Search

Disruption of vision intervention (VI) worsens global development of children with multiple disability (MD). Digital platforms help parents to continue vision intervention in pandemics. To the best of our knowledge, no studies have been done to assess the impact of online VI, therefore this is first. The aim is to study the impact of online VI on functional vision of children with MD during COVID-19. Fifteen children with MD recruited for in-office VI had abandoned it during the first pandemic, but had been able to continue through online during second pandemic and were recruited. Impact of online VI was retrospectively examined, by comparing functional vision (grating acuity [GA] and contrast sensitivity [CS]) at the time of discontinuance and period with online sessions. Parents received questionnaire to assess their perceptions about online VI. Discontinuity of in-office sessions during the first wave resulted in deterioration of functional vision. GA decreased from 1.5 to 0.9 cycles per degree (CPD; p =.012) and CS decreased from baseline in eight children. Upon lockdown relaxation, resumption of in-office VI showed improvement. GA improved from 0.9 to 1.7 CPD (p =.009) and CS improved in 10 children. However, during the second wave, with institution of online sessions, GA and CS were either maintained or improved. Results from questionnaire showed high satisfaction level of online VI among parents. Although advantages of in-office VI are undeniable, functional vision outcomes and parental satisfaction encourages to combine online and in-office VI whenever necessary. [ABSTRACT FROM AUTHOR]

The primary causes of low vision in children include genetic factors, congenital anomalies, and perinatal issues. The visual rehabilitation for these children is a complex and crucial process that involves comprehensive assessments and interventions, particularly focusing on functional vision evaluation and rehabilitation. The rehabilitation of children with low vision encompasses not only vision training but also the use of appropriate optical and non-optical aids, improvement of functional vision, and enhancement of the environment and related service facilities. Preventing, early screening, and evaluating low vision in children are also of paramount importance. This includes perinatal screenings, systematic eye health services, and comprehensive visual function assessments. Currently, the visual rehabilitation of children with low vision faces several challenges, including difficulties in early diagnosis and intervention, challenges within the educational system, a lack of specialized rehabilitation institutions and professionals, and a limited variety and quality of assistive products. In the future, it is necessary to further improve the rehabilitation service network and institution development, strengthen the training of professionals, and increase policy investment to enhance the effectiveness of visual rehabilitation and the quality of life for children with low vision. [ABSTRACT FROM AUTHOR]

Sophie J Bakri,1 Winfried MK Amoaku,2 Danielle Altman,3 Stéphane Quéré,4 Jaclyn Quilantan,5 Julia Carpenter-Conlin,5 Sujata P Sarda,5 Daniel L Jones,5 Jared S Nielsen6, † 1Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 2Faculty of Medicine & Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, England, UK; 3Modus Outcomes, a THREAD Company, Cary, NC, USA; 4Modus Outcomes, a THREAD Company, Lyon, France; 5Apellis Pharmaceuticals, Inc, Waltham, MA, USA; 6Wolfe Eye Clinic PC, West Des Moines, IA, USA†Dr Jared S Nielsen passed away on June 14, 2024Correspondence: Sophie J Bakri, Department of Ophthalmology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA, Tel +1 507-284-3614, Email bakri.sophie@mayo.eduPurpose: Geographic atrophy (GA) impacts both patients and caregivers, yet little is understood about their respective burdens. The MOSAIC study aimed to identify the clinical, emotional, and financial burden among patients with GA and caregivers.Methods: A total of 28 patients with GA and 17 caregivers from the United States (US), the United Kingdom, and Australia participated in individualized qualitative interviews followed by a cross-sectional quantitative survey of 102 patients and 102 caregivers in the US. Interview transcripts were analyzed to develop conceptual models, which were then used to guide the design of quantitative surveys. Data were described at the item level and score level when appropriate (National Eye Institute Visual Function Questionnaire [NEI VFQ]-39 and Zarit Burden Interview [ZBI]). For the patient/caregiver dyad sample, the association between the NEI VFQ-39 scores and ZBI score was explored through correlation coefficients and scatterplots.Results: GA had a substantial impact on patients’ vision-related quality of life, activities of daily living, and instrumental activities of daily living. There was considerable overlap between perspectives and key concerns identified by patients and caregivers. Eighty-three percent of caregivers reported having to drive patients to appointments due to limited patient mobility, for example, and 41% reported a change in their employment status after becoming a caregiver, with 50% of them unable to work due to caregiving. The burden of patients and caregivers had a correlation ranging from − 0.63 to − 0.21 between NEI VFQ-39 subscale and composite scores and ZBI score.Conclusion: This study confirms the paucity of support for both patients with GA and caregivers. Both groups require expanded access to financial, social, and mental health resources.Plain Language Summary: What is this summary about?People with geographic atrophy, also called GA, can lose their eyesight and have a hard time driving, reading, and recognizing faces. This can worsen their quality of life. Often, people with GA need someone to care for them. The MOSAIC study was done to find out how GA affects health, happiness, and finances of people with GA and their caregivers.What were the results?One hundred and two people with GA and 102 caregivers in the United States were interviewed. The average age of people with GA was 68 years and of caregivers was 46 years. The findings showed that most people with GA did not drive because of their poor eyesight and instead counted on their caregivers to drive them to doctor appointments and other places. They also had a reading and doing things around their home because of their worsened eyesight.Both people with GA and caregivers said they felt stressed. They both worried about spending money on things they need to make living with GA easier. They also felt stressed about their finances because they could not work as much. People with GA worried most about losing their independence and caregivers worried most about the future of their loved one with GA.What do the results mean?This study showed that GA has a serious effect on people’s health and quality of life while also having a major impact on their caregivers.Keywords: age-related macular degeneration, functional vision, geographic atrophy, health-related quality of life, caregiver burden, disease burden

Vision is the most powerful sense guiding our interaction with the environment. Its process starts with the retinal image as input and results in visually guided behaviors as output. This paper summarizes insights I gained over >40 years dealing with clinical ophthalmology, visual science, and vision rehabilitation, disciplines that all involve vision, but from different points of view. The retinal image contains 2-dimensional forms that have no inherent meaning. The brain matches this input to stored concepts, to create a Mental Model that is filled with 3-dimensional objects that are meaningful and linked to other senses. Ultimately this leads to the output of goal-directed visually guided behavior. The processes involved are too complex to be covered by a single practitioner. Optimal vision rehabilitation requires teamwork that includes contributions from various professions. It also requires an understanding, as well as possible, of the cerebral processes involved. The visual sciences study mostly the input-driven process from retinal image to visual percepts. Their studies deal mostly with groups and group averages and only occasionally with individual disease conditions. Clinical ophthalmology deals mostly with individuals, rather than group averages. The motto of the American Academy of Ophthalmology reminds us that the end point of patient care goes beyond “preserving sight.” It also includes “empowering lives” by creating the conditions for goal-directed interaction with the environment through visually directed behavior. Traditionally, the study of vision has mainly involved the conscious part of vision, handled mostly in the ventral stream. However, the subconscious part of vision, handled mostly in the dorsal stream must also be considered. This is further stimulated by the demands of computer vision, image processing, and artificial intelligence. Vision rehabilitation traditionally deals with the input side through better illumination and various magnification devices. This is the domain of low vision aids. Increasingly, however, it must also address the output side, and the involvement of other senses (braille, long cane, and talking books). This requires better understanding of the goal-directed higher visual processes. The supplemental material covers the development of numerical scales to quantify not only visual acuity but also visual abilities, and the use of different tests. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

目的 探讨动脉内溶栓（intra-arterial thrombolysis，IAT）治疗视网膜中央动脉阻塞（central retinal artery occlusion，CRAO）患者的临床特征及功能性视觉恢复情况。 方法 纳入2018年1月—2023年8月西北大学附属第一医院神经内科和神经眼科连续收治的非动脉炎性CRAO患者，根据入院后是否进行IAT治疗分为IAT组和非IAT组。功能性视觉定义为 视力≥20/100。比较分析两组患者的临床特征和不同时间段（入院、出院时和出院1个月时）功能性视觉恢复情况。 结果 共纳入131例（131只眼）非动脉炎性CRAO患者，男性93例（71.0%），平均年龄为（61.6±12.6）岁， 其中IAT组57例（43.5%），非IAT组74例（56.5%）。与非IAT组患者相比，IAT组患者年龄更低[（58.4±12.5）岁 vs.（64.1±12.2）岁，P=0.011]、合并卒中病史者比例更低[10（17.5%）vs. 25（33.8%）， P=0.037]、发病至就诊时间更短[10.0（6.0～24.0）h vs. 55.0（20.2～162.0）h，P＜0.001]、醒后发病者比例更高[26（45.6%）vs. 15（20.3%），P=0.002]和患侧颈内动脉血管状态更佳（无狭窄∶轻度狭窄∶中-重度狭窄∶闭塞=41∶7∶7∶2 vs. 32∶11∶21∶10，P=0.006）。IAT组患者出院1个月时功能性视觉比例较非IAT组患者更高[25（43.9%）vs. 18（24.3%），P=0.018]，而入院和出院时差异无统计学意义 （P＞0.05）。多因素logistic回归分析显示，IAT组患者出院1个月时的功能性视觉较非IAT组患者显著改善（OR 3.24，95%CI 1.08～9.69，P=0.036）。IAT组患者术中发生眼动脉痉挛2例（3.5%）、穿刺部位皮肤出血2例（3.5%）和新发脑栓塞（均为无症状性栓塞）事件4例（7.0%）。 结论 是否进行IAT治疗的CRAO患者部分临床特征存在差异，IAT治疗可显著提高CRAO患者出院1个月时的功能性视觉，且手术安全性较好。提示临床医师需重视CRAO患者的IAT治疗，以期改善患者的视觉功能。 Abstract: Objective To investigate the clinical characteristics and functional visual recovery of patients with central retinal artery occlusion (CRAO) treated with intra-arterial thrombolysis (IAT). Methods The non-arteriotic CRAO patients admitted to the Department of Neurology and Neuro-ophthalmology of the First Affiliated Hospital of Northwest University from January 2018 to August 2023 were included. They were divided into IAT group and non-IAT group according to whether IAT was performed after admission. Functional vision is defined as visual acuity≥20/100. The clinical features and functional visual recovery at different time periods (admission, discharge and 1 month after discharge) were compared and analyzed between the two groups. Results A total of 131 patients (131 eyes) with non-arteriotic CRAO were included, including 93 males (71.0%) with a mean age of (61.6±12.6) years. There were 57 patients (43.5%) in IAT group and 74 patients (56.5%) in non-IAT group. Compared with patients in non-IAT group, patients in IAT group had younger age [(58.4±12.5) years vs. (64.1±12.2) years, P=0.011], lower proportion of stroke history [10 (17.5%) vs. 25 (33.8%), P=0.037], shorter time from onset to visit [10.0 (6.0-24.0) h vs. 55.0 (20.2-162.0) h, P0.05). Multivariate logistic regression analysis showed that the functional vision of CRAO patients in the IAT group at 1 month after discharge was significantly improved compared with those in the non-IAT group (OR 3.24, 95%CI 1.08-9.69, P=0.036). In the IAT group, ophthalmic artery spasm occurred in 2 cases (3.5%), skin bleeding at the puncture site in 2 cases (3.5%), and new cerebral embolism (all asymptomatic embolism) occurred in 4 cases (7.0%). Conclusions Some clinical features of CRAO patients who were treated with or without IAT were different. IAT can significantly improve the functional vision of CRAO patients at 1 month after discharge, and the surgical safety is good. This suggests that clinicians should pay more attention to IAT in CRAO patients in order to improve their visual function.

Purpose: The purpose of this study is to investigate test-retest reliability and agreement of the quantitative contrast sensitivity function test (qCSF) in the retina clinic. Methods: A total of 121 right eyes of 121 patients were tested and consecutively re-tested with qCSF in the retina clinic. Outcomes included area under the logarithm of contrast sensitivity function curve (AULCSF), contrast acuity, and contrast sensitivity thresholds at 1–18 cycles per degree (cpd). Test-retest means were compared with paired t-test, variability was compared with the Brown-Forsythe test, and intraclass correlation coefficient (ICC) and Bland Altman plots evaluated reliability and agreement. Results: Mean test-retest differences for all qCSF metrics ranged from 0.02 to 0.05 log units without statistically significant differences in variability. Standard deviations ranged from 0.08 to 0.14. Coefficients of repeatability ranged from 0.16 to 0.27 log units. ICC > 0.9 for all metrics except 1cpd (ICC = 0.84, all p < 0.001); AULCSF ICC = 0.971. Conclusion: qCSF-measured contrast sensitivity shows great test-retest repeatability and agreement in the retina clinic. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Stroke is the property of Chinese Journal of Stroke Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction - Vision is an important means of physical, behavioural, and cognitive development in children, having great relevance in the learning process. Aim of the study - To characterize the visual function anomalies that contribute to writing difficulties in 3rd and 4th year of schooling. Methods - Quantitative, descriptive, observational, cross-sectional, and correlational study. Sample of 232 students, aged between seven and twelve years. To assess the difficulties in writing, the Protocol for Measuring Difficulties in Reading and Writing was applied. For visual analysis, the clinical protocol of orthoptics was applied. Results - It was found that students with changes in visual acuity at near (3.45%), at the near point of convergence (17.3%), and at the near point of accommodation (32.4%), made more errors in copying, by changing letters. Students with altered vergences, namely in convergence towards near (69.6%), and in convergence towards far (76.4%), made, respectively, more errors in dictation and copy also due to changing letters. Conclusions - The most common anomalies in school-age children are: refractive errors, amblyopia, convergence insufficiency, and oculomotor imbalance (strabismus). Although students with changes in visual acuity for near, near point of convergence, near point of accommodation, and convergence for near and far gave more errors, the correlations were not statistically significant. [ABSTRACT FROM AUTHOR]

This paper explores whether a structured history-taking tool yields useful descriptions of children's looking skills. Parents of 32 children referred to a specialist communication clinic reported their child's looking skills using the Functional Vision for Communication Questionnaire (FVC-Q), providing descriptions of single object fixation, fixation shifts between objects and fixation shifts from object to person. Descriptions were compared with clinical assessment. 24/32 children were reported to have some limitation in fixation. Limitation was subsequently seen in 30/32 children. Parental report and assessment agreed fully in 23/32 (72%). The largest area of discrepancy was object-person fixation shifts, with five children not observed to show this behavior despite its being reported. Findings indicate a structured questionnaire yields description of fixations, which correspond well with clinical assessment. Descriptions supported discussion between parents and clinicians. It is proposed that the FVC-Q is a valuable tool in supporting clinicians in eliciting information about fixation skills. [ABSTRACT FROM AUTHOR]

Rebecca Sumalini,1– 3 Premalatha Errolla,4 Lokesh Lingappa,4 Miriam Conway,3 Ahalya Subramanian,3 PremNandhini Satgunam1 1Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India; 2Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India; 3Division of Optometry and Vision Sciences, City, University of London, London, United Kingdom; 4Department of Pediatric Neurology, Rainbow Children’s Hospitals, Hyderabad, IndiaCorrespondence: Rebecca Sumalini, Brien Holden Institute of Optometry and Vision Sciences, Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India, Tel +91-40-68102825, Email rebecca@lvpei.orgPurpose: Children with cerebral visual impairment (CVI) present with delayed developmental milestones. Pediatricians and pediatric neurologists are usually the first point of contact, and eye exam largely remains referral based. This study documented the visual concerns reported by parents of children with CVI visiting a pediatric neurology clinic. Additionally, we investigated the association between visual concerns, functional vision measures and visual functions.Patients and Methods: A cross-sectional study was undertaken in children with CVI (chronological age range: 7 months-7 years). Visual concerns reported by the parents/caregivers were documented as open-ended statements. Additionally, a functional vision assessment was conducted using the CVI Range instrument with phase 1, 2 and 3 indicating low, moderate and high visual functioning, respectively. Grating acuity and contrast sensitivity were measured using Teller acuity cards-II and Ohio contrast cards respectively.Results: A total of 73 children (mean age of 2.84 ± 1.87 years) were recruited. Sixty-eight parents reported visual concerns that were broadly grouped into 14 unique concerns. Nineteen parents (27.9%) reported more than one visual concern. Difficulty maintaining eye contact and recognizing faces were the top two visual concerns in phases 1 and 2. Missing objects in the lower visual field was the top concern in phase 3. A larger number of visual concerns were reported in phase 1 (43%) than phase 2 (40.6%) and phase 3 (16.2%). Multiple regression analysis revealed that grating acuity, contrast sensitivity and chronological age were able to predict the functional vision, F (3, 55) = 63.0, p < 0.001, r2 = 0.77.Conclusion: Targeted questions enquiring about eye contact and face recognition can be included in history elicitation in children with CVI in pediatric neurology clinics. In the presence of visual concerns, it will be important to assess grating acuity and contrast sensitivity. A poor functional vision score requires referral for eye examination and vision rehabilitation services.Keywords: functional vision, neurological visual impairment, CVI range, Teller acuity cards-II, Ohio contrast cards

Context: Cerebral visual impairment (CVI) is an overarching term, defined as a brain-based visual impairment with onset in childhood, unexplained by an ocular disorder and associated with unique visual and behavioral characteristics. Good vision and awareness of visual function in a child are highly essential as neuroplasticity is maximum in the first three years of life and response to intervention is utmost in this period. Awareness is lacking regarding CVI, and the diagnosis is largely missed. This can be easily addressed if a structured approach is employed. Purpose: This study aims to evaluate the etiology and radiological correlation with the severity of CVI and outcome after structured intervention in children with CVI. Settings and Design: Prospective--interventional study. Methods and Material: Children attending the Child Development Centre (CDC) of a tertiary care hospital in North Karnataka and diagnosed with CVI in the age group of six months to 12 years and meeting the sampling criteria were screened and enrolled consecutively after obtaining parental consent/assent. Statistical analysis used is nonparametric test with SPSS software. Results: Age showed a significant association with the phase of CVI. Perinatal insult was associated significantly with the severity of CVI. Magnetic resonance imaging (MRI) findings did not hamper the recovery of CVI. Conclusions: Enrolment in early intervention programs tailored according to child's specific needs should be encouraged, with stress on ophthalmic screening of preterm and high-risk babies with perinatal hypoxia and history of convulsions, as early as six months. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to develop a visually guided swim assay (VGSA) for measuring vision in mouse retinal disease models comparable to the multi-luminance mobility test (MLMT) utilized in human clinical trials. METHODS: Three mouse retinal disease models were studied: Bardet–Biedl syndrome type 1 (Bbs1M390R/M390R), n = 5; Bardet–Biedl syndrome type 10 (Bbs10−/−), n = 11; and X linked retinoschisis (retinoschisin knockout; Rs1-KO), n = 5. Controls were normally-sighted mice, n = 10. Eyeless Pax6Sey-Dey mice, n = 4, were used to determine the performance of animals without vision in VGSA. RESULTS: Eyeless Pax6Sey-Dey mice had a VGSA time-to-platform (TTP) 7X longer than normally-sighted controls (P < 0.0001). Controls demonstrated no difference in their TTP in both lighting conditions; the same was true for Pax6Sey-Dey. At 4–6 M, Rs1-KO and Bbs10−/− had longer TTP in the dark than controls (P = 0.0156 and P = 1.23 × 10−8, respectively). At 9–11 M, both BBS models had longer TTP than controls in light and dark with times similar to Pax6Sey-Dey (P < 0.0001), demonstrating progressive vision loss in BBS models, but not in controls nor in Rs1-KO. At 1 M, Bbs10−/− ERG light-adapted (cone) amplitudes were nonrecordable, resulting in a floor effect. VGSA did not reach a floor until 9–11 M. ERG combined rod/cone b-wave amplitudes were nonrecordable in all three mutant groups at 9–11 M, but VGSA still showed differences in visual function. ERG values correlate non-linearly with VGSA, and VGSA measured the continual decline of vision. CONCLUSION: ERG is no longer a useful endpoint once the nonrecordable level is reached. VGSA differentiates between different levels of vision, different ages, and different disease models even after ERG is nonrecordable, similar to the MLMT in humans. [ABSTRACT FROM AUTHOR]

Introduction – Parkinson’s disease is a progressive neurodegenerative disorder with motor symptoms, as well as non-motor symptoms at the oculo-visual level. It has an annual incidence rate of 14 patients per 100,000 inhabitants, increasing with age. With an estimated 10 million people in the world population living with the disease. Objectives – The aim of conducting this scoping review is to identify the changes caused by Parkinson’s Disease on Vision, described in the literature based on scientific articles. Methods – The articles selected for this scoping review were collected between November 2020 and January 2021 in the PubMed/ MEDLINE and Web of Science databases. Studies on vision alterations in Parkinson’s disease including articles published in the last five years. Results and Discussion – A total of 104 articles were obtained, and 22 articles were selected according to the inclusion and exclusion criteria. The two main visual functions most affected in Parkinson’s disease are contrast sensitivity – changed in a greater number of articles in the intermediate stage, phase 2 (Hoehn and Yahr scale) and from the value 22.4 (ETDRS III scale) – and color vision. The change in visual acuity, the reduction in reading speed resulting from changes in saccadic movements, and the reduction in mobility – phase 3 (Hoehn and Yahr scale) and from value 37 (ETDRS III scale), visual attention and stereopsy were also reported. Changes in functional vision usually appear in the advanced stages of the disease, while in visual function they appear in earlier stages. Conclusions – The oculo-visual dysfunction is increasingly recognized as a non-motor manifestation of Parkinson’s disease, causing changes both in visual function (visual acuity, stereopsis, eye movement and contrast sensitivity and colour vision) and in functional vision (reading and mobility). Further studies should be carried out with the purpose of analyzing the impact of these changes on the quality of life of these patients. [ABSTRACT FROM AUTHOR]

Cataract is a leading cause of visual impairment in old age. Lens opacification is notoriously associated with several geriatric conditions, including frailty, fall risk, depression and cognitive impairment. The association is largely attributable to visual impairment, while other mechanisms, associated with extraocular comorbidity and lifestyle, might partly explain this correlation. Available literature suggests that cataract surgery may be effective in decreasing fall risk, improving depressive symptoms and limiting the risk of cognitive impairment and dementia incidence, although intervention studies on these outcomes are still limited. In this review we also emphasize the need to move from the concept of visual acuity to functional vision, especially in the context of the geriatric patient. Research is needed regarding the effect on the cited outcomes of different cataract treatment strategies, such as systematic bilateral versus monolateral surgery and use of different intraocular lenses.

Background: Smooth pursuit eye movements (SPEM) are critical to humans' ability to see and interact with the world. However, limitations exist in the assessment of oculomotor training designed to improve SPEM. The purpose of this study was to determine whether participants with poor SPEM improved via a standardized oculomotor training program. The secondary objective was to quantify the change in SPEM accurately using eye tracking. The third objective was to examine participants' neurobehavioral symptoms before and after oculomotor training using the Neurobehavioral Symptom Inventory (NSI). Methods: Four SPEM metrics, including Functional Vision EyeQ score, on target, latent and predictive pursuit percentages, and symptoms using NSI were assessed. Participants were randomly assigned either to the intervention (IG) or no intervention (NI) groups. The intervention group performed 10 minutes of oculomotor training daily for five days using the EyeQ Trainer, while the NI group did not receive any intervention. Each group comprised 46 participants, with mean ages of 35.43±22.9 and 41.59±22.3 years for the intervention and NI groups, respectively. Results: There were significant interactions between groups (intervention and NI) and times (pre- and post-oculomotor training) for all four SPEM metrics and NSI symptoms (p<0.05). The SPEM metrics showed improved tracking abilities and a significant reduction in NSI symptoms in the intervention group compared to the NI group post training. Conclusions: This study demonstrated that oculomotor training showed improved SPEM metrics and reduction in symptoms. Future research should consider the examination of eye movement metrics for saccades and gaze stability. [ABSTRACT FROM AUTHOR]

The sense of sight plays a very important role in the life of every individual, since we receive most of the information from the environment with the help of sight. Visually impaired children have difficulty receiving information from the world around them. Lack of visual experience can negatively affect their development. Timely examinations and assessments will indicate the occurrence of various neurological disorders in children, if any are present. A very common cause of neurological disorders is perinatal brain damage. Children with perinatal brain damage often have difficulties in visual functioning and it is therefore very important to assess functional vision in these children. If there are any neurodevelopmental disorders in the child, it is important to start vision rehabilitation as soon as possible, in order to effectively influence the improvement of visual functions.

Background: Information, including healthrelated material, is increasingly being shared electronically. Older adults with relatively normal visual acuity can have functional vision loss (e.g., visual field, contrast) that can impact their ability to view this material. Smartphones have builtin vision accessibility settings that allow text to be enhanced. However, many may not be aware of these features. Older adults presenting for eye examinations were surveyed about their use of smartphones and vision accessibility features. Methods: A convenience sample attending a geriatric-based eye clinic was surveyed. Respondents had visual acuity better than or equal to 20/40, were =60 years old, and verified their own smartphone use/ownership. Results: Of the 59 people surveyed, all used their smartphone as a telephone. The majority used it for texting (91.5%), internet access (72.9%), e-mail (69.5%), additional light (62.7%), other apps (52.5%), and social media (50.8%). Fewer respondents (27.2%) reported using apps for health/diet/wellness. When the use of multiple methods to access content was considered, only 35.6% used it to text, e-mail, and access the internet/apps related to health diet or wellness. Many may not be seeking out additional training on smartphone use since the majority (82%) reported already using their smartphone for everything that they desired. Accessibility feature use was reported by 33.9%. The majority (70.0%) solely increased font size. Accessibility settings were changed by patients themselves or by a friend/family member (90%). About one-quarter (23.7%) did not use/know about these features. There was a statistical correlation between younger age and social media use. Conclusion: The large majority of respondents used their smartphone to access electronic communication/information; however, variability existed. These findings support the development/recommendation of electronic health materials. However, consideration should be given to methods for accessing content. The majority of respondents were not using vision accessibility features, and many did not know about them. None had an eye care provider/staff modify these features. Examination findings can be used to tailor suggestions about optimal smartphone settings. [ABSTRACT FROM AUTHOR]

Abstract Background To describe the outcomes of patients with retinitis pigmentosa (RP) who received the Argus II Retinal Prosthesis System. Methods This retrospective, interventional case series evaluated 10 consecutive patients who received the Argus II retinal implant and underwent visual function tests with the system on and system off. The main outcome measures were safety (the number, seriousness, and relatedness of adverse events), and visual function measured by computer-based objective tests, including square localization (SL) and direction of motion (DOM). Secondary measures included functional vision performance, including orientation and mobility (O&M) tasks. Results There were no intraoperative complications and all prostheses remained implanted at the end of follow up. The mean patient age was 41.3 years; mean duration of the implant in vivo was 2.1 years. One patient had a suture exposure over the coil suture tab and over the inferior case suture tab at 2 years postoperatively, which was managed successfully. One patient developed mild vitreous hemorrhage that resolved spontaneously. One patient developed high intraocular pressure postoperatively due to a tight scleral band (SB) that was managed successfully. Patients performed significantly better with the Argus II system on than off on all tasks. Conclusion Patients who received the Argus II had a safety profile out to 4 years post-implantation that was markedly better than that observed in the pre-approval phase of the Argus II. In this population of RP patients, the Argus II retinal prosthesis provided useful visual function over several years that likely translates into improved quality of life. Trial Registration: clinicaltrials.gov identifier, NCT00407602.

Health-related Quality of Life (HRQOL) and its relation with functional vision is understudied in cerebral visual impairment (CVI). Characterising HRQOL, comparing child self- and parent proxy-reports, and exploring relations with functional vision. Seventy-three children with CVI (n females = 33; n males = 40; Mean performance age = 7y2m) were included. HRQOL was measured with Pediatric Quality of Life Inventory (PedsQL) child self- and parent proxy-reports and compared using Wilcoxon signed-rank tests. Risk for impaired HRQOL was evaluated using cut-off scores. Parents scored functional vision using the Insight Questions Inventory and the Flemish CVI Questionnaire. 61 % (self-reported) or 66 % of children (proxy-reported) were at-risk for impaired total HRQOL. Ratings were correlated (r s = 0.305; p = 0.013); however, children rated higher total HRQOL compared to parent-proxy (r = 0.382; p = 0.002). The Insight Questions Inventory and the PedsQL proxy-report were correlated (r p = −0.454; p < 0.001), the Flemish CVI Questionnaire was negligibly correlated (r p = −0.244; p = 0.041). HRQOL is reduced in CVI, and both child and parent perspectives are crucial. HRQOL and functional vision are intricately related, and impairment in one negatively affects the other. • Children with cerebral visual impairment are at risk for impaired quality of life. • Children with cerebral visual impairment rate quality of life higher than parents. • 61 % of children with cerebral visual impairment report impaired quality of life. • 66 % of parents report impaired quality of life in their children. • Impaired functional vision relates to impaired health-related quality of life. [ABSTRACT FROM AUTHOR]

Accurate visual information is needed to guide and perform efficient movements in daily life. To investigate the relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy (uCP). In 49 children with uCP (7-15 y), we investigated the relation between stereoacuity (Titmus Stereo Fly test), visual perception (Test of Visual Perceptual Skills), visuomotor integration (Beery Buktenica Test of Visual-Motor Integration) and functional vision (Flemish cerebral visual impairment questionnaire) with bimanual dexterity (Tyneside Pegboard Test), bimanual coordination (Kinarm exoskeleton robot, Box opening task), and functional hand use (Children's Hand-use Experience Questionnaire; Assisting Hand Assessment) using correlations (r s) and elastic-net regularized regressions (d). Visual perception correlated with bimanual coordination (r s =0.407-0.436) and functional hand use (r s =0.380-0.533). Stereoacuity (r s =−0.404), visual perception (r s =−0.391 to −0.620), and visuomotor integration (r s =−0.377) correlated with bimanual dexterity. Functional vision correlated with functional hand use (r s =−0.441 to −0.458). Visual perception predicted bimanual dexterity (d =0.001-0.315), bimanual coordination (d =0.004-0.176), and functional hand use (d =0.001-0.345), whereas functional vision mainly predicted functional hand use (d =0.001-0.201). Visual functions and functional vision are related to bimanual function in children with uCP highlighting the importance of performing extensive visual assessment to better understand children's difficulties in performing bimanual tasks. Previous findings showed that up to 62 % of children with unilateral cerebral palsy (uCP) present with visual impairment, which can further compromise their motor performance. However, the relation between visual and motor function has hardly been investigated in this population. This study makes a significant contribution to the literature by comprehensively investigating the multi-level relation between the heterogenous spectrum of visual abilities and bimanual function in children with uCP. We found that mainly decreased visual perception was related to decreased bimanual dexterity, bimanual coordination, and functional hand use while impairments in functional vision were only related to decreased functional hand use. Additionally, elastic-net regression models showed that visual assessments can predict bimanual function in children with uCP, however, effect sizes were only tiny to small. With our study, we demonstrated a relation between visual functions and bimanual function in children with uCP. These findings suggest the relevance of thoroughly examining visual functions in children with uCP to identify the presence of visual impairments that may further compromise their bimanual function. • Visual impairment related to bimanual function deficits in children with uCP. • Mostly visual perception was related to bimanual function. • Functional vision mainly related to the perceived quality of bimanual activities. • Visual functions/functional vision predicted different aspects of bimanual function. • Visual assessment is warranted to understand the clinical complexity of CP. [ABSTRACT FROM AUTHOR]

When we study the human ability to attend, what exactly do we seek to understand? It is not clear what the answer might be to this question. There is still so much to know, while acknowledging the tremendous progress of past decades of research. It is as if each new study adds a tile to the mosaic that, when viewed from a distance, we hope will reveal the big picture of attention. However, there is no map as to how each tile might be placed nor any guide as to what the overall picture might be. It is like digging up bits of mosaic tile at an ancient archeological site with no key as to where to look and then not only having to decide which picture it belongs to but also where exactly in that puzzle it should be placed. I argue that, although the unearthing of puzzle pieces is very important, so is their placement, but this seems much less emphasized. We have mostly unearthed a treasure trove of puzzle pieces but they are all waiting for cleaning and reassembly. It is an activity that is scientifically far riskier, but with great risk comes a greater reward. Here, I will look into two areas of broad agreement, specifically regarding visual attention, and dig deeper into their more nuanced meanings, in the hope of sketching a starting point for the guide to the attention mosaic. The goal is to situate visual attention as a purely computational problem and not as a data explanation task; it may become easier to place the puzzle pieces once you understand why they exist in the first place. [ABSTRACT FROM AUTHOR]

Cerebral Visual Impairment (CVI) has become the leading cause of children's visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized diagnostic methods to assess CVI in children, and the role of visual functions in children's neuropsychological profiles has been poorly investigated. In the present paper, we aim to describe the clinical and neuropsychological profiles and to investigate the possible effects of visual functions on neuropsychological performance of a cohort of children diagnosed with CVI. Fifty-one children with CVI were included in our retrospective analysis (inclusion criteria: verbal IQ > 70 in Wechsler scales; absence of significant ocular involvement). For each participant, we collected data on neuropsychological assessment (i.e., cognitive, cognitive visual, and learning abilities), basic visual functions (e.g., Best Corrected Visual Acuity—BCVA, contrast sensitivity, and ocular motor abilities) and global development features (e.g., neurological signs and motor development delay) based on standardized tests, according to patients' ages. The results showed that oculomotor dysfunction involving saccades and smooth pursuit may be a core symptom of CVI and might have a significant impact on cognitive visual and other neuropsychological abilities. Furthermore, visual acuity and contrast sensitivity may influence cognitive, cognitive visual, and academic performances. Our findings suggest the importance of a comprehensive assessment of both visual and neuropsychological functions in children when CVI is suspected, which is needed to provide a more comprehensive functional profile and define the best habilitation strategy to sustain functional vision. [ABSTRACT FROM AUTHOR]

ObjectiveThe purpose of this analysis was to compare observer-rated tasks in patients implanted with the Argus II Retinal Prosthesis System, when the device is ON versus OFF.MethodsThe Functional Low-Vision Observer Rated Assessment (FLORA) instrument was administered to 26 blind patients implanted with the Argus II Retinal Prosthesis System at a mean follow-up of 36 months. FLORA is a multi-component instrument that consists in part of observer-rated assessment of 35 tasks completed with the device ON versus OFF. The ease with which a patient completes a task is scored using a four-point scale, ranging from easy (score of 1) to impossible (score of 4). The tasks are evaluated individually and organised into four discrete domains, including 'Visual orientation', 'Visual mobility', 'Daily life and 'Interaction with others'.ResultsTwenty-six patients completed each of the 35 tasks. Overall, 24 out of 35 tasks (69 per cent) were statistically significantly easier to achieve with the device ON versus OFF. In each of the four domains, patients' performances were significantly better (p < 0.05) with the device ON versus OFF, ranging from 19 to 38 per cent improvement.ConclusionPatients with an Argus II Retinal Prosthesis implanted for 18 to 44 months (mean 36 months), demonstrated significantly improved completion of vision-related tasks with the device ON versus OFF.

Introduction: Stereo vision adds an extra dimension to aid depth perception and gives a binocular advantage in task completion. Aim: To study the perception of the presence and importance of binocular vision in the general population. Materials and Methods: A standard questionnaire in the local language was circulated amongst 500 people in the outpatient department (OPD). Group 1 had studied < 12th standard, and Group 2 had studied up to 12th standard or more. Results: More participants in Group 2 said that the purpose of having two eyes was to see, for aesthesis, and also for a better quality of vision than those in Group 1 (P = 0.011 s); they knew that it was advantageous to have both eyes work together as one unit than did those in Group 1. (P = 0.010 s) Similarly, Group 2 knew why a squint developed (P = 0.002) and that there was a relationship between a squint and binocular single vision (BSV) (P = 0.000). Group 2 knew that a squint could be treated (P < 0.0001 s). Group 1 did not know the importance of the early treatment of strabismus (P < 0.0001 s). Participants in both groups were aware that they could face difficulty in doing certain jobs due to less vision in one eye (P = 0.201 ns); as well as that visual impairment in children could be prevented in at least some children if vision testing was done during the preschool years. Conclusion: It is important to raise awareness among the general population of the concept of binocular vision and its relationship to strabismus.

Abnormal dislocation of cone opsin protein affects the sensitivity function of photoreceptors and results in depressed central vision. Nutraceutical therapy is needed to restore the residual function of photoreceptors. Crocin is a natural substance for retinal health. However, its effect on the restoration of functional vision and its underlying mechanisms have not been fully studied. This study analyzed the restorative effect of crocin on residual functional vision in vivo in a mouse model. High-energy light-evoked photoreceptor dysfunction was confirmed by M opsin dislocation in the retina accompanied by a loss of functional vision. Crocin treatment significantly increased brain-derived neurotrophic factor (BDNF) protein in retinas, thus contributing to the re-localization of the M opsin protein, restoration of the visual acuity (VA), and high spatial frequency-characterized visual contrast sensitivity function (VCSF). In contrast, such effects were significantly reversed after the washout period. Additionally, the restorative effect of crocin on functional vision and M opsin re-localization can be reversed and blocked by synchronous injection of a tropomyosin receptor kinase B (TrkB) receptor antagonist (ANA-12). This study demonstrated the major functional vision-rescuing or restoring effect of crocin in vivo by modulating M opsin location plasticity and increasing the capacity of the residual photoreceptor function through the BDNF–TrkB receptor pathway. [ABSTRACT FROM AUTHOR]

Light-evoked retinal photodamage is considered an important factor contributing to functional vision deterioration and can even lead to light maculopathy or dry age-related macular degeneration. Loss of visual acuity (VA) and visual contrast sensitivity function (VCSF) are the major symptoms of retinal degenerative diseases. Cordyceps militaris is a carotenoid-rich Chinese medicinal fungus with antioxidant, anti-inflammatory, and immunomodulatory functions. C. militaris extract is a natural substance, and its bioactive constituents have been shown to confer health benefits, but their application in retinal tissue and functional vision protection in vivo remain incompletely understood. In the present study, we evaluated the influence of water-soluble, carotenoid-rich C. militaris extracts on the visual performance of light-damaged mouse retinas in vivo, using adult female CD-1® (ICR) albino mice. We showed that oral administration of this C. militaris extract (10 mg/kg, twice daily) protected the neural retina tissue against light-evoked photoreceptor cell death, reduced Müller cell hypertrophic gliosis, and elevated GSH levels and promoted the recovery of VA- and VCSF-thresholds, especially for high spatial frequency-characterized vision. These results suggest that, probably because of its water-soluble carotenoids, C. militaris extract has the potential to prevent or treat light-induced visual dysfunction. [ABSTRACT FROM AUTHOR]

IntroductionA comprehensive assessment of visual functioning at an early age is important not only for identifying and defining visual impairment but also for planning personalized rehabilitation programs based on the visual diagnosis. Since existing tools to evaluate visual functioning present some important limitations (e.g., they are based on qualitative reports, they do not take into account environmental adaptations of visual testing or they have not been formally validated as clinical instruments), the present work has the main aim to propose a new clinical tool (Visual Function Score, VFS) to detect and define visual disorders at an early age.MethodsThe Visual Function Score was administered to one hundred visually impaired children (age range 4 months to 17.75 years old) in the form of a professional-reported protocol for a total of 51 items, each of which is assigned a score from 1 to 9 (or from 0 to 9 in some specific cases). The VFS produces three sub-scores and a global score (from 0 to 100), resulting in a quantitative evaluation of visual functioning.ResultsThe VFS can detect the well-known differences between different types of visual impairment (cerebral, oculomotor, and peripheral or grouped as central and peripheral) and takes into account different environments in the definition of a quantitative score of visual functioning.DiscussionOverall, the use of a quantitative tool to evaluate visual functions and functional vision such as the VFS would be fundamental to monitor the progresses of patients over time in response to rehabilitation interventions.

ObjectivesTo evaluate the eye-related quality of life (ER-QOL), functional vision, and their determinants in children following congenital and developmental cataract surgery, as the impact on their families, using the Pediatric Eye Questionnaire (PedEyeQ).Materials and MethodsThis was a retrospective cross-sectional study involving 107 children (aged 0–11 years) with congenital and developmental cataracts who had undergone surgery, as well as 59 visually healthy controls (aged 0–11 years). One parent for each child completed either the Proxy 0–4 PedEyeQ, the Proxy 5–11 PedEyeQ, or the Parent PedEyeQ, depending on their child's age. Mann-Whitney U and Kruskal-Wallis tests were then conducted to compare the differences between groups and to analyze their determinants.ResultsPedEyeQ scores were found to be lower in postoperative children with congenital and developmental cataracts compared with the control group across all study domains. The PedEyeQ Proxy 0 to 4 years' greatest mean difference was 27 points worse in the Functional Vision domain (95% CI −34 to −19; p < 0.001). We also found that the occurrence of nystagmus (p < 0.005) and strabismus (p < 0.005) were the major factors affecting participants' functional vision. The PedEyeQ Proxy 5 to 11 years' greatest mean difference was 23 points worse in this same domain (95% CI −30 to −15; p < 0.001), with nystagmus (p < 0.05) being the main determinant herein. Parent PedEyeQ 0 to 4 years' greatest difference was 46 points worse on the Worry about their Child's Eye Condition domain (95% CI −57 to −36; p < 0.001). Similarly, parents of children with ophthalmologic abnormalities, including nystagmus (p < 0.001) and strabismus (p < 0.05), were significantly more worried about their children's eye condition. Parent PedEyeQ 5 to 11 years' greatest difference was also found to be 30 points worse on the Worry about their Child's Eye Condition domain (95% CI −43 to −17; p < 0.005).ConclusionsChildren who have undergone congenital and developmental cataract surgery experience a lower quality of life and reduced functional vision. Their families are also significantly and adversely affected herein. Thus, more attention is needed on these groups, with more focused measures being administered to both children and their families.

Purpose: The aim of this study was to evaluate the effect of four different filters on contrast sensitivity under photopic and mesopic conditions with and without glare.Methods: A forced choice algorithm in a Bayesian psychophysical procedure was utilized to evaluate the spatial luminance contrast sensitivity. Five different spatial frequencies were evaluated: 1.5, 3, 6, 12, and 18 cycles per degree (cpd). The measurements were performed under 4 settings: photopic and mesopic luminance with glare and no glare. Two long pass filters (LED light reduction and 511nm filter) and two selective absorption filters (ML41 and emerald filter) and a no filter condition were evaluated. The measurements were performed in 9 young subjects with healthy eyes.Results: For the no filter condition, there was no difference between glare and no glare settings for the photopic contrast sensitivity measurements whereas in the mesopic setting, glare reduced the contrast sensitivity significantly at all spatial frequencies. There was no statistically significant difference between contrast sensitivity measurements obtained with different filters under both photopic conditions and the mesopic glare condition. In the mesopic no glare condition, the contrast sensitivity at 6 cpd with 511, ML41 and emerald filters was significantly reduced compared to no filter condition (p = 0.045, 0.045, and 0.071, respectively). Similarly, with these filters the area under the contrast sensitivity function in the mesopic no glare condition was also reduced. A significant positive correlation was seen between the filter light transmission and the average AULCSF in the mesopic non-glare condition.Conclusion: The contrast sensitivity measured with the filters was not significantly different than the no filter condition in photopic glare and no glare setting as well as in mesopic glare setting. In mesopic setting with no glare, filters reduced contrast sensitivity.

Purpose: The aim of this study was to evaluate the effect of four different filters on contrast sensitivity under photopic and mesopic conditions with and without glare. Methods: A forced choice algorithm in a Bayesian psychophysical procedure was utilized to evaluate the spatial luminance contrast sensitivity. Five different spatial frequencies were evaluated: 1.5, 3, 6, 12, and 18 cycles per degree (cpd). The measurements were performed under 4 settings: photopic and mesopic luminance with glare and no glare. Two long pass filters (LED light reduction and 511nm filter) and two selective absorption filters (ML41 and emerald filter) and a no filter condition were evaluated. The measurements were performed in 9 young subjects with healthy eyes. Results: For the no filter condition, there was no difference between glare and no glare settings for the photopic contrast sensitivity measurements whereas in the mesopic setting, glare reduced the contrast sensitivity significantly at all spatial frequencies. There was no statistically significant difference between contrast sensitivity measurements obtained with different filters under both photopic conditions and the mesopic glare condition. In the mesopic no glare condition, the contrast sensitivity at 6 cpd with 511, ML41 and emerald filters was significantly reduced compared to no filter condition (p = 0.045, 0.045, and 0.071, respectively). Similarly, with these filters the area under the contrast sensitivity function in the mesopic no glare condition was also reduced. A significant positive correlation was seen between the filter light transmission and the average AULCSF in the mesopic non-glare condition. Conclusion: The contrast sensitivity measured with the filters was not significantly different than the no filter condition in photopic glare and no glare setting as well as in mesopic glare setting. In mesopic setting with no glare, filters reduced contrast sensitivity. [ABSTRACT FROM AUTHOR]

Background: To describe the outcomes of patients with retinitis pigmentosa (RP) who received the Argus II Retinal Prosthesis System. Methods: This retrospective, interventional case series evaluated 10 consecutive patients who received the Argus II retinal implant and underwent visual function tests with the system on and system off. The main outcome measures were safety (the number, seriousness, and relatedness of adverse events), and visual function measured by computer-based objective tests, including square localization (SL) and direction of motion (DOM). Secondary measures included functional vision performance, including orientation and mobility (O&M) tasks. Results: There were no intraoperative complications and all prostheses remained implanted at the end of follow up. The mean patient age was 41.3 years; mean duration of the implant in vivo was 2.1 years. One patient had a suture exposure over the coil suture tab and over the inferior case suture tab at 2 years postoperatively, which was managed successfully. One patient developed mild vitreous hemorrhage that resolved spontaneously. One patient developed high intraocular pressure postoperatively due to a tight scleral band (SB) that was managed successfully. Patients performed significantly better with the Argus II system on than off on all tasks. Conclusion: Patients who received the Argus II had a safety profile out to 4 years post-implantation that was markedly better than that observed in the pre-approval phase of the Argus II. In this population of RP patients, the Argus II retinal prosthesis provided useful visual function over several years that likely translates into improved quality of life. Trial Registration: clinicaltrials.gov identifier, NCT00407602. [ABSTRACT FROM AUTHOR]

Many children have undetected vision problems or insufficient visual information processing that may be a factor in lower academic outcomes. The aim of this paper is to contribute to a better understanding of the importance of vision screening for school-aged children, and to investigate the possibilities of how eye-tracking (ET) technologies can support this. While there are indications that these technologies can support vision screening, a broad understanding of how to apply them and by whom, and if it is possible to utilize them at schools, is lacking. We review interdisciplinary research on performing vision investigations, and discuss current challenges for technology support. The focus is on exploring the possibilities of ET technologies to better support screening and handling of vision disorders, especially by non-vision experts. The data orginate from a literature survey of peer-reviewed journals and conference articles complemented by secondary sources, following a rapid review methodology. We highlight current trends in supportive technologies for vision screening, and identify the involved stakeholders and the research studies that discuss how to develop more supportive ET technologies for vision screening and training by non-experts. [ABSTRACT FROM AUTHOR]

Abstract Background To assess cross-cultural validity between Dutch and English versions of the FVQ_CYP, a patient-reported outcome measure developed in the United Kingdom (UK) for children and adolescents with (severe) visual impairment or blindness (VI for brevity) to measure functional vision. Methods The 36-item FVQ_CYP was translated and adapted into Dutch using standard guidelines. The questionnaire was administered to Dutch children and adolescents aged 7–17 years (N = 253) with impaired vision (no restrictions regarding acuity). Data were compared to existing UK data of children and adolescents aged 10–15 years (N = 91) with VI (acuity LogMar worse than 0.48). As with the original UK FVQ_CYP validation, a rating scale model (RSM) was applied to the Dutch data. Results Minor adaptations were needed in translation-rounds. Significant differences in item responses were found between the Dutch and UK data. Item response theory assumptions were met, but fit to the RSM was unsatisfactory. Therefore, psychometric properties of the Dutch FVQ_CYP were analysed irrespective of the original model and criteria used. A graded response model led to the removal of 12 items due to missing data, low information, overlapping content and limited relevance to Dutch children. Fit indices for the remaining 24 items were adequate. Conclusions Differences in population characteristics, distribution of responses, non-invariance at the model level and small sample sizes challenged the cross-cultural validation process. However, the Dutch adapted FVQ_CYP showed high measurement precision and broad coverage of items measuring children’s functional vision. The underlying reasons for differences between countries in instrument performance are discussed with implications for future studies.

When we study the human ability to attend, what exactly do we seek to understand? It is not clear what the answer might be to this question. There is still so much to know, while acknowledging the tremendous progress of past decades of research. It is as if each new study adds a tile to the mosaic that, when viewed from a distance, we hope will reveal the big picture of attention. However, there is no map as to how each tile might be placed nor any guide as to what the overall picture might be. It is like digging up bits of mosaic tile at an ancient archeological site with no key as to where to look and then not only having to decide which picture it belongs to but also where exactly in that puzzle it should be placed. I argue that, although the unearthing of puzzle pieces is very important, so is their placement, but this seems much less emphasized. We have mostly unearthed a treasure trove of puzzle pieces but they are all waiting for cleaning and reassembly. It is an activity that is scientifically far riskier, but with great risk comes a greater reward. Here, I will look into two areas of broad agreement, specifically regarding visual attention, and dig deeper into their more nuanced meanings, in the hope of sketching a starting point for the guide to the attention mosaic. The goal is to situate visual attention as a purely computational problem and not as a data explanation task; it may become easier to place the puzzle pieces once you understand why they exist in the first place.

Cerebral Visual Impairment (CVI) has become the leading cause of children’s visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized diagnostic methods to assess CVI in children, and the role of visual functions in children’s neuropsychological profiles has been poorly investigated. In the present paper, we aim to describe the clinical and neuropsychological profiles and to investigate the possible effects of visual functions on neuropsychological performance of a cohort of children diagnosed with CVI. Fifty-one children with CVI were included in our retrospective analysis (inclusion criteria: verbal IQ > 70 in Wechsler scales; absence of significant ocular involvement). For each participant, we collected data on neuropsychological assessment (i.e., cognitive, cognitive visual, and learning abilities), basic visual functions (e.g., Best Corrected Visual Acuity—BCVA, contrast sensitivity, and ocular motor abilities) and global development features (e.g., neurological signs and motor development delay) based on standardized tests, according to patients’ ages. The results showed that oculomotor dysfunction involving saccades and smooth pursuit may be a core symptom of CVI and might have a significant impact on cognitive visual and other neuropsychological abilities. Furthermore, visual acuity and contrast sensitivity may influence cognitive, cognitive visual, and academic performances. Our findings suggest the importance of a comprehensive assessment of both visual and neuropsychological functions in children when CVI is suspected, which is needed to provide a more comprehensive functional profile and define the best habilitation strategy to sustain functional vision.

Five table-top tasks were developed to test the visual search ability of children and young people in a real-world context, and to assess the transfer of training-related improvements in visual search on computerised tasks to real-world activities. Each task involved searching for a set of target objects among distracting objects on a table-top. Performance on the Table-top Visual Search Ability Test for Children (TVSAT-C) was measured as the time spent searching for targets divided by the number of targets found. A total of 108 typically developing children (3–11 years old) and eight children with vision impairment (7–12 years old) participated in the study. A significant correlation was found between log-transformed age and log-transformed performance (R 2 =.65, p = 4 × 10−26) in our normative sample, indicating a monomial power law relationship between age and performance with an exponent of − 1. 67 , 95 % CI [ − 1. 90 , − 1. 43 ]. We calculated age-dependent percentiles and receiver operating characteristic curve analysis indicated the third percentile as the optimal cut-off for detecting a visual search deficit, giving a specificity of 97. 2 % , 95 % CI [ 92. 2 % , 99. 1 % ] and sensitivity of 87. 5 % , 95 % CI [ 52. 9 % , 97. 8 % ] for the test. Further studies are required to calculate measures of reliability and external validity, to confirm sensitivity for visual search deficits, and to investigate the most appropriate response modes for participants with conditions that affect manual dexterity. In addition, more work is needed to assess construct validity where semantic knowledge is required that younger children may not have experience with. We have made the protocol and age-dependent normative data available for those interested in using the test in research or practice, and to illustrate the smooth developmental trajectory of visual search ability during childhood. [ABSTRACT FROM AUTHOR]

Background: Age-related vision changes significantly contribute to fatal crashes at night among older drivers. However, the effects of lighting conditions on age-related vision changes and associated driving performance remain unclear., Objective: This pilot study examined the associations between visual function and driving performance assessed by a high-fidelity driving simulator among drivers 60 and older across 3 lighting conditions: daytime (photopic), nighttime (mesopic), and nighttime with glare., Methods: Active drivers aged 60 years or older participated in visual function assessments and simulated driving on a high-fidelity driving simulator. Visual acuity (VA), contrast sensitivity function (CSF), and visual field map (VFM) were measured using quantitative VA, quantitative CSF, and quantitative VFM procedures under photopic and mesopic conditions. VA and CSF were also obtained in the presence of glare in the mesopic condition. Two summary metrics, the area under the log CSF (AULCSF) and volume under the surface of VFM (VUSVFM), quantified CSF and VFM. Driving performance measures (average speed, SD of speed [SDspeed], SD of lane position (SDLP), and reaction time) were assessed under daytime, nighttime, and nighttime with glare conditions. Pearson correlations determined the associations between visual function and driving performance across the 3 lighting conditions., Results: Of the 20 drivers included, the average age was 70.3 years; 55% were male. Poor photopic VA was significantly correlated with greater SDspeed (r=0.26; P<.001) and greater SDLP (r=0.31; P<.001). Poor photopic AULCSF was correlated with greater SDLP (r=-0.22; P=.01). Poor mesopic VUSFVM was significantly correlated with slower average speed (r=-0.24; P=.007), larger SDspeed (r=-0.19; P=.04), greater SDLP (r=-0.22; P=.007), and longer reaction times (r=-0.22; P=.04) while driving at night. For functional vision in the mesopic condition with glare, poor VA was significantly correlated with longer reaction times (r=0.21; P=.046) while driving at night with glare; poor AULCSF was significantly correlated with slower speed (r=-0.32; P<.001), greater SDLP (r=-0.26; P=.001) and longer reaction times (r=-0.2; P=.04) while driving at night with glare. No other significant correlations were observed between visual function and driving performance under the same lighting conditions., Conclusions: Visual functions differentially affect driving performance in different lighting conditions among older drivers, with more substantial impacts on driving during nighttime, especially in glare. Additional research with larger sample sizes is needed to confirm these results., (©Jingzhen Yang, Enas Alshaikh, Deyue Yu, Thomas Kerwin, Christopher Rundus, Fangda Zhang, Cameron G Wrabel, Landon Perry, Zhong-Lin Lu. Originally published in JMIR Formative Research (https://formative.jmir.org), 26.06.2024.)

Children with special needs form a unique subset with regards to visual function and examination techniques needed to assess them. With more awareness among the general public, neurologists, and pediatricians, these children are referred for assessment to the ophthalmologist or optometrist and sometimes even to the rehabilitation professional at an early age. This clinical practice guideline and review gives a systematic approach for examining the visual functions of a child with special needs. It outlines the procedures to be followed with equipment needed in clinical practice. Functional vision assessment guidelines are also included. This is the first part in a two-part series, with the first part presenting clinical examination guidelines and the second presenting intervention and vision enhancement techniques.

Introduction: This study analyzed 39 data collection tools used by teachers of students with visual impairments when completing functional vision assessments (FVAs). Methods: In 2017, teachers of students with visual impairments submitted data collection tools used in the FVA process. These tools were then compared with the 23 FVA components suggested by two established resources, Erin and Paul and D'Andrea and Farrenkopf. Results: The most commonly assessed skills and abilities were near visual acuity, distance visual acuity, and color perception. Only five of the submitted data collection tools contained at least 80% of the FVA components identified by the established resources. Fewer than 25% of the tools incorporated an orientation and mobility (O&M) screening. Discussion: There was considerable variation in the background information, medical data, and visual skills information that was collected. Variability in the data collected during the FVA process may impact a teacher's recommendations, including referrals for specialized evaluations such as O&M and clinical low vision evaluations. Implications for practitioners: Since FVA reports are used by Individualized Education Program teams, it is essential that data collection tools used during the assessment process are complete and address key areas such as near visual acuity and color perception. Teachers should carefully review their tools to determine whether the data collected are sufficient to make informed recommendations regarding accommodations, goals, and referrals. If the data collected are not sufficient, then the tools should be revised or additional data should be collected. [ABSTRACT FROM AUTHOR]

BACKGROUND: The study aimed to assess the vision improvement with low vision aids (LVA) and functional vision among children learning in schools for the blind in North-East India. MATERIAL AND METHODS: 515 students from 17 blind schools of North-East India were recruited. The comprehensive ocular examination, functional vision assessment, and vision assessment using LVA were carried out for all the subjects after determining the magnification required for each subject. RESULTS: Of 515 children, 124 required LVA. Spectacle magnifiers were the most preferred (73 students, 58.87%), followed by magnifiers (50 students, 40.32%). A statistically significant improvement in the mean visual acuity was noted after the use of LVA (p < 0.001). CONCLUSION: A detailed assessment of low vision prior to admission to schools should be made mandatory in blind schools. These schools would be able to cater to really blind children, while children with low vision could attend regular schools. [ABSTRACT FROM AUTHOR]

The past two decades have witnessed an unprecedented evolution in the management of keratoconus that demands a holistic approach comprising of inhibiting the ectatic progression as well as visual rehabilitation. The advent of corneal cross-linking (CXL) in the late 1990s resulted in long-term stabilization of the ectatic cornea along with limited reduction in corneal steepening and regularization of corneal curvature. However, CXL as a standalone procedure does not suffice in rehabilitating the functional vision especially in patients who are unwilling or intolerant towards contact lenses. The concept of "CXL plus" was proposed which incorporates adjunctive use of refractive procedures with CXL in order to overcome the optical inefficiency due to corneal irregularity, decrease the irregular astigmatism, correct the residual refractive error and improve functional visual outcome in keratoconus. Several refractive procedures such as conductive keratoplasty (CK), photorefractive keratectomy (PRK), transepithelial phototherapeutic keratectomy (t-PTK), intrastromal corneal ring segments (ICRS) implantation, phakic intraocular lens (PIOL) implantation and multiple other techniques have been combined with CXL to optimize and enhance the CXL outcome. This review aimed to summarize the different protocols of CXL plus, provide guidelines for selection of the optimum CXL plus technique and aid in decision-making for the comprehensive management of cases with primary keratoconus in addition to discussing the future and scope for innovations in the existing treatment protocols. [ABSTRACT FROM AUTHOR]

Many children have undetected vision problems or insufficient visual information processing that may be a factor in lower academic outcomes. The aim of this paper is to contribute to a better understanding of the importance of vision screening for school-aged children, and to investigate the possibilities of how eye-tracking (ET) technologies can support this. While there are indications that these technologies can support vision screening, a broad understanding of how to apply them and by whom, and if it is possible to utilize them at schools, is lacking. We review interdisciplinary research on performing vision investigations, and discuss current challenges for technology support. The focus is on exploring the possibilities of ET technologies to better support screening and handling of vision disorders, especially by non-vision experts. The data orginate from a literature survey of peer-reviewed journals and conference articles complemented by secondary sources, following a rapid review methodology. We highlight current trends in supportive technologies for vision screening, and identify the involved stakeholders and the research studies that discuss how to develop more supportive ET technologies for vision screening and training by non-experts.

Sri Ganesh, Sheetal Brar, Archana PawarNethradhama Superspeciality Eye Hospital, Bangalore, Karnataka, India Purpose: To study the long-term visual and refractive outcomes and evaluate patient satisfaction after bilateral implantation of trifocal intraocular lenses (IOLs).Setting: Nethradhama Superspeciality Eye Hospital, Bangalore.Design: Prospective, nonrandomized study.Methods: Eligible patients undergoing bilateral phacoemulsification with trifocal IOL implantation were included. Follow-up examinations were conducted at day 1, 1 week, 1 month, 6 months, and 12 months. Postoperatively, 1 month onward evaluation of uncorrected and distance-corrected far and near visual acuity; reading acuity and reading speeds (using Salzburg Reading Desk) at 70, 80, and 90 cm; contrast sensitivity; defocus curves; and patient satisfaction was carried out.Results: Fifty eyes from 25 patients with a mean age of 58±13.44 years were included. All eyes showed significant improvement in spherical equivalent, uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, and corrected near visual acuity at 1 month compared to preoperative values (P0.05). At 12 months, mean uncorrected reading acuities and reading speeds at 70, 80, and 90 cm were in the range of 0.09–0.04 logMAR units and 153.6–169.0 words per minute, respectively, with significantly better results at 80 cm. Five eyes underwent YAG laser capsulotomy for early posterior capsule opacification (PCO) at a mean follow-up of 7.2±2.9 months. Contrast sensitivity scores at 12 months were comparable to 1 month (P>0.05 for all spatial frequencies). All patients reported good tolerance and 100% independence from spectacles for all activities.Conclusion: Trifocal IOLs provided excellent unaided vision at all distances. Reading performance was good through the complete intermediate distance range. PCO occurrence and subsequent YAG capsulotomy did not affect the long-term visual outcomes.Keywords: diffractive, trifocal, salzberg reading desk, reading speeds, intermediate vision, patient satisfaction

• Cerebral visual impairment (CVI) is the most common individual cause of pediatric visual impairment and blindness in developed countries. • Large gaps remain in our understanding of brain reorganization in CVI compared to the case of ocular based blindness. • Paradigms utilizing virtual reality may characterize visual deficits in an ecologically valid and clinically meaningful manner. • Advanced structural and functional neuroimaging approaches highlight key differences in the neural correlates associated CVI compared to ocular blindness. Cerebral visual impairment (CVI) results from perinatal injury to visual processing structures and pathways and is the most common individual cause of pediatric visual impairment and blindness in developed countries. While there is mounting evidence demonstrating extensive neuroplastic reorganization in early onset, profound ocular blindness, how the brain reorganizes in the setting of congenital damage to cerebral (i.e. retro-geniculate) visual pathways remains comparatively poorly understood. Individuals with CVI exhibit a wide range of visual deficits and, in particular, present with impairments of higher order visual spatial processing (referred to as "dorsal stream dysfunction") as well as object recognition (associated with processing along the ventral stream). In this review, we discuss the need for ongoing work to develop novel, neuroscience-inspired approaches to investigate functional visual deficits in this population. We also outline the role played by advanced structural and functional neuroimaging in helping to elucidate the underlying neurophysiology of CVI, and highlight key differences with regard to patterns of neural reorganization previously described in ocular blindness. [ABSTRACT FROM AUTHOR]