilising large scale population‐level data. This study phase developed a method to extract HFA data into a large standardised population‐based database including point sensitivity data with additional derived variables. Methods: Retrospective, longitudinal, population study of visual field data from people who attended an ophthalmology service and had a HFA field test, in Western Australia, between 1988 and 2022. Raw test data included patient demographic fields, sensitivity readings and test parameters. Calculated fields included reliability scores, and a novel combined reliability score. Results: There were 606 230 tests for 92 215 study individuals, from 22 ophthalmology practices in metropolitan Perth and three public hospital eye clinics, representing around 85% of the field tests performed by ophthalmologists each year. Raw sensitivity values were available for all tests, and additional descriptors were available for most tests (97.5%–100% of tests) with the exception of data variables retired by the manufacturer. Conclusions: Visual field data from 606 230 tests were collated into a single dataset, which is highly representative over a long period of time, for a defined population. This dataset has been linked to other administrative datasets to allow for epidemiological investigation of field of vision disorders. [ABSTRACT FROM AUTHOR]

Retinitis pigmentosa (RP) is an inherited eye disease that causes progressive vision loss. Microglial activation and inflammation play essential roles in photoreceptor degeneration in RP, although the underlying mechanisms remain unclear. Here, we examined the progressive degeneration of photoreceptors in rd1 mice, a mouse model of RP. We investigated the molecular changes in various retinal cells in rd1 mice using single‐cell RNA sequencing and found that potentiation of JNK signaling is associated with photoreceptor degeneration in RP. Moreover, inflammation‐related molecules, which function downstream of JNK, are elevated in RP. Furthermore, inhibiting JNK alleviates microglial activation and rescues photoreceptor degeneration in rd1 mice. Thus, our findings suggest that targeting JNK is a promising approach for slowing RP progression. [ABSTRACT FROM AUTHOR]

Background: The Developmental Origins of Health and Disease Hypothesis (DOHaD) suggests prenatal alcohol exposure (PAE) should have implications for adult physical and mental health. Since the health profile of older adults with PAE and diagnoses of fetal alcohol spectrum disorder (FASD) is unknown, the current study evaluates self‐reported health problems of midlife adults with and without a history of PAE to describe these outcomes. Methods: Participants (N = 357) recruited from longitudinal cohorts in Atlanta, GA and Seattle, WA completed a health survey assessing a range of physical conditions. Initial analysis compared the frequency of conditions between alcohol‐exposed and nonexposed groups. To identify patterns within groups, 10 problem areas were subjected to latent class analysis (LCA). Finally, the direct effect of PAE on health outcomes was evaluated using multilevel modeling, controlling for effects of other factors. Results: Compared with unexposed controls, individuals with PAE reported significantly higher frequencies of problems with hearing, dentition, heart, cancer, gastritis, kidney stones, bladder, diabetes, thyroid, skin, and seizures. LCA found that controls yielded two classes, with 45% reporting sleep and vision problems and 55% reporting sleep, vision, cardiovascular, endocrine, immune, and dental problems. The PAE group yielded three classes, with 13% endorsing few health problems, 43% reporting sleep, vision, immune, and dental problems, and 43% reporting sleep, vision, cardiovascular, urinary, endocrine, skin, immune, dental, and gastrointestinal problems. With multivariate analysis, controlling for other influences, PAE was associated directly with hearing, urinary, dental, and gastrointestinal problems. A similar pattern was found for alcohol‐exposed individuals who did and did not meet criteria for fetal alcohol syndrome (FAS). Discussion: Patients affected by alcohol may report greater frequency and range of health adversity. That PAE was only uniquely associated with a limited set of problems suggests that many health outcomes in midlife result from an initial vulnerability potentiated by postnatal stress resulting from other associated factors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Meibomian gland dysfunction (MGD) and dry eye syndrome (DES) are common eye diseases characterized by altered tear film stability and inflammation of the ocular surface, causing significant discomfort and possible visual impairment. This study aimed to investigate the efficacy of curcumin-loaded liposomes (Lipo@Cur) compared to cyclosporine A-loaded liposomes (Lipo@CycA) in experimental rabbit models of MGD and DES, with a focus on their ability to improve tear film stability and reduce ocular surface inflammation. Methods: MGD and DES were induced using complete Freund's adjuvant (CFA) and treated to evaluate the effect of liposomal formulations on tear break-up time (TBUT), clinical signs of inflammation (telangiectasia, conjunctival hyperemia, meibomian foramen occlusion), and corneal as well as conjunctival histological cells. Results: Lipo@Cur increased TBUT and reduced the signs of ocular surface inflammation, potentially approaching the effectiveness of clinically approved cyclosporine A encapsulated in liposomes (Lipo@CycA). Histological analysis suggested improvements in corneal epithelial thickness and goblet cell density in the treated groups, which may indicate a reversal of DES-induced damage to the ocular surface. Conclusions: Plant-originated curcumin encapsulated in liposomes offers a promising therapeutic strategy for the management of MGD and DES that may improve patient outcomes by addressing the underlying inflammatory mechanisms of these conditions. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to investigate the prevalence of macular complications detected by spectral-domain optical coherence tomography (SD-OCT) in a large Caucasian cohort of RP patients, highlight the major alterations in chorioretinal structure, and compare the macular structural changes in eyes affected by retinal dystrophies with those in healthy controls. Methods: This was an observational, retrospective, and cross-sectional study. Three hundred and seven patients with RP were consecutively enrolled and underwent clinical assessment. In particular, SD-OCT images were used to ascertain the morphology of the posterior pole of patients with RP by evaluating the residual ellipsoid zone (EZ), the volume and thickness of the outer nuclear layer (ONLT), and subfoveal choroid thickness (SCT). At the same time, the pathological finding that the patients' vision was reduced under treatment was analyzed. Results: A total of 436 eyes of 218 patients with RP were studied. Considering all of the eyes studied, 103 had cystoid macular edema (CME) (23.62%), 123 (28.21%) had vitreomacular traction (VMT), and 199 (45.75%) had epiretinal membranes (ERMs). There were also 12 (2.75%) cases of lamellar macular holes (LMHs), of which 3 (1.38% of all patients) cases were bilateral. Only 137 eyes (31.42%) did not have the above-mentioned alterations. SCT was significantly reduced compared to that of the control group (193.03 µm ± 67.90 SD vs. 295 µm ± 69.04 SD), while the foveal central macular thickness (FCMT) was greater (270.91 μm ± 74.04 SD vs. 221 µm ± 37.25 SD). Conclusions: This research highlights the high incidence of macular complications. The results of our study indicate the importance of regular monitoring of RP patients and early intervention to avoid further complications in this group of subjects with severe visual field impairment to avoid further central vision loss. [ABSTRACT FROM AUTHOR]

Background/Objectives: Neuroretinitis (NR) is a rare inflammatory condition characterized by sudden vision loss, optic disc edema and macular star appearance predominantly affecting individuals in their third and fourth decades of life. Methods: This paper describes the case of 33-year-old Caucasian man with no significant medical history complaining of decreased vision for about a week. Results: The ophthalmological exam revealed best-corrected visual acuity (BCVA) for the right eye (RE) of 0.8 (decimal notation) and of 0.9 for the left eye (LE). Intraocular pressure (IOP) was 20 mmHg in RE and 18 mmHg in LE. Slit-lamp examination of both eyes (OU) showed no evidence of intraocular inflammation in the anterior chamber or vitreous cavity. Examination of the posterior pole of the right eye showed bilateral papilledema with an incomplete macular fan pattern. Conclusions: Despite extensive laboratory tests, including serologic and imaging investigations, a definitive etiology remained unclear. It is very important to differentiate NR from other optic nerve disorders, requiring careful clinical evaluation and observation of the evolution of symptoms. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Ankle sprains are highly common and can lead to chronic ankle instability (CAI). Individuals with CAI have a variety of sensorimotor impairments including poor postural control and altered sensory organization strategies. Visual occlusion modalities, if worn during neuromuscular control exercises, may facilitate greater postural control gains and a more appropriate sensory organization strategy. However, a cumulative review of the ability of visual occlusion modalities (e.g., stroboscopic goggles) to impair postural control and thus demonstrate the potential to facilitate greater postural gains has not yet been completed. Clinical Question: Does stroboscopic vision impair postural control in those with and without CAI, and if so, is the impairment comparable between the groups? Summary of Key Findings: Regardless of how postural control was assessed, stroboscopic vision impaired postural control relative to an eyes open (i.e., no goggles) condition. All studies demonstrated that those with and without CAI were impacted equally. Stroboscopic vision resulted in postural control impairments comparable to an eyes closed in some but not all studies. Clinical Bottom Line: Stroboscopic vision impairs postural control in both those with CAI and uninjured controls. Strength of Recommendation: There is moderate-quality evidence (Grade B) that stroboscopic vision impairs postural control in those with CAI and uninjured controls. [ABSTRACT FROM AUTHOR]

Objective: To conduct a retrospective cross‐sectional multicenter study to validate the relationships between migraine‐associated symptoms. Background: Symptoms associated with headache—photophobia and phonophobia, nausea, and/or vomiting—are required criteria for migraine diagnosis based on the International Classification of Headache Disorders‐Third Edition (ICHD‐3). However, individuals with migraine report high rates of other symptoms (e.g., lightheadedness, difficulty thinking). We recently completed a single‐center study assessing the relationships between an expanded set of migraine‐associated symptoms. Methods: A pre‐registered cross‐sectional multicenter retrospective analysis was conducted on standardized questionnaire data of youth ages 6–17 years from two headache registries at pediatric tertiary care centers. Cluster Analysis of Migraine‐associated Symptoms (CAMS) was implemented to assess associations between 11 migraine‐associated symptoms. We explored differences between the two centers, and how CAMS was associated with demographics, including sex and age, and headache burden. Results: There were 10,721 participants who were 66.5% female and had a median (interquartile range) age of 13 (10–15) years. The first three CAMS dimensions accounted for 46.5% of the variance and were consistent across sites. The first dimension indicated those reporting any migraine‐associated symptoms were likely to report multiple. The second dimension separated symptoms into those included in ICHD‐3 migraine diagnostic criteria and non‐ICHD symptoms (e.g., lightheadedness, difficulty thinking). The third dimension separated sensory hypersensitivity and vestibular symptoms. An abundance of migraine‐associated symptoms correlated with greater headache severity (Spearman's ρ = 0.18, 95% confidence interval [CI] 0.17–0.20; small effect size) and disability (ρ = 0.26, 95% CI 0.25–0.28; small effect size). We also observed differences in associated symptoms across age and sex. Discussion: Associations between an expanded set of migraine‐associated symptoms are informative for headache burden and reveal intriguing changes across child development and sex. We were able to replicate findings across two centers, indicating that these symptom clusters are inherent to migraine. Plain Language Summary: The presence of symptoms such as light or sound sensitivity, nausea, and vomiting can help clinicians differentiate between migraine and other headache disorders, such as tension‐type headache. However, people with migraine commonly experience symptoms that are not part of migraine diagnostic criteria per the International Classification for Headache Disorders‐Third Edition criteria, including lightheadedness, vision changes, and vertigo. In this study, we found that by considering these other associated symptoms, we were able to better understand the burden of headache in children and adolescents; e.g., we found that having more associated symptoms was associated with more headache severity and greater headache impact in children and teenagers. [ABSTRACT FROM AUTHOR]

Objectives: We used Cluster Analysis of Migraine‐associated Symptoms (CAMS) to critically evaluate current International Classification of Headache Disorders‐Third Edition (ICHD‐3) migraine‐associated symptoms criteria. Background: Diagnostic criteria play a central role in guiding clinical trial inclusion, and therefore available treatments. Migraine and tension‐type headaches (TTH) are differentiated in ICHD‐3 by many headache characteristics, including associated symptoms. A diagnosis of probable migraine indicates some but not all features of migraine are met. Photophobia and phonophobia, or nausea and/or vomiting, are required to meet a diagnosis of migraine; however, CAMS—a model that describes associated symptoms across youth with headache—indicates that a broader range of symptoms contain information about migraine burden. Methods: In this multisite retrospective cross‐sectional study, we evaluated ICHD‐3 migraine criteria. Youth aged 6–17 years with migraine (including probable migraine) or TTH were included in the analysis. We used CAMS to evaluate the migraine‐associated symptom criterion. With CAMS as a guide, we evaluated how changes to the migraine‐associated symptom criterion altered who met the diagnosis of migraine. Results: Of the 9017 participants included in this study, 66.7% were female and had a median (interquartile range) age of 13 (10–15) years. Most participants had migraine or probable migraine (99.0%), and the remainder had TTH (1.0%). A sizable percentage (10.1%) of youth under the umbrella diagnosis of migraine were diagnosed with probable migraine because they did not meet migraine‐associated symptom criterion D; however, many in this group reported several non‐ICHD migraine‐associated symptoms. We explored alterations to criterion D based on CAMS. Allowing for photophobia or phonophobia re‐categorized 55.6% of youth as having migraine, though some only had one symptom. Including lightheadedness or lightheadedness and spinning re‐categorized 19.7% and 25.8% of youth with migraine, respectively, but all of those who were re‐categorized had at least two migraine‐associated symptoms. Conclusion: The ICHD‐3 captures the most prevalent migraine‐associated symptoms; however, many youths with probable migraine who do not meet full criteria due to insufficient associated symptoms nonetheless experience multiple non‐ICHD migraine‐associated symptoms. Changes to criterion D should be considered for the ICHD‐4. Plain Language Summary: For clinicians to make a diagnosis of migraine based on International Classification of Headache Disorders‐Third Edition (ICHD‐3) criteria, patients must have headache‐associated nausea, vomiting, or light and sound sensitivity (criterion D). However, migraine can also be associated with other symptoms like lightheadedness, difficulties with thinking, and vertigo. In this study of youth aged 6–17 years with migraine, probable migraine, or tension‐type headache, we looked at how altering the ICHD‐3 criterion D changed participants' diagnosis based on their symptoms; overall, our results suggest that the next version of ICHD should account for the fact that many youth who do not experience nausea, vomiting, or light and sound sensitivities still experience manyx other migraine associated symptoms. [ABSTRACT FROM AUTHOR]

Objective: To determine sex differences in clinical profiles and treatment outcomes in patients with spontaneous intracranial hypotension. Background: Spontaneous intracranial hypotension is associated with considerable functional disability and potentially fatal complications, and it is uncertain whether males and females should be managed differently. Methods: This was a cohort study of consecutive patients with spontaneous intracranial hypotension enrolled from a medical center. Medical records and imaging findings were reviewed. The outcome of treatment responses to epidural blood patches and risks of subdural hematoma were measured. Results: In total, 442 patients with spontaneous intracranial hypotension (165 males, 277 females) were included in the analysis. Males were more likely to have a delayed (>30 days) initial presentation than females (32.1% [53/165] vs. 19.9% [55/277], p = 0.004), and males were less likely to have nausea (55.8% [92/165] vs. 67.1% [186/277], p = 0.016), vomiting (43.0% [71/165] vs. 54.2% [150/277], p = 0.024), photophobia (9.7% [16/165] vs. 17.0% [47/277], p = 0.034), and tinnitus (26.7% [44/165] vs. 39.7% [110/277], p = 0.005) compared with females despite comparable radiologic findings. Among the 374 patients treated with epidural blood patches, males were more likely to be nonresponders to the first epidural blood patch (58.0% [80/138] vs. 39.0% [92/236], OR = 2.2, 95% CI = 1.4–3.3, p < 0.001). Males were at a higher risk of having subdural hematoma (29.7% [49/165] vs. 10.8% [30/277], OR = 3.5, 95% CI = 2.1–5.8, p < 0.001). Among patients with subdural hematoma, males had greater thickness (12.8 ± 4.3 vs. 8.1 ± 5.9 mm, p < 0.001) and were more likely to receive surgical drainage (55.1% [27/49] vs. 10.0% [3/30], OR = 11.0, 95% CI = 3.0–41.3, p < 0.001) than females. Conclusion: In the present study, spontaneous intracranial hypotension in males was characterized by a delayed presentation, poorer response to the first epidural blood patch, and a higher risk of subdural hematoma. Caution should be exercised in the management of males with spontaneous intracranial hypotension. The generalizability of the findings needs to be further confirmed. Plain Language Summary: Spontaneous intracranial hypotension is associated with considerable functional disability and potentially fatal complications, and it is uncertain whether management of this condition should differ between males and females. In this large cohort of 442 patients with spontaneous intracranial hypotension, we found that males had a longer delay in presentation, poorer response to the first epidural blood patch, and higher risks for developing subdural hematoma and having surgical drainage compared to females. The findings suggest that spontaneous intracranial hypotension in males should be managed with great caution; more aggressive measures, such as early or multiple epidural blood patches, might be necessary. [ABSTRACT FROM AUTHOR]

Diabetes is a common and serious global disease that damages blood vessels in the eye, leading to vision loss. Early and accurate diagnosis of this issue is crucial to reduce the risk of visual impairment. The typical deep learning (DL) methods for diabetic retinopathy (DR) grading are often time‐consuming, resulting in unsatisfactory detection performance due to inadequate representation of lesion features. To overcome these challenges, this research proposes a new automated mechanism for detecting and classifying DR, aiming to identify DR severities and different stages. To figure out and capture feature characteristics from DR samples, a conjugated attention mechanism and vision transformer are utilized within a collective net model, which automatically generates feature maps for diagnosing DR. These extracted feature maps are then fused through the feature fusion function in a fused attention net model, calculating attention weights to produce the most powerful feature map. Finally, the DR cases are identified and discriminated using the kernel extreme learning machine (KELM) model. For evaluating DR severity, our work utilizes four different benchmark datasets: APTOS 2019, MESSIDOR‐2 dataset, DiaRetDB1 V2.1, and DIARETDB0 datasets. To illuminate data noise and unwanted variations, two preprocessing steps are carried out, which include contrast enhancement and illumination correction. The experimental results evaluated using well‐known indicators demonstrate that the suggested method achieves a higher accuracy of 99.63% compared to other baseline methods. This research contributes to the development of powerful DR screening techniques that are less time‐consuming and capable of automatically identifying DR severity levels at a premature level. [ABSTRACT FROM AUTHOR]

Objective: This study was to investigate the differences between young older adults with and without vision impairment on neuropsychological and psychiatric outcomes following falls during the past year and to identify predictors of cognitive decline or mental distress. Methods: A secondary analysis of 668 young older Chinese adults aged 65 ∼ 79 years old with a history of falls was conducted from the cross-sectional survey data in the 2018 wave of the Chinese Longitudinal Health Longevity Survey (CLHLS). Results: Participants with vision impairment scored significantly higher on anxiety and depression and lower on cognitive function and SWB than those without vision impairment. And vision impairment was a significant predictor of adverse outcomes for all four neuropsychological and psychiatric measures. Conclusion: Neurocognitive deficits, psychological problems, and decreased self-sufficiency are quite common among community-dwelling older adults with visual impairment who have a history of falls within a year. [ABSTRACT FROM AUTHOR]

Retinal ischemia/reperfusion injury (RI/R) is a common pathological process in ophthalmic diseases, which can cause severe visual impairment. The mechanisms underlying RI/R damage and repair are still unclear. Scholars are actively exploring effective intervention strategies to restore impaired visual function. With the development of nucleic acid nanomaterials, tetrahedral framework nucleic acids (tFNAs) have shown promising therapeutic potential in various fields such as stem cells, biosensors, and tumour treatment due to their excellent biological properties. Besides, miRNA‐22‐3p (miR‐22), as an important regulatory factor in neural tissue, has been proven to have positive effects in various neurodegenerative diseases. By stably constructing a complex of tetrahedral framework nucleic acids miR22 (tFNAs‐miR22), we observed that tFNAs‐miR22 had a positive effect on the repair of RI/R injury in retinal neural tissue. Previous studies have shown that tFNAs can effectively deliver miR‐22 into damaged retinal neurons, subsequently exerting neuroprotective effects. Interestingly, we found that there was a certain synergistic effect between tFNAs and miR‐22. tFNAs‐miR22 can selectively activated the ERK1/2 signalling pathway to reduce neuronal apoptosis, accelerate cell proliferation, and restore synaptic functional activity. In this study, we established a simple yet effective small molecule drug for RI/R treatment which may become a promising neuroprotectant for treating this type of vision impairment disease in the future. [ABSTRACT FROM AUTHOR]

Non-compliance with spectacle wear undermines global health initiatives aimed at eliminating uncorrected refractive error—a preventable cause of visual impairment—by providing free or affordable spectacles to underserved populations. Non-compliance, however, is often identified too late, delaying effective health promotion strategies. This study evaluates the association between early-assessed vision-related quality of life (QoL) following spectacle correction and long-term compliance in adults. A comprehensive eye examination was conducted on 3052 university students to identify those visually impaired (presenting acuity ≥ Snellen 6/12 in the better eye) due to uncorrected refractive error. After refractive correction, participants achieving a best-corrected visual acuity of Snellen 6/6 completed the National Eye Institute 25-item Visual Function Questionnaire (NEI-VFQ-25) at baseline and within the first week of correction. A 6-month follow-up assessed compliance with spectacle wear. The average baseline NEI-VFQ-25 score improved from 67.35 (± 13.53%) to 90.56 (± 8.45%) with spectacle correction (P < 0.001) in the first week, with individual changes ranging from 2 to 70%. After 6 months, only 54 (47%) out of the 115 eligible participants (58 females; ages 18 to 29) were compliant. Following the adjustment for covariates, the results revealed that gains in NEI-VFQ-25 score below 40 were significantly associated with reduced compliance over the 6-month period (OR: 0.39, 95% CI: 0.06–0.99, P = 0.047). This supports an association between early vision-related QoL and long-term compliance. Scheduling a short follow-up to assess vision-related QoL within the first week after dispensing spectacles may help identify potential non-compliant wearers early, allowing for timely interventions. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration (AMD) is a leading cause of vision impairment in people over 50 years of age and has a great impact on quality of life as it affects central vision. Although there have been treatments available for the neovascular form of late AMD for decades, until now there have not been treatments available for the atrophic form of late AMD – geographic atrophy (GA). Recently, treatments acting on the complement pathway have been approved by the United States Food and Drug Administration, with other jurisdictions such as Australia considering their approval. Furthermore, there are many more potential treatments for GA currently in clinical trials. However, unlike the treatments for neovascular AMD, where clinicians have treated virtually all patients presenting with exudation, the decision to treat those with GA will be more nuanced and individualised. Longitudinal retinal imaging will be one important asset that will help tremendously when counselling patients, as through these images, the growth pattern of the atrophy can be determined. Even without individual prior imaging history, there are other imaging clues to help predict growth rates and threats to the fovea, and hence imminent vision loss. Optometrists have a critical role in this new era where GA treatments will be available, as they are often the first to have contact with GA patients. Insightful, well-informed counselling and appropriate referral for those seeking more information on potential treatment to confirm the diagnosis and perform baseline imaging at a location likely to undertake any future treatment will ensure that appropriate patients have had the best workup to be individually managed once these treatments arrive in Australia. [ABSTRACT FROM AUTHOR]

Clinical relevance: In all countries, there are population groups that are underserved by eye health services. By exploring access to eye care for these communities, optometrists and other eye care providers can promote equitable access to quality eye care, including strengthening patient relationships, and championing inclusive, people-centred services. Background: New Zealand has very few policies to enable access to primary eye health services. The aim of this study was to explore the barriers and facilitators to accessing eye health services among adults from an underserved community in Auckland. Methods: A qualitative study was conducted using in-depth interviews, drawing on the domains of a widely accepted patient-centred framework for health care access. Twenty-five adults with vision impairment were recruited from a community-based eye clinic in a suburb with high area-level deprivation. Interviews were audio-recorded, transcribed verbatim, coded, and analysed using thematic analysis. Results: Twenty-five participants were interviewed, aged between 47 and 71 years, of whom 13 were female. The participants included 13 Pacific people, 6 Māori, 4 New Zealand Europeans and 2 people of other ethnicities. Thematic analysis revealed five themes describing accessing eye care from a community perspective. Two major themes related to barriers were identified, financial barriers and barriers due to location of services and transport. The facilitators of access were, the ability of individuals to identify available eye health services, the provision of appropriate eye health services, and the crucial role played by whānau (family) in supporting participants to seek eye health services. Conclusion: Cost is a major barrier to accessing eye health services in New Zealand. The barriers and facilitators expressed by this underserved community can inform efforts to improve eye health access in New Zealand through people-centred service designs. [ABSTRACT FROM AUTHOR]

Purpose: Visual impairment (VI) is still underdiagnosed in patients with acquired brain injury despite the large impact on daily life activities and rehabilitation. The aim of this study was to explore the current practice of identification of VI, management plans, referrals, and experienced barriers in Norwegian hospital settings. Materials and Methods: An online survey was sent out to leaders (n = 62) in hospitals treating patients with acquired brain injury. Data from 22 items covering routines, interdisciplinary collaboration, assessment tools, protocols, barriers, referral practice, and background information were collected. Results: Respondents (n = 108) comprised various professions from mainly acute or subacute settings. Visual field deficits, oculomotor dysfunction, and neglect were most commonly but not routinely assessed (53%–57%). Besides medical examination, patient interviews, and observations rather than standardized tests or questionnaires (82% vs.25%) were used. Few workplaces seemed to have interdisciplinary vision teams (13%). Barriers were patient characteristics such as cognitive and language impairment and limited resources. Below half (45%) felt competent in assessing VI or had attended courses on the topic (44%). Conclusions: The study highlights the need to implement standardized assessment, improve interdisciplinary collaboration, and facilitate training courses to enable hospital staff to assess VI after brain injury. These steps could contribute to improved assessment and management of VI and contribute to overcome the indicated barriers leading to better patient care and outcome. [ABSTRACT FROM AUTHOR]

Cerebral adrenoleukodystrophy (CALD) can cause visual impairment, but early symptoms are often missed or misdiagnosed. The framework of cerebral visual impairment (CVI) distinguishes deficits in sensory detection ("lower order") from those of perception and interpretation ("higher order"). This study describes visual deficits in patients with CALD and higher order visual function assessed with a virtual reality (VR) interface combined with eye tracking. A retrospective medical record review assessed the prevalence of visual deficits in patients with CALD, as well as lesion burden on brain MRI using the Loes MRI severity score. A VR-based task measured visual spatial processing performance in participants with CALD and controls. Out of 89 CALD patients, 69 % had at least one sign or symptom of visual impairment. Lower order deficits were seen in 56 % of patients, and higher order deficits were seen in 59 % of patients who underwent neuropsychological testing. Even in early stage disease (Loes MRI severity score ≤ 3), visual impairment was present in more than half of patients (58 %). On prospective VR-based assessment, the CALD group (n = 30) had impaired visual search performance (lower success rate and longer reaction time) compared with controls (n = 38). In both groups, there was a trend of worsening performance with increasing task difficulty. Higher order visual deficits, not just impairment of visual acuity, visual fields, or oculomotor function, are common in all stages of CALD. Beyond neuropsychological testing, VR-based functional testing allows for quantitative assessment of higher order visual perceptual deficits that are relevant to everyday tasks and may serve as an important marker of neurological decline. [ABSTRACT FROM AUTHOR]

Background: Mild traumatic brain injury (mTBI) is becoming a more common emergency department (ED) presentation. Towards this end, many types of testing in the acute setting are being investigated. One of these is screening for convergence insufficiency (CI) symptoms. These are common problems reported by patients with mTBI, but such oculomotor testing is rarely performed in the ED. Objective: To assess the feasibility of convergence insufficiency screening in the ED and investigate whether CI is associated with adverse events such as post-concussive symptoms or hospital admission. Methods: Written informed consent was obtained from patients age 18 years or older who experienced a mild head injury from any mechanism resulting in an mTBI. Patients underwent screening for CI symptoms using a standardized instrument of 15 questions, known as the convergence insufficiency symptom survey (CISS), with responses based on the Likert scale. These data were correlated to outcomes of hospital admission, occurrence of post-concussive symptoms, and 30-day hospital re-admission. Results: A total of 116 patients were prospectively enrolled, of which 58 were male. The median age was 31 years, with a range of 18 to 95 years of age. The median CISS score was 13, with an interquartile range (IQR) of 6 to 21 and an overall range of 0 to 53. Females presented with a median CISS score of 14, which was higher compared to the male median score of 10. The higher the CISS score, the more likely the patient was to be admitted to the hospital (p = 0.0378), develop symptoms of post-concussive syndrome at 30-day follow up (p = 0.0322), and be readmitted within 30 days (p = 0.0098). Conclusions: Screening for CI symptoms using the CISS can be a solid adjunct in the evaluation of mTBI in the ED. The CISS is easy and fast to administer, and it is a useful tool to stratify patients in terms of who is at the highest risk of developing complications related to the mTBI. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The certificate of vision impairment has an important role in enabling access to support for people with vision impairment (VI) and the provision of epidemiological data regarding sight loss. However, the rates of certification may not accurately reflect the number of people living with certifiable VI.Observational data from a national primary care low vision rehabilitation service between 1 April 2021 and 31 March 2022 were analysed. Descriptive statistics were used to describe the certification status of patients with certifiable VI. For patients with age‐related macular degeneration (AMD) and best‐corrected visual acuity of 6/60 or worse, logistic regression was undertaken to assess the effects of patient characteristics on certification status.For patients with AMD and certifiable levels of visual acuity, 41.00% (n = 426) were not certified. The reported certification was 60.09% (n = 256) and 58.24% (n = 357) for neovascular AMD and atrophic AMD, respectively. Existing patients of the service were 3.87 times more likely to be certified than new patients (OR 3.87, 95% CI 2.7–5.4). Increasing age (OR 1.02, 95% CI 1.004–1.038) and decreasing visual acuity (OR 0.62, 95% CI 0.50–0.78) were associated with an increased likelihood of certification.A significant number of patients live with certifiable vision impairment but do not access certification. Policy changes in Wales now enable patients with bilateral atrophic AMD to access certification within the primary care setting. Given the unmet need, consideration should be given to primary care certification in the rest of the UK, and in Wales, the potential to expand the scope of conditions. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion This qualitative study explored the lived experiences of the patients with microphthalmia and anophthalmia and their parents, focusing on the healthcare, school settings and daily life challenges to improve patient management.In‐depth interviews were conducted in Stockholm, Sweden, from October 2022 to June 2023. Participants were recruited through the St Erik Eye Hospital database (2008–2022), and the data was analysed using reflexive thematic analysis.The study included 15 patients (9 female and 6 male), with a median age of 21 years (range 15–31), and 1 parent per patient. Five key themes were identified from the parental interviews and three from the patient interviews. Both groups emphasised the need for improvements in healthcare, including better physician continuity, emotional support, information provision and prosthesis functionality. Families of those with severe bilateral visual impairment highlighted the need for additional school and daily life support. While some parents had future concerns, most patients viewed their condition as a natural part of life.Patients and parents shared insights on the psychosocial impact and suggested improvements in the healthcare and school settings, providing valuable guidance for enhancing care and management for this patient group. [ABSTRACT FROM AUTHOR]

We report two patients who displayed evidence of localized ocular inflammation after CAR T-cell infusion. To manage the resulting severe visual impairment, systemic corticosteroids were administered to both patients. This treatment led to a reduction in local inflammation and restored vision in one of the patients. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric uveitis poses unique challenges, characterized by difficulties in performing comprehensive examinations, potential delays in diagnosis, and a heightened risk of ocular complications. This study evaluate the etiologic and clinical characteristics of uveitis in children presenting to the Mansoura Ophthalmic Center, Mansoura, Egypt. Methods: A cross-sectional observational study was undertaken involving children diagnosed with uveitis attending the uveitis outpatient clinic at Mansoura University Ophthalmic Center. Comprehensive clinical evaluations were carried out, including detailed history taking and exhaustive ophthalmological examinations. Whenever deemed necessary, Spectral Domain Optical Coherence Tomography (OCT) and Fluorescein Fundus Angiography (FFA) were utilized to secure retinal images. An extensive systemic evaluation was also conducted to discern the diverse causes of uveitis among the participants. Results: The cohort comprised 63 children, impacting 97 eyes. Bilateral involvement was seen in 54% of cases, with a male predominance of 58.7%. The predominant etiologies of uveitis were presumed trematode-induced (36.7%), Juvenile Idiopathic Arthritis (JIA) accounting for 28.6%, and in 12.7% of cases, the cause remained undetermined. Anterior uveitis emerged as the primary presentation in 79.4% of cases. Regarding visual loss, cataract was the leading cause at 56.4%, followed by vitritis at 38.4%, and macular edema at 20.5%. Conclusion: Anterior uveitis was the most frequent presentation in our pediatric cohort. Despite the challenges, the majority of children with uveitis exhibited no significant visual impairment, with most causes of visual loss being reversible. [ABSTRACT FROM AUTHOR]

Purpose: To examine the real-world management and outcomes of uveitic cystoid macular oedema (CME). Design: Retrospective study. Methods: Patients with uveitic CME were identified from the Inflammatory Eye Disease database. 248 eyes of 218 patients with uveitic CME were identified. Main Outcome Measures: Time to resolution, time to recurrence and vision loss. Results: Median age at time of CME was 51.7 years [IQR 37.3–63.9]. Overall likelihood of resolution was 209/248 eyes (85.3%). Resolution occurred in 34.1% with topical therapy, 69.2% treated with oral prednisone (72.9% if prednisone dose ≥ 60 mg/day), 73.5% treated with orbital floor steroid, and 86.7% treated with intravitreal steroid. On multivariate analysis, ERM was associated with decreased resolution of CME (HR 0.735 p = 0.045). Additionally, infectious aetiology approached significance (HR 0.635 p = 0.059) for CME resolution. Recurrence occurred in 85 eyes (36.5%). Predictors of increased likelihood of recurrence were current smoking status (HR 1.818 p = 0.042) and subretinal fluid at diagnosis (HR 1.577 p = 0.043). Eyes with infectious aetiology had lower chance of CME resolution, but those that did resolve had lower probability of recurrence (HR 0.891 p = 0.019). Moderate vision loss (20/50–20/200) occurred in 24 eyes (9/7%) and severe vision loss (≤20/200) in 17 eyes (6.9%). Conclusions: Management of CME is challenging given the heterogeneous aetiologies, severity of the macular edema as well as response to the therapy. A high rate of resolution was observed, given sufficient time, but recurrence occurs in one-third. Current smoking status plays an important role in the risk of recurrence of CME and patients should be encouraged to stop smoking. [ABSTRACT FROM AUTHOR]

Purpose: To report the first case of acute Abiotrophia defectiva endophthalmitis post-keratoplasty and review the current literature. Methods: A 47-year-old male, post-keratoplasty, presented with vision loss and severe anterior chamber reaction. Diagnostic investigations included vitreous cultures and molecular analysis. Results: Abiotrophia defectiva was identified. Despite aggressive treatment, visual acuity remained low. We reviewed a total of 14 post-procedural cases of A. defectiva endophthalmitis, focusing on antibiotic and steroidal treatment regimens and long-term prognosis. Conclusion: We emphasize aggressive treatment of external disease prior to intraocular surgery. In cases of A. defectiva endophthalmitis, we advocate judicious use of steroids. [ABSTRACT FROM AUTHOR]

Purpose: To describe a cohort of patients with retinal vasoproliferative tumours (RVPT) seen in the uveitis clinic of a single tertiary eye care institute in India. Methods: Retrospective Chart Review Results: In our study of 17 patients with 18 eyes affected by RVPTs, 94.1% showed unilateral involvement, one patient had bilateral RVPTs, and another had two RVPTs in the same eye. The mean age was 36.3 ± 15.1 years (range: 12–63 years), with a male majority (76.4%). The most common location was inferotemporal quadrant (44.4%). The most common associated uveitic condition was intermediate uveitis (50%). Patients were treated with oral corticosteroid (in 94.1%) and immunosuppressive (35.2%) in addition to transconjunctival cryotherapy (in 52.9%) or laser photocoagulation (in 41.1%). Regression of the RVPT was achieved in all cases except one. Visual acuity at time of detection of RVPT ranged from 6/6 to HM. No significant change was noted in the mean best corrected visual acuity pre and post treatment in the study group. Conclusion: RVPTs, rare peripheral retinal lesions often associated with intermediate uveitis, require early diagnosis with targeted therapy to prevent vision loss and achieve favorable long-term outcomes with rare recurrences. [ABSTRACT FROM AUTHOR]

Objective: To assess fetal and neonatal eyes abnormalities and their progression during the last ZIKV outbreak and summarize learned lessons. Methods: A systematic review and meta-analysis was conducted by a team of obstetricians and ophthalmologists. Results: Studies reporting ocular abnormalities during the prenatal (n = 5) and postnatal (n = 24) periods were included in the analysis. In the prenatal period, the most common ocular findings were intraocular calcification cases (4/6, 66.6%) and microphthalmia (3/6, 50%). Postnatal ocular abnormalities of congenital ZIKV infection were described after birth in 479 cases. Among them microphthalmia was reported in 13 cases (13/479, 2.7%). Posterior segment (retina and optic nerve) was the most affected structure, consisting of pigmentary changes (229/479, 47.8%), macular chorioretinal atrophy (216/479, 45%), optic nerve atrophy (181/479, 37.8%), increased cup-to-disk ratio (190/479, 39.6.%), optic nerve hypoplasia (93/479,19.4%), vascular changes (26/479, 5.4%), and retinal coloboma (20/479, 4.1%). The anterior segment was involved in 4.6% (22/479) of cases, including cataract (9/479, 1.8%), lens subluxation (1/479, 0.2%), iris coloboma (5/479, 1%), and congenital glaucoma (7/479, 1.4%). These ocular anomalies were isolated in one case (1/479, 0.2%) and multiple anomalies were found in the other cases. Long-term visual disorders have been described, with no possible improvement and even a worsening of some of the ocular anomalies previously observed. No reactivation of ocular lesions was observed. Conclusion: This review highlights the severe ocular abnormalities associated with congenital ZIKV infections. The importance of multidisciplinary communication between the obstetrician, the maternal-fetal medicine specialist, and the ophthalmologist is emphasized. Protocol registration: This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration440 188. [ABSTRACT FROM AUTHOR]

Purpose/Objective: Small sample sizes are a common problem in disability research. Here, we show how Bayesian methods can be applied in small sample settings and the advantages that they provide. Method/Design: To illustrate, we provide a Bayesian analysis of employment status (employed vs. unemployed) for those with disability. Specifically, we apply empirically informed priors, based on large-sample (N = 95,593) July 2019 Current Population Survey (CPS) microdata to small subsamples (average n = 26) from July 2021 CPS microdata, defined by six specific difficulties (i.e., hearing, vision, cognitive, ambulatory, independent living, and self-care). We also conduct a sensitivity analysis, to illustrate how various priors (i.e., theory-driven, neutral, noninformative, and skeptical) impact Bayesian results (posterior distributions). Results: Bayesian findings indicate that people with at least one difficulty (especially ambulatory, independent living, and cognitive difficulties) are less likely to be employed than people with no difficulties. Conclusions/Implications: Overall, results suggest that Bayesian analyses allow us to incorporate known information (e.g., previous research and theory) as priors, allowing researchers to learn more from small sample data than when conducting a traditional frequentist analysis. Impact and Implications: We provide a Bayesian tutorial for selecting priors, computing, and interpreting results within the context of disability research. We hope to inspire future research using Bayesian analysis for small sample disability data. [ABSTRACT FROM AUTHOR]

As the number of social media users continues to increase globally, it is important to explore the experiences of different segments of users. While research on social media use by people with vision impairment is growing, lacking is research in this area in Nigeria. This qualitative study describes the lived experiences and perceptions of social media use among Nigerian adults with vision impairment, using a transcendental approach. Findings showed that people with vision impairment experienced a reduction in social connectedness due to their vision impairment, but those who used social media were able to enhance social connectedness, increase social interaction, develop social relationships and expand their social networks. Participants described social media as a good medium for learning and education as it enabled ready access to information. Results indicated that supporting adults with vision impairment experiencing reduced social connectedness to engage with social media could help improve their social well-being. [ABSTRACT FROM AUTHOR]

The role of the classroom assistant (CA) is considered pivotal in inclusive provision for pupils with additional needs. CAs' support of pupils who have a visual impairment (VI) is greatly underreported in the literature. Scaffolding theory was applied to investigate the role of CAs in supporting pupils who have a VI in mainstream schools in Northern Ireland, UK. Focus groups were conducted with 18 CAs who were embarking on an accredited VI-focused professional development programme. Findings revealed the majority of assistants had received no formal training to work with these pupils although they provided support in a wide range of ways to ensure their educational, social and physical inclusion in school. Although positive aspects of their contribution were described in inclusive terms, challenges were identified that mainly impacted on the participatory options of pupils with VI. Most prominently, minimal access to professional development engendered uncertainty that pupils were being appropriately and effectively supported. Viewed through the lens of scaffolding theory, CAs occupy a predominantly supporting role, with paucity in upskilling opportunities and hierarchical structures limiting further professional progression. More strategic consideration of the CA role could contribute to greater equity of access to education for children with VI. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR), a common diabetes complication leading to vision loss, presents early clinical signs linked to retinal vasculature damage, affecting the neural retina at advanced stages. However, vascular changes and potential effects on neural cells before clinical diagnosis of DR are less well understood. To study the earliest stages of DR, we performed histological phenotyping and quantitative analysis on postmortem retinas from 10 donors with diabetes and without signs of DR (e.g., microaneurysms, hemorrhages), plus three control eyes and one donor eye with DR. We focused on capillary loss in the deeper vascular plexus (DVP) and superficial vascular plexus (SVP), and on neural retina effects. The eye with advanced DR had profound vascular and neural damage, whereas those of the 10 randomly selected donors with diabetes appeared superficially normal. The SVP was indistinguishable from those of the control eyes. In contrast, more than half of the retinas from donors with diabetes had capillary dropout in the DVP and increased capillary diameter. However, we could not detect any localized neural cell loss in the vicinity of dropout capillaries. Instead, we observed a subtle pan-retinal loss of inner nuclear layer cells in all diabetes cases (P < 0.05), independent of microvascular damage. In conclusion, our findings demonstrate a novel histological biomarker for early-stage diabetes-related damage in the human postmortem retina; the biomarker is common in people with diabetes before clinical DR diagnosis. Furthermore, the mismatch between capillary dropout and neural loss leads us to question the notion of microvascular loss directly causing neurodegeneration at the earliest stages of DR, so diabetes may affect the two readouts independently. Article Highlights: In this study of the earliest stages of diabetic retinopathy (DR), we histologically analyzed postmortem retina from donors with diabetes but no DR. We found in many donors vascular damage in the deeper plexus of the retinal vasculature in the absence of changes in the superficial plexus or other manifest DR signs. We also found pan-retinal neural loss not spatially correlated with local microvascular nonperfusion and even in tissue with no vascular damage. Retinal neurodegeneration, therefore, seems not directly linked to microvascular dropout at the earliest stage of DR. Deeper plexus perfusion can be a useful early biomarker to assess DR. [ABSTRACT FROM AUTHOR]

Despite the importance of writing skill development, we know very little about how writing instruction is provided to students with visual impairments (VI) with and without co-occurring disabilities (e.g., multiple disabilities, deaf-blindness). The purpose of this study was to survey a national sample of U.S. teachers of students with visual impairments (TSVIs) on several important constructs, including their preparation to teach writing; their beliefs, attitudes, and experiences about teaching writing; and the writing practices they use for students with various visual conditions. We received responses from 457 TSVIs. The results showed that TSVIs vary considerably in their preparation to teach writing and disagree as to whether writing instruction (above and beyond braille) is part of their responsibilities. Most TSVIs indicated that they believe writing to be important for their students with VI, and they reported using various writing practices in their instruction within different student groups. [ABSTRACT FROM AUTHOR]

The Picture Exchange Communication System (PECS) has been widely used to teach functional requesting and commenting skills to children with autism spectrum disorder. Some researchers also modified the PECS to explore its effect on children with other disabilities. The main purpose of this study was to add tangible symbols to PECS (PECS-TS) in teaching requesting skills to three children with visual impairment (VI) and intellectual disability (ID) aged 6–12 years (two females, one male). A non-concurrent multiple probe design across participants was used in the present study to evaluate the effectiveness of the adapted training with PECS-TS. Data were collected across baseline, training, and maintenance conditions. Generalisation probes were also conducted. The results showed that all three participants who acquired the target requesting skills were able to generalise their use to similar untaught situations (different classrooms with different teachers), and they also reached the criterion during maintenance sessions. This study added to the evidence about using PECS-TS for students with VI and ID. Individualised symbols are very important for student success, however, more research is needed to establish PECS-TS as an evidence-based practice for children with VI and ID. [ABSTRACT FROM AUTHOR]

Objective: Optic nerve hypoplasia (ONH), the congenital underdevelopment of the optic nerve, is an increasing cause of visual impairment and is associated with pituitary dysfunction. Past studies have focused on the relationship between ONH, pituitary deficiencies, and brain imaging. However, recent studies have demonstrated the true risk for hypopituitarism lies with the presence or absence of ONH, irrespective of midline brain findings. This study reviewed the relationship between the health of the optic nerve (visual acuity) and pituitary gland (number and age of development of pituitary deficiencies) as a way to stratify risk, regardless of imaging findings. Design, Patients and Measurements: Retrospective chart review of 197 patients seen at a single center from 2013 to 2022. Visual assessment was defined by distance acuity, and the presence of nystagmus or afferent pupillary defect. Pituitary deficiencies were diagnosed per Endocrine Society guidelines. Results: In children with bilateral ONH (bONH), profound visual impairment was associated with more pituitary deficiencies between 0 and 15 years of age. The odds of having any pituitary deficiency were 4.9 times higher (95% confidence interval [95% CI]: 2.4–10.1) for patients with bONH versus unilateral ONH (uONH). Central hypothyroidism was the most common first presenting pituitary deficiency followed by growth hormone across all patients. Conclusion: This study shows a significant association between severity of visual impairment and increased probability of pituitary deficiencies in children with bONH versus uONH. Children with ONH require urgent endocrine evaluation due to risk of pituitary deficiencies, but risk stratification may also be based on severity of visual impairment. [ABSTRACT FROM AUTHOR]

To examine the frequency of recurrence and identify risk factors for recurrence in patients with acute anterior uveitis (AAU). Retrospective cohort study from a single tertiary ophthalmic clinical center. All subjects with AAU identified from a database of Inflammatory Eye Disease presenting to Te Whatu Ora (Auckland, New Zealand) between 2008 and 2021. Data were collected retrospectively from chart review and electronic patient records for all patients during the study period. Rates of recurrence were reported using the Kaplan–Meier estimator. Multivariate analysis of risk factors for recurrence was calculated using a marginal Cox regression model. The primary outcome measure was disease recurrence. Secondary outcome measure was moderate vision loss (≤20/50). A total of 2763 eyes of 2092 subjects with AAU were studied, with a median follow-up time of 8.9 years and a total follow-up of 19 794.9 eye-years. Recurrence occurred in the ipsilateral eye in 1258 eyes (45.5%) and in the contralateral eye in 522 eyes (27.3%). Rates of ipsilateral recurrence over 10 years were 38.1% for idiopathic disease, 43.2% for human leukocyte antigen B27 (HLA-B27)/inflammatory arthritis, and 44.9% for viral uveitis. On multivariate analysis, the following were associated with increased risk of ipsilateral recurrence: older age (P < 0.001), Māori ethnicity (P = 0.006), Asian ethnicity (P < 0.001), HLA-B27/inflammatory arthritis (P < 0.001), and viral uveitis (P = 0.018). There was no association with gender, smoking, bilateral disease, or hypertensive uveitis. Rates of contralateral eye involvement were significantly lower than ipsilateral eye recurrence. Contralateral recurrence at 10 years was 15.2% in idiopathic uveitis, 37.6% in HLA-B27/inflammatory arthritis, and 2.0% in viral uveitis. Risk factors identified for contralateral eye involvement were Māori ethnicity (P = 0.003), Pasifika (Pacific Islanders) ethnicity (P = 0.021), and HLA-B27/inflammatory arthritis (P < 0.001). Moderate vision loss (≤20/50) was present in 411 eyes (14.9%) at final follow-up and was more common if time to first recurrence was shorter (P < 0.001). Approximately half of patients with AAU will develop recurrence in the ipsilateral eye, and one-quarter will have recurrence in the contralateral eye. Patients with viral disease have the highest risk of ipsilateral recurrence and lowest risk of contralateral recurrence. Patients with risk factors for recurrence should be managed and counseled appropriately to minimize the risk of visual loss and complications of uveitis. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Aim: To identify the factors related to preoperative anxiety in older adults with sensory impairment. Design: Descriptive quantitative research design. Methods: Study participants were 120 older adults admitted to a tertiary hospital in Seoul, South Korea to undergo eye or ear surgery. Data were collected from 11 February to 30 April 2023. The collected data were analysed using descriptive statistics, t‐tests, ANOVA, and multiple regression analysis using SPSS 28.0. The study was reported following the STROBE checklist. Results: Preoperative anxiety differed significantly according to gender (p =.002), average monthly household income (p <.001), subjective health status (p =.003), subjective vision loss (p =.004), one‐sided or both‐sided eye discomfort (p =.002), use of glasses (p =.010), subjective hearing loss (p =.022) and anxiety coping mechanisms (p <.001). The results of a multiple regression analysis on the significant variables identified that gender (β =.178, p =.036) and anxiety coping mechanisms (β =.336, p <.001) had the most significant effect on preoperative anxiety, with an explanatory power of 34.5%. Conclusion: The development and practical application of tailored nursing interventions catering to specific genders and anxiety coping mechanisms would contribute to reducing preoperative anxiety and providing efficient nursing care for older adults with sensory impairment. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to describe the temporal changes in causes and prevalence of childhood visual impairment in Denmark based on the National Danish Registry of Children with Visual Impairment (NDRCVI). Methods: Annual reports on the NDRCVI since its establishment in 1979 were reviewed and data on the number of registered children and the causes for registration with a visual impairment were evaluated. Results: The average annual incidence of childhood visual impairment in Denmark is 2.8 per 1000 live‐born children and the prevalence of childhood visual impairment is 1.6 per 1000 children <18 years. Today, fewer children are severely visually impaired (visual acuity ≤6/60) at the time of registration (31.6% since 2010 vs. 51.1% in the 1980s). Cerebral visual impairment and optic nerve atrophy have remained common causes of childhood visual impairment whereas sequelae to retinopathy of prematurity have been almost eliminated as a cause. Systemic comorbidities are more common now in children with visual impairment (seen in 63.9% in the last decades vs. 44.6%in the 1980‐ties). Conclusion: Whereas the prevalence of visual impairment has remained relatively stable over the years, the severity of visual impairment has improved, suggesting that more children will be able to live an active life supported by aids compensating vision loss. However, more children have systemic comorbidities in combination with their visual impairment suggesting that children with visual impairment face a life not only limited by the obstacles of poor vision. This calls for multidisciplinary management and support of affected children and families. [ABSTRACT FROM AUTHOR]