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Universal Design aims to ensure that as many people as possible can participate equally in society, with equal access to housing, education, workplaces, institutions, and public spaces. In the construction field, many of our existing guidelines still need to catch up regarding the diversity of user needs and preferences. Recent developments in low vision rehabilitation have underscored the pivotal role of domestic lighting in fostering independent living and enhancing the quality of life for people with visual impairments. Moreover, several stakeholder organizations and associations in the field of low-vision rehabilitation have published lighting guidelines for this target group. A direct comparison of the different guidelines is difficult, as their focus, vocabulary, and level of abstraction differ: the rehabilitation process focuses on optimizing lighting to support and aid the individual's abilities in the existing environment. It is not directly related to the design- or construction process. Yet, how do the guidelines for lighting fit the actual settings and conditions in Danish homes of people with incipient vision loss or visual impairment today? In this paper, a selection of these guidelines is assessed and analyzed in relation to three lighting categories: illuminance, luminance, and the visual system. The guidelines are also compared to the initial findings of an ongoing field study. This field study, a crucial component of the research, investigates the role of lighting for individuals experiencing incipient vision loss. This comprehensive approach, which includes both theoretical guidelines and real-world observations, ensures the reliability and relevance of the research, providing a solid foundation for the findings. The practical implications of this research are significant, as it provides valuable insights for architects, researchers, and individuals with visual impairment. Through observations and walk-along interviews in their home environment, we get their personal narratives and observe their lived everyday environments. 37 walk-along interviews were conducted from October 2023 - March 2024 during dark hours. The preliminary findings of the field observations, including observations and measurements, are compared to the guidelines of both the context of building design and -construction and the context of low-vision rehabilitation and stakeholder organizations.

The rich set of mechanoreceptors found in human skin 1,2 offers a versatile engineering interface for transmitting information and eliciting perceptions 3,4 , potentially serving a broad range of applications in patient care 5 and other important industries 6,7 . Targeted multisensory engagement of these afferent units, however, faces persistent challenges, especially for wearable, programmable systems that need to operate adaptively across the body 8-11 . Here we present a miniaturized electromechanical structure that, when combined with skin as an elastic, energy-storing element, supports bistable, self-sensing modes of deformation. Targeting specific classes of mechanoreceptors as the basis for distinct, programmed sensory responses, this haptic unit can deliver both dynamic and static stimuli, directed as either normal or shear forces. Systematic experimental and theoretical studies establish foundational principles and practical criteria for low-energy operation across natural anatomical variations in the mechanical properties of human skin. A wireless, skin-conformable haptic interface, integrating an array of these bistable transducers, serves as a high-density channel capable of rendering input from smartphone-based 3D scanning and inertial sensors. Demonstrations of this system include sensory substitution designed to improve the quality of life for patients with visual and proprioceptive impairments., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: Individuals with visual impairments use assistive technology in various aspects of life. Professionals who work with visually impaired people need to know about assistive technologies. The purpose of this study was to analyse the benefits and challenges of assistive technologies by assessing the degree of satisfaction with assistive technologies in different life situations expressed both by users and by professionals., Materials and Methods: Data were collected from 36 individuals with visual impairments and 27 professionals using online questionnaires. Further information was obtained from five individuals with visual impairments through focus group interviews., Results: The results show that 26 (72.2%) individuals with visual impairments and almost all professionals ( N  = 25; 92.6%) acknowledge the benefits of using assistive technology. They recognise the importance of assistive technology in independent living for individuals with visual impairments. However, 27 (75%) individuals with visual impairment and 26 (96.3%) professionals consider financial constraints to be the biggest problem., Conclusion: More cost-effective technologies need to be developed, and social policies and opportunities created so that every individual with visual impairment can obtain assistive technologies that meet their needs. This would increase the independence of individuals with visual impairments in all areas of life.

Background: This meta-analysis aimed to assess the impact of aerobic exercise on the balance and mobility of visually impaired individuals and identify potential factors affecting these outcomes., Methods: A systematic review was conducted following PRISMA guidelines. The eligibility criteria for the study included visual impairment in the participant population, type of visual impairment, aerobic exercise intervention, controlled trials, age, design, and outcomes. Data were extracted based on these seven questions, and a narrative synthesis approach was employed for analysis. A comprehensive search of the database yielded 1987 articles, and ultimately, 14 randomized controlled trials involving 685 participants were selected for inclusion., Results: The study findings indicate that aerobic exercise can greatly enhance the static balance ability [SMD = 1.23, 95%CI 0.80-1.66, p  < 0.00001] and dynamic balance ability [SMD = 1.04, 95% CI 0.09-1.99, p  = 0.03] of individuals with visual impairment. However, it appeared that mobility did not exhibit significant improvement [SMD = -0.49, 95% CI -1.06 to 0.09, p  = 0.10]. Through subgroup analysis, it was found that exercise frequency, age, and degree of visual impairment significantly affect static balance., Conclusions: Engaging in aerobic exercise 3-6 times per week, with each session lasting between 30 and 60 min, and continuing for a cycle of 8-16 weeks has been shown to enhance both dynamic and static balance in individuals with visual impairments.

Background: Collaborative interventions, involving partnerships between professionals and families, make it possible to actively engage families in the rehabilitation process. However, no study was found that used a physiotherapy intervention via telehealth for infants with Down syndrome (DS)., Objective: Describe the case report of a family-professional collaborative intervention via telehealth for an infant with Down syndrome and visual impairment during the COVID-19 pandemic., Case Description: A male infant five months old participated in a collaborative intervention for a period of eight weeks. Three goals were set with the family, and a goal-oriented home program, involving visual stimulation strategies, was organized., Outcomes: Two goals were achieved. The family scored changes in performance and satisfaction with the infant's performance according to the adapted Canadian Occupational Performance Measure. Improvement of motor skills was verified by Alberta Infant Motor Scale and changes in mobility and daily activities performance were measured by the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test., Conclusion: The use of family-professional collaborative intervention via telehealth during the COVID-19 pandemic shows promising results for achieving the goals established by the family collaboratively with the physical therapists.

Introduction: Occupational therapists working in low vision rehabilitation make recommendations for assistive technology (AT) and provide training in AT use for people with vision impairment (PVI) to support participation and independence. Smartphones and apps are an important AT for PVI, yet little is known about the training needs of PVI or what training is currently provided. Research exploring PVI's learning and training experiences is required to inform training development., Purpose: This study aimed to explore the perspectives, needs, and recommendations of PVI from Australia and Singapore on smartphone training methods., Methods: An online survey collected data between November 2020 to February 2021. Participants were recruited from Australia and Singapore using purposeful sampling. The survey had three sections: (i) demographics, (ii) use of smartphones and apps, and (iii) training. It consisted of 26 closed and open-ended questions. The quantitative results from the survey were analysed descriptively, and responses to open-ended questions were analysed using content analysis., Results: Sixty-eight PVI responded to the survey, with 34 (50%) participants from each country. There were more Australians (n = 19/34, 55.9%) who had accessed formal training compared to Singaporeans (n = 11/34, 32.3%). Participants valued both formal and informal training, and self-training was the most used method for informal training (Australia: n = 29/34, 85%, Singapore: n = 22/34, 64.7%). Participants stated they preferred individualised formal training that caters to their learning needs and is provided by patient and knowledgeable trainers. They also preferred formal training, which is flexible and convenient to access, including online training with peers., Conclusion: Findings such as providing individualised training, ensuring increased awareness of formal training, and using both formal and informal training methods can be considered by occupational therapists to enhance and develop training for PVI in the use of smartphones and apps., Consumer and Community Consultation: Consumers were involved at the development stage. Three people with vision impairment reviewed and provided feedback on the survey's accessibility and content., (© 2024 The Author(s). Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)

Purpose: To explore how youth with visual impairments perceive the usefulness of the Y-PEM (Youth and Young-adult Participation and Environment Measure) in capturing their participation and how information generated contributes to their understanding of participation experiences., Materials and Methods: A qualitative descriptive design was employed among 11 youth with visual impairment (3 females, 8 males) aged 17-24 (x¯ = 21, SD = 2.6) involving two remote sessions one week apart. First, the Y-PEM and QQ-10 questionnaire were administered to evaluate Y-PEM's utility (value and burden), analyzed descriptively. Then, youth reflected on their Y-PEM results via an individual semi-structured Stimulated Recall Interview (SRI), analyzed thematically., Results: A mean value-score of 77% (SD = 10.4) and burden-score of 19% (SD = 5.6) on the QQ-10 indicated the Y-PEM was perceived as valuable with relatively low burden. Three themes emerged from the interviews. Insights on participation revealed increased awareness of participation patterns and environmental factors. This led to a reflection on personal attributes about levels of comfort and familiarity, efforts required to participate, and personal preferences influencing participation experiences. Finally, approaches to participation elucidated strategies used in decision-making processes about pursuing participation., Conclusion: Findings suggest the Y-PEM is useful in capturing and promoting reflection of youth's participation patterns and environmental supports/barriers.

Individuals with multiple disabilities are among the most challenging to serve and AAC teams often lack direction in determining effective interventions. The purpose of this scoping review was to summarize the research evidence on AAC interventions for individuals with complex communication needs and simultaneous motor, and visual impairments as part of their multiple disabilities; to consider implications for practice; and to determine gaps and directions for future research. A total of 27 studies were identified and reviewed, involving 55 unique participants with multiple disabilities. Most studies focused on direct intervention to increase requesting or choice-making, with little focus on social communication. Only two studies focused on training communication partners. Results indicated that AAC interventions can be highly effective to increase communication for individuals with multiple disabilities. However, there is an urgent need for increased rigor and more detailed participant information in future AAC intervention research with this population. Future research should investigate AAC intervention to improve social communication and increase language development, not just expression of needs and wants. Future research should focus on the needs of individuals with multiple disabilities from culturally and linguistically diverse backgrounds and on implementation of AAC within natural environments.

Purpose: Despite the benefits of vision rehabilitation services (VRS) for uveitis patients, limited literature has examined issues in VRS access within uveitis. We surveyed American Uveitis Society members regarding VRS referral practices, criteria, and barriers., Methods: Survey responses were collected from November 2022 to January 2023. Analysis summarized responses and compared response patterns of frequently-referring and infrequently-referring providers through Fisher's exact tests and logistic regression., Results: Most of the 33 respondents completed 1 to 5 monthly referrals using criteria of visual acuity loss, visual field loss, and difficulty performing vision-related activities. Key referral barriers included cost of services and insufficient patient-provider communication regarding vision loss. The practice of speaking to patients about vision loss during clinic visits was correlated with higher VRS referral rates ( P  = 0.047)., Conclusions: Greater patient-provider communication about vision loss may represent an opportunity to increase access to VRS.

Purpose: In vocational education and training of computer literacy as part of vocational rehabilitation, learners often work on problem-solving exercises as self-study assignments, and check if their answers are correct. Sighted learners can get information on their incorrect answers by comparing their answers with the correct answers. However, learners with visual impairments largely depend on their teachers for getting this feedback. To remove this dependence, we designed a self-checking system for learners with visual impairments to verify the correctness of their answers. In this paper, we report the results of a usability study to evaluate whether learners with visual impairments can self-check spreadsheet problem-solving exercises using our system in a teacherless environment., Methods: Usability evaluation experiment was conducted using 2 × 2 crossover design with people with visual impairments ( n  = 11). The participants checked their answers (detected and corrected errors) after working on problem-solving exercises in two ways: (i) manually; and (ii) using our system. The system usability was evaluated by measuring Detection-And-Correction (DAC) ratio as effectiveness, time taken and the number of steps required for DAC as efficiency, and System Usability Scale score as satisfaction., Results and Conclusions: The results show that all the participants could complete the DAC task by using our system, and the time required for DAC task was significantly reduced by using our system as compared to by checking manually. Our system enables learners with visual impairments to self-check problem-solving exercises answers. However, to increase the user satisfaction, the number of required keystrokes needs to be decreased.

Non-invasive brain stimulation techniques allow targeted modulation of brain regions and have emerged as a promising tool for vision rehabilitation. This review presents an overview of studies that have examined the use of non-invasive brain stimulation techniques for improving vision and visual functions. A description of the proposed neural mechanisms that underpin non-invasive brain stimulation effects is also provided. The clinical implications of non-invasive brain stimulation in vision rehabilitation are examined, including their safety, effectiveness, and potential applications in specific conditions such as amblyopia, post-stroke hemianopia, and central vision loss associated with age-related macular degeneration. Additionally, the future directions of research in this field are considered, including the need for larger and more rigorous clinical trials to validate the efficacy of these techniques. Overall, this review highlights the potential for brain stimulation techniques as a promising avenue for improving visual function in individuals with impaired vision and underscores the importance of continued research in this field.

Significance: The number of patients with mild to moderate visual impairments (MVIs) is increasing as the average age of the population increases. Thus, it is important to understand the training and resources available for rehabilitation practitioners to provide adequate care to these patients within their scope of practice., Purpose: This study explores rehabilitation professionals' perceptions of their competence in screening and treating patients with MVI, and identifying the tools and resources needed to increase these professionals' comfort level in managing these patients., Methods: Data collection was carried via an online questionnaire to Quebec rehabilitation professionals and student-trainees who are members of their respective professional orders. The questionnaire consisted of 29 to 30 questions (open- and close-ended) related to demographics, service provision to MVI patients, education in MVI and future training, and future service delivery to MVI patients., Results: Data were collected from 96 professionals, with 52 fully completing the questionnaire, with all the responses included in the analysis. Most respondents had little or no confidence in adequately screening or treating patients with MVI and mentioned that they knew little or nothing about the range of services offered by vision rehabilitation centers in Quebec (81%), whereas 55% at least occasionally offer services to these patients. The majority felt that their profession would benefit from continuing education on MVI (73%), with a marked interest in online training., Conclusions: Rehabilitation professionals in Quebec are not confident in identifying or treating patients presenting MVI but express an interest in attending continuing education courses given by optometrists, low vision professionals, or a member of their own profession. Numerous barriers account for this problem, including a lack of experience and competence in the assessment and treatment options for MVI, as well as a lack of informational and human resources available in their workplaces., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Optometry.)

Purpose: Physical activity (PA) can provide multiple benefits for children with visual impairments (VI). To date, little research has explored the retention effects of PA interventions for children with VI. Thus, the purpose of this study was to explore the PA experiences of parents of children with VI three months after completing a PA intervention., Method: This descriptive-qualitative study was situated in the Theory of Planned Behavior. Five parents completed semi-structured interviews that were transcribed and analyzed using a thematic line-by-line analysis., Results: Four themes characterizing how parents created PA opportunities for their children with VI were constructed: (a) Teaching from Awareness (b) Advocating for Needs, (c) Engaging Family through Community, and (d) Seeking More PA Opportunities., Conclusion: Parent's awareness of their child's abilities, parents' advocacy, and parents' teaching skills all helped to expose their children to new types of PA in the community. Parents reflected about a lack of consistently offered community-based PA for their children. Researchers must consider the importance of educating parents on how to teach skills, increase awareness, and advocate for more community-based PA programs.

Objectives: To explore current hospital practice in relation to the assessment of vision problems in patients with acquired brain injury., Design: A survey study., Subjects: A total of 143 respondents from hospital settings, with background in occupational therapy and physical therapy, participated in the survey., Methods: The survey questionnaire, developed collaboratively by Danish and Norwegian research groups, encompassed 22 items categorically covering "Background information", "Clinical experience and current practice", "Vision assessment tools and protocols", and "Assessment barriers". It was sent out online, to 29 different hospital departments and 18 separate units for occupational therapists and physiotherapists treating patients with acquired brain injury., Results: Most respondents worked in acute or subacute hospital settings. Few departments had an interdisciplinary vision team, and very few therapists had formal education in visual problems after acquired brain injury. Visual assessment practices varied, and there was limited use of standardized tests. Barriers to identifying visual problems included patient-related challenges, knowledge gaps, and resource limitations., Conclusion: The study emphasized the need for enhanced interdisciplinary collaboration, formal education, and standardized assessments to address visual problems after acquired brain injury. Overcoming these challenges may improve identification and management, ultimately contributing to better patient care and outcomes in the future.

Background: Perceptual visual impairment leads to impaired functional vision in children with cerebral visual impairment. Yoked prisms have been used in behavioral vision therapy for children with autism (dysfunctional dorsal visual processing pathway) and in neurorehabilitation to treat visual neglect, hemianopia, and abnormal egocentric localization. In particular, they are employed for treating perceptual visual problems., Purpose: To share our experience in implementing yoked prisms and their impact on the rehabilitation of children with cerebral visual impairment-related perceptual vision disorders., Synopsis: The first child with periventricular leukomalacia exhibits no eagerness to explore her new environment along with poor grasp. With 4-PD base-down prisms, she explores her surroundings and appreciates her lateral supports. Her grasp improved as well. The second child with cerebral visual impairment exhibits difficulty in climbing downstairs with poor obstacle negotiation. This could be due to impaired inferior field awareness or optic ataxia. With 4-PD base-down prisms, the field shift toward the apex helps him to climb downstairs without difficulty with an improved obstacle negotiation. The third child prefers a closer look at the object of interest along with poor hand-eye coordination. We employed 4-PD base-down prisms in her rehabilitation session. She showed good improvement in her hand-eye coordination., Highlights: Poor hand-eye coordination, difficulty climbing downstairs, optic ataxia, impaired field awareness, and triggering spontaneous exploration in children with perceptual visual problems can be effectively tackled by the simple incorporation of yoked prisms., Video Link: https://youtu.be/BW3cwiGDTLY., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: This study aims to identify the disability specialists currently needed for students with vision or hearing impairment in the United Arab Emirates (UAE). It also aims to identify the university-level training courses available for these specialists., Materials and Methods: This study adopted a mixed-methods design. The qualitative strand involved a thematic analysis of semi-structured interviews conducted with 20 employees of 10 UAE organizations providing support services to students with vision or hearing impairment. The quantitative strand determined the number of disability-related degree courses offered at UAE universities from 2018 to 2020., Results: The interviewees revealed that students with visual impairment most need teachers for the visually impaired, braille trainers, orientation and mobility trainers, and assistive technology specialists, whereas students with hearing impairment most need teachers of the deaf or hard of hearing, speech therapists, and sign language specialists. Regarding disability-related training, 10 UAE universities each offered one disability-related programme between 2018 and 2020. These included nine general programmes for special or inclusive education and one programme for speech pathology., Conclusion: UAE universities are currently unable to train the disability specialists required for students with vision or hearing impairment. An interim option is to offer scholarships to enable Emirati students planning to become disability specialists to gain these specialized qualifications overseas. Current efforts in the UAE to address the needs of people with disabilities should include a development and implementation plan for UAE university programmes to offer specialized courses for people with vision or hearing impairment.

Introduction: Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double-blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL-based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs., Methods: Stroke outpatients with VFDs (>6 months after stroke onset) were randomized into NV (defective field training) or Nunap Vision-Control (NV-C, central field training) groups. Both interventions provided visual perceptual training, consisting of orientation, rotation, and depth discrimination, through a virtual reality head-mounted display device 5 days a week for 12 weeks. The two groups received VFD assessments using Humphrey visual field (HVF) tests at baseline and 12-week follow-up. The final analysis included those completed the study (NV, n = 40; NV-C, n = 35). Efficacy measures included improved visual area (sensitivity ≥6 dB) and changes in the HVF scores during the 12-week period., Results: With a high compliance rate, NV and NV-C training improved the visual areas in the defective hemifield (>72 degrees 2 ) and the whole field (>108 degrees 2 ), which are clinically meaningful improvements despite no significant between-group differences. According to within-group analyses, mean total deviation scores in the defective hemifield improved after NV training (p = .03) but not after NV-C training (p = .12)., Conclusions: The current trial suggests that VPL-based digital therapeutics may induce clinically meaningful visual improvements in patients with poststroke VFDs. Yet, between-group differences in therapeutic efficacy were not found as NV-C training exhibited unexpected improvement comparable to NV training, possibly due to learning transfer effects., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background: Despite an increased risk of certain eye conditions which can lead to visual impairment (V.I.), there is evidence of a greater delay to treatment-seeking among adults from minority ethnic communities (MEC). MEC adults may also be underrepresented on V.I. registers, within early intervention services, and among the beneficiaries of national V.I. charities. However, much of this evidence is outdated or anecdotal., Methods: This secondary analysis of V.I. Lives survey data explored use of eye health and support services and mobility aids among a matched control sample of 77 MEC and 77 adults aged 18 and over from white communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Additional subgroup analysis was conducted for Asian ( n  = 46) and black participants ( n  = 22)., Results: There were no significant group differences in areas such as eye health service use, registration status, contact with charities, and level of practical support received. But MEC participants were significantly more likely than WC participants to have received direct payments from social services to cover their care needs, Χ 2 (1, 154) = 8.27, p  = 0.004, and to use apps on their mobile for mobility, Χ 2 (1, 154) = 5.75, p  = 0.017. In contrast, WC participants were significantly more likely to agree that they were getting the level of emotional support to get on with their life, U  = 3,638, p  = 0.010, to feel confident to ask their friends for support, U  = 2,416, p  = 0.040, and to have a guide dog for mobility, Χ 2 (1, 154) = 3.62, p  = 0.057, although the latter did not reach statistical significance. Within the MEC group, Asian participants were significantly more likely than black participants to use a long cane, Χ 2 (1, 68) = 7.24, p  = 0.007, but they were significantly less likely to agree that they had received the right level of support when they started to experience V.I., U  = 236.5, p  = 0.040., Conclusion: The preliminary findings suggests that there is scope to increase support provided by V.I. charities and the V.I. register, although, contrary to existing evidence, there were no statistically significant differences in eye health service use, registration status and use of wider support services. Further research is required to confirm these findings and explore reasons for differences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Heinze and Jones.)

Background: The high rate of unemployment among individuals with vision impairment remains a pressing issue, even with the implementation of disability laws and coordinated effort to foster inclusive workplace. Employment integration challenges persist for people with vision impairment due to inaccessible job markets and workplaces., Objective: To create new knowledge from previous studies related to employment among people with vision impairment and to understand what has been explored and identify the gaps in employment integration., Method: A comprehensive search of six databases was conducted utilizing both index terms and keywords. The title and abstract of identified studies were screened, followed by a full-text screening using pre-set criteria. Only available peer-reviewed studies with a focus on employment and vision impairment were included, irrespective of location and publication year., Result: Of 2264 studies screened, only 43 studies were eligible for review and data extraction. Using thematic analysis, 8 key themes emerged: social support, disability rights and service systems, transition strategies and challenges, career, employment integration, employment environment, adaptive potential, and employment sustainability. These studies considered the perspectives of people living with vision impairment, rehabilitation practice, and employers. Identified gaps include transition strategies, workplace participation, the perception of colleagues, and work evolution., Conclusion: The primary focus of studies was on the individual factors that impact workplace integration; work environment impact was not explored in depth. The need to examine the readiness of the work environment is also importance because environmental factors can be modified according to the functional needs of people with vision impairment.

Visual difficulties are common after brain tumors, despite a lack of visual complaints at diagnosis. These include difficulties with eye movements, visual coordination, vergence, accommodation, and photophobia, in addition to more obvious problems such as visual field defects. This case report presents the results of a thorough neuro-visual evaluation in a boy with sequelae after a brain tumor including intermittent double vision that was not explained by routine visual examination. Subjective complaints included poor reading perseverance, intermittent blurred and double vision, headache around the eyes when performing near activities, less efficient eye movement behavior in reading tasks, and increased sensitivity to visual motion. The patient participated in a multidisciplinary visual rehabilitation program that included reading glasses with prism compensation and tinted glasses, as well as training with the aim of improving eye teaming, near vision functions, and perseverance in eye movements. The patient responded quickly to the vision therapy program, with positive changes after just four weeks. Repeated neuro-visual evaluations over eight months showed remarkable improvements that were stable over time. This encouraging case report supports the notion that neuro-visual evaluation and rehabilitation should be included in the follow-up of patients after brain tumors.

Objective: This study aimed to evaluate the impact of a standardized vision screen guideline on occupational therapy vision screens in a pediatric inpatient rehabilitation unit., Methods: Charts of patients admitted to a pediatric inpatient rehabilitation before guideline implementation (n = 47) versus charts after implementation (n = 47) were randomly, retrospectively reviewed to explore differences in visual skills screened and use of standardized assessments., Results: Significant improvements (p < = 0.05) were found in the number of visual skills screened (p = 0.034), use of standardized assessments (p = 0.005), and screening of the specific visual skills of accommodative amplitude (p = 0.05), suppression (p = 0.015), and double vision (p < 0.001)., Conclusion: Implementation of a standardized vision screen guideline improved the frequency of vision screens during occupational therapy evaluations in a pediatric inpatient rehabilitation unit. The use of standardized assessments may also improve the quality of vision screens by encouraging staff to complete more comprehensive vision screens, including screening more visual skills, and by prompting use of standardized assessments, which can improve accuracy of screening procedures.

Purpose: To evaluate the impact of special software training in computer and smartphone apps as a form of rehabilitation to improve the quality of life of individuals with visual impairment (VI)., Methods: The study utilized a one-group pretest-posttest design. A total of 50 individuals aged 15 years and older with VI participated in the training, which included special software (NVDA) and mobile app training for 60 hours at the Visual Rehabilitation Center. The Low Vision Quality of Life Questionnaire was administered before the start of training and six months after completion. The questionnaire covered the following domains: (1) mobility, distance vision, and lighting; (2) reading and fine work; (3) social well-being; (4) economic impact; (5) attitude toward life; and (6) activities of daily living. Statistical software STATA 14.0 (Texas, USA) was used for data analysis. Paired t-tests and Wilcoxon signed-rank tests were conducted to compare the mean differences before and after training., Results: Significant improvements were observed in five dimensions, namely mobility, distance vision and lighting, reading and fine work, and attitude toward life, at a highly significant level of 1% probability. The dimensions of social well-being and economic impact showed significant improvement at a 5% level of probability., Conclusion: Visual impairment, whether congenital or acquired later in life, affects independence in all aspects of life. To the best of our knowledge, this is the first study to investigate the impact of special software training on the quality of life of visually impaired individuals. The authors suggest that this form of rehabilitation enhances accessibility to mainstream living, promotes independence, and ultimately improves quality of life. Participants experienced an improved quality of life through increased access to mainstream resources, enhanced ability to navigate and manage daily activities independently, and reduced reliance on multiple low vision aids or assistance from sighted individuals., Competing Interests: None

Age-related vision loss (ARVL) has been shown to interfere with older adults' occupational engagement. The primary purpose was to examine the role social networks play in facilitating/constraining engagement in desired occupations for older adults with ARVL. This study adopted a constructivist narrative methodology. Five older adults, ≥ 60 years of age with ARVL, participated in three virtual interviews, which were coded using thematic analysis. Three overarching themes were identified: (a) Diverse Social Networks Fulfill Different Occupational and Psychosocial Needs, (b) Retaining a Sense of Independence through Seeking Reciprocity in Social Relationships, and (c) Community Mobility and Technology Support as Essential for Preserving Social Relationships. Findings broaden understandings of how informal/formal social networks are involved in shaping visually-impaired older adults' adaptation to ARVL and related occupational changes. Findings may help improve the quality and delivery of low-vision rehabilitation services to optimize their contribution to occupational engagement.

Background: Perception is the ability to understand information from our senses. It allows us to experience and meaningfully interact with our environment. A stroke may impair perception in up to 70% of stroke survivors, leading to distress, increased dependence on others, and poorer quality of life. Interventions to address perceptual disorders may include assessment and screening, rehabilitation, non-invasive brain stimulation, pharmacological and surgical approaches., Objectives: To assess the effectiveness of interventions aimed at perceptual disorders after stroke compared to no intervention or control (placebo, standard care, attention control), on measures of performance in activities of daily living.  SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group, CENTRAL, MEDLINE, Embase, and three other databases to August 2021. We also searched trials and research registers, reference lists of studies, handsearched journals, and contacted authors., Selection Criteria: We included randomised controlled trials (RCTs) of adult stroke survivors with perceptual disorders. We defined perception as the specific mental functions of recognising and interpreting sensory stimuli and included hearing, taste, touch, smell, somatosensation, and vision. Our definition of perception excluded visual field deficits, neglect/inattention, and pain., Data Collection and Analysis: One review author assessed titles, with two review authors independently screening abstracts and full-text articles for eligibility. One review author extracted, appraised, and entered data, which were checked by a second author. We assessed risk of bias (ROB) using the ROB-1 tool, and quality of evidence using GRADE.  A stakeholder group, comprising stroke survivors, carers, and healthcare professionals, was involved in this review update., Main Results: We identified 18 eligible RCTs involving 541 participants. The trials addressed touch (three trials, 70 participants), somatosensory (seven trials, 196 participants) and visual perception disorders (seven trials, 225 participants), with one (50 participants) exploring mixed touch-somatosensory disorders. None addressed stroke-related hearing, taste, or smell perception disorders. All but one examined the effectiveness of rehabilitation interventions; the exception evaluated non-invasive brain stimulation. For our main comparison of active intervention versus no treatment or control, one trial reported our primary outcome of performance in activities of daily living (ADL):  Somatosensory disorders: one trial (24 participants) compared an intervention with a control intervention and reported an ADL measure.  Touch perception disorder: no trials measuring ADL compared an intervention with no treatment or with a control intervention.  Visual perception disorders: no trials measuring ADL compared an intervention with no treatment or control.  In addition, six trials reported ADL outcomes in a comparison of active intervention versus active intervention, relating to somatosensation (three trials), touch (one trial) and vision (two trials).   AUTHORS' CONCLUSIONS: Following a detailed, systematic search, we identified limited RCT evidence of the effectiveness of interventions for perceptual disorders following stroke. There is insufficient evidence to support or refute the suggestion that perceptual interventions are effective. More high-quality trials of interventions for perceptual disorders in stroke are needed. They should recruit sufficient participant numbers, include a 'usual care' comparison, and measure longer-term functional outcomes, at time points beyond the initial intervention period. People with impaired perception following a stroke should continue to receive neurorehabilitation according to clinical guidelines., (Copyright © 2022 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.)

Purpose : To validate a vision-screening tool for use by nurses and other non-eye care health practitioners (NECHP) to aid identification of visual deficits and ocular conditions in stroke survivors. Material and Methods : Stroke survivors were recruited from two metropolitan Sydney public hospitals who had no access to on-site eye care professionals. Those admitted for 3 days and who were able to provide clear responses were randomly allocated into two groups. All were assessed by a NECHP using a purposely designed bedside vision-screening tool to assess their visual function. In Group 1, the orthoptist repeated the assessment with the same vision-screening tool, in Group 2 they performed a comprehensive orthoptic assessment. Levels of agreement and sensitivity and specificity for key outcomes were assessed. Findings : Levels of agreement for most items analyzed for Group 1 reached 80%. Comparison of the screening tool to a comprehensive orthoptist assessment (Group 2), demonstrated high (88.57-91.12%) sensitivity and specificity for detecting pre-existing and acquired visual problems. Conclusion : The vision-screening tool is a valid instrument for use by NECHP, for the detection of vision defects in stroke survivors. Improved detection of eye conditions may facilitate timely identification and management of visual conditions in stroke survivors, potentially improving patient care and rehabilitation outcomes.

Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Purpose: To report a case of Gundersen flap removal where the ocular surface was restored without the need for additional limbal stem cell transplantation., Methods: We describe a case of 57-year-old man who underwent Gundersen flap for a nonhealing corneal ulcer in right eye 17 years ago. He recently lost eyesight in left eye after blunt trauma. Gundersen flap removal was performed in right eye along with amniotic membrane transplantation., Results: The ocular surface recovered completely after surgery without any evidence of limbal stem cell deficiency. His corrected distance visual acuity improved to 20/60 along with a stable ocular surface, which was maintained till last follow-up of 12 months., Conclusions: A normal ocular surface can be restored after Gundersen flap surgery if removal of limbal epithelium is not performed during the primary procedure. Additional corneal surgery might be required depending on corneal clarity., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Millions of individuals with visual impairment use vision assistance apps to help with their daily activities. The most widely used vision assistance apps are magnifier apps. It is still largely unknown what the apps are used for. Lack of insight into the visual needs of individuals with visual impairment is a hurdle for the development of more effective assistive technologies., Objective: This study aimed to investigate how needs for visual aids may vary with social activities, by observing the changes in the usage of a smartphone magnifier app when many users take breaks from work., Methods: The number of launches of the SuperVision Magnifier app was determined retrospectively from 2018 to 2020 from among active users worldwide. The fluctuation in app usage was examined by comparing weekday vs weekend periods, Christmas and new year vs nonholiday seasons, and COVID-19 lockdowns vs the easing of restriction during the pandemic., Results: On average, the app was used 262,466 times by 38,237 users each month in 2020 worldwide. There were two major trough points on the timeline of weekly app usage, one aligned with the COVID-19 lockdowns in April 2020 and another aligned with the Christmas and new year week in 2018 and 2019. The app launches declined by 6947 (11% decline; P<.001) during the lockdown and by 5212 (9% decline; P=.001) during the holiday weeks. There was no significant decline during March to May 2019. App usage compensated for seasonal changes was 8.6% less during weekends than during weekdays (P<.001)., Conclusions: The need for vision assistance technology was slightly lower during breaks and lockdowns, probably because the activities at home were different and less visually demanding. Nevertheless, for the entire user population, the needs for visual aids are still substantial., (©Gang Luo, Shrinivas Pundlik. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 12.05.2021.)

Purpose: To evaluate the long-term results of combining cataract surgery, intraocular lens (IOL) implantation, and Descemet membrane endothelial keratoplasty with peripheral stromal support (DMEK-S)., Methods: The outcomes of 107 eyes of 37 patients who had undergone a combination of cataract surgery, IOL implantation, and DMEK-S between October 2007 and February 2015 were retrospectively evaluated. The average follow-up duration was 18.2 ± 18.3 months (range, 6-84 months). Changes in uncorrected and corrected distance visual acuity, spherical equivalent, and corneal endothelial cell density were analyzed. Intraoperative and postoperative complications were also recorded., Results: The mean logMAR uncorrected distance visual acuity improved from 0.92 ± 0.60 preoperatively to 0.33 ± 0.33, 0.28 ± 0.25, 0.24 ± 0.20, and 0.27 ± 0.27 at 6, 12, 24, and 36 months postoperatively (P < 0.001), respectively. The mean logMAR corrected distance visual acuity improved from 0.62 ± 0.65 preoperatively to 0.17 ± 0.29, 0.13 ± 0.21, 0.07 ± 0.16, and 0.11 ± 0.23 at 6, 12, 24, and 36 months postoperatively (P < 0.001), respectively. The mean endothelial cell density decreases were 50.7% ± 21.1%, 50.8% ± 19.8%, 60.7% ± 16.6%, 62.2% ± 11.8%, and 61.8% ± 20.0% at 6, 12, 24, 36, and 48 months after surgery, respectively. Similar trends, although with slightly better visual outcomes, were found in the subgroup of patients without other eye diseases. The mean final deviation from intended spherical equivalent was 0.77 ± 1.19 D, representing a hyperopic shift., Conclusions: A combined procedure of cataract surgery, IOL implantation, and DMEK-S is an effective method of treatment in patients with combined corneal disease and cataract, maintaining visual rehabilitation in the long term. Future developments should be performed to minimize the incidence of complications., Competing Interests: D. P. Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal (RYC-2016-20471). The remaining authors have no funding or conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose This scoping study sought to establish a baseline for how well the needs of children with cortical visual impairment (CVI) who use augmentative and alternative communication (AAC) are currently aligned with the services available to them. CVI is the most common cause of visual impairment in children today, and AAC methods rely heavily on vision. Yet, the prevalence of CVI in children who use AAC methods is not yet known, and there is virtually no research concerning use of AAC with children with CVI. Our overarching goals were to identify barriers and suggest priorities for improving outcomes for these children. Method Surveys were distributed anonymously online to professionals from multiple disciplines in different school-based settings and to parents of children with CVI who use AAC. Results School-based professionals identified many barriers, including a lack of knowledge and skills about CVI and about AAC, limited access to training and experts, and concerns about services being delivered in isolated silos with limited time allotted for interprofessional collaboration and planning. Parent reported that their children ( M age = 11 years) continued to rely predominantly on body-based forms of communication and lacked access to symbolic language, which, in AAC, is primarily visually based. Conclusions The barriers to services identified by school-based professionals indicate a need to develop and disseminate reliable information about CVI and AAC, both at a preservice and in-service level and, while doing so, to respect the diversity of stakeholders who need this information, including parents. Future research on what types of AAC approaches support the development of language and communication skills for children with CVI is essential.

Purpose: To describe the outcomes of Descemet membrane endothelial keratoplasty (DMEK) performed in amblyopic aged (younger than 8 years) children., Methods: This is a single-center retrospective study, including 11 eyes (7 congenital hereditary endothelial dystrophy and 4 congenital glaucoma) of 6 children in amblyopic age undergoing DMEK by a single surgeon (N.C.P.) at Sorocaba Eye Hospital from December 2015 to November 2017. Best spectacle-corrected visual acuity, biomicroscopy, pachymetry, endothelial cell density, and complications were evaluated., Results: No intraoperative complications occurred. Graft detachment occurred in 1 eye (9.1%) and was successfully managed with rebubbling. No primary graft failure or pupillary block was observed. All pachymetric measurements improved, and the corneal edema clinically resolved in all eyes within 2 weeks after the procedure. At the last follow-up (mean 30 months), best spectacle-corrected visual acuity was ≥20/40 in 7 (77.8%) of 9 eyes from patients cooperative enough to assess vision. All children began visual stimulation therapy and amblyopic treatment within 1 month of surgery, and all grafts remained clear until the last follow-up. The mean preoperative donor endothelial cell density was 2588 ± 236 cells/mm, which decreased to 1726 ± 292 cells/mm 2 years after surgery, yielding a 33% reduction (P < 0.001). No immunologic graft reaction, secondary graft failure, or cataracts were observed during the follow-up period., Conclusions: In this series, DMEK was performed to successfully treat endothelial dysfunction in children. However, the procedure is more challenging, and more studies with more patients and longer follow-up are needed to confirm the superiority of DMEK in treating endothelial dysfunction in children.

Purpose: The COVID-19 outbreak poses a global crisis in health care delivery system, including habilitation and rehabilitation services. In this study, we shared our experiences on telerehabilitation services established primarily for students with visual disabilities (SwVD) amidst COVID-19 pandemic and its outputs., Methods: Following the lockdown declared on March 23, 2020, the rehabilitative team of a tertiary eye center in north India received information that many visually challenged students (VCS) were stranded in schools for the blind in Delhi, and feeling with anxiety and panic in absence of teachers. Shortly, the room for vision rehabilitation clinic was set-up for telefacilities. The intended services were explained while disseminating the mobile numbers. A semi-structured questionnaire consisting of closed and open-ended was developed to record COVID-19 knowledge and concerns. Inductive content analysis was used to report the qualitative information., Results: As of June 30, 2020, a total of 492 clients contacted the team, with maximum from Delhi (41.5%), and predominantly males (78.8%). Around 80.3% of callers were VCS with age range of 11 to 30 years. The two most frequently encountered health needs were itching in eyes (36.1%) and headache (29%). Television news was the most used medium among callers to get COVID-19 information. Cough is a less frequently known mode of transmission (28%), similarly handwashing as a less known for prevention (17.2%). Eight concerns were recorded based on qualitative data analysis., Conclusion: Telerehabilitation provides valuable insights and has the potential to address various concerns, uncertainty, anxiety, and fear among VCS during the pandemic., Competing Interests: None

Purpose of Review: Homonymous visual field defects are a common sequela of stroke, and are assumed to be permanent within a few weeks of the event. Because consensus about the efficacy of rehabilitation is lacking, visual therapy is rarely prescribed. Here, we review current rehabilitation options and strategies in the translational pipeline that could change these perspectives., Recent Findings: The mainstays of available therapy for homonymous visual defects are compensation training and substitution, which allow patients to better use their spared vision. However, early clinical studies suggest that vision can partially recover following intensive training inside the blind field. Research into the relative efficacy of different restorative approaches continues, providing insights into neurophysiologic substrates of recovery and its limitations. This, in turn, has led to new work examining the possible benefits of earlier intervention, advanced training procedures, noninvasive brain stimulation, and pharmacological adjuvants, all of which remain to be vetted through properly powered, randomized, clinical trials., Summary: Research has uncovered substantial visual plasticity after occipital strokes, suggesting that rehabilitative strategies for this condition should be more aggressive. For maximal benefit, poststroke vision-restorative interventions should begin early, and in parallel with strategies that optimize everyday use of an expanding field of view., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

We are reporting the case of a 25-year-old female who developed acanthamoeba keratitis after wearing contact lenses for high myopia. She was diagnosed as acanthamoeba and started the treatment of antiacanthamoeba for 3 consecutive weeks, followed by bare Descemet's therapeutic lamellar keratoplasty (LKP) with the maintenance of antiacanthamoeba treatment to control the infection. In the late postoperative period, visual rehabilitation was obtained by insertion of implantable Collamer lens (ICL) with her final visual outcome was 20/30. For acanthamoeba keratitis, early bare Descemet's therapeutic LKP has a better outcome in comparison to late penetrating keratoplasty in terms of infection eradication and globe preservation. After removal of all sutures, the refractive error can be corrected with photorefractive procedures as well as ICL., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Middle East African Journal of Ophthalmology.)

This study aimed to compare the effectiveness of component-based, occupation-based, and a combined intervention for visual-scanning to improve occupational performance. This exploratory case study used a 55-year-old female, seven years post-stroke with visual field deficits, who completed a component-based intervention ( Vision Coach ), an occupation-based intervention (IADL activities that incorporated scanning tasks), and a combined intervention. The Assessment of Motor and Process Skills (AMPS) was completed prior to and after each intervention. Participant's data was compared between interventions and AMPS standardization sample, with observable improvements in motor skills and process skills. Visual-scanning training as a compensatory method appears to be effective for chronic visual field deficits post-stroke, particularly using component-based and occupation-based interventions in combination.

Purpose of Review: Fitting rigid gas permeable contact lenses (RGP CLs) in keratoconic patients is the most common visual rehabilitation option to improve patients' quality of life, but require long patient and practitioner chair time. The purpose of this review is to provide evidence-based clinical practice guidelines (CPG) in the management of patients with keratoconus with RGP CLs., Recent Findings: An extensive literature review from 1990 to 2017 identified 354 potentially relevant publications. Fifty-two articles were reviewed and included in the CPG. An international expert panel of eight contact lens practitioners, with vast experience in keratoconus management reviewed and appraised the CPG following the Appraisal of Guidelines for Research and Evaluation II consortium requirements. The developed CPG clearly outlines a strategy for the successful fitting of RGP CLs in patients with keratoconus. This includes how to calculate parameters of the first diagnostic lens, criteria for assessing good fit and a standardized schedule of wear time and follow-up appointments., Summary: The current evidence and consensus-based CPG helps guide clinicians in a successful strategy for fitting RGP CLs in patients with keratoconus., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and severe thermal or chemical injury are considered severe ocular surface disorders (OSDs) because they affect the entire ocular surface, including corneal and conjunctival epithelial stem cells. In patients with severe OSDs, the long-term prognosis for limbal transplantation is poor, and the related corneal opacity and cicatrization lead to devastating visual impairment. To date, there is no standardized treatment to improve vision in cases with severe OSD. Investigating novel treatment methods for severe OSDs, our group began cultivated oral mucosal epithelial transplantation in 2002 and developed a limbal-supported rigid-type contact lens that can be applied as a nonsurgical treatment. When used in combination, these treatment methods make it possible to successfully restore vision in cases with severe OSDs.

Aim: To investigate the utility of the Insight Inventory (a structured clinical inventory completed by caregivers) for assessment of children with cerebral visual impairment; and to investigate effectiveness of tailored habilitational strategies derived from the responses to the Insight Inventory., Method: Fifty-one eligible children (26 males, 25 females; mean age 9y 5mo, SD 3y, range 5-16y) were recruited from Great Ormond Street Hospital, London. They underwent baseline assessment including neuro-ophthalmological and neuropsychological evaluations, and parent- and child-reported ratings on a questionnaire-based measure of quality of life. Parents also completed the Insight Inventory. On the basis of responses to the Inventory, families received individualized habilitational strategies. Follow-up assessments 6 months later included repeating the Insight Inventory and quality of life questionnaires., Results: Correlations were found between the Insight Inventory and the Wechsler Intelligence Scale for Children, Fourth Edition, the Beery-Buktenica Test of Visual-Motor Integration, and the Benton Facial Recognition Test, suggesting that the Insight Inventory is an effective tool to estimate visual-perceptual difficulties. At 6 months follow-up, caregiver reports indicated significant improvements in the quality of life of children below the age of 12 years., Interpretation: The Insight Inventory is a simple questionnaire which covers practical aspects of cognitive visual function in everyday life. It provides in-depth information about the aspects that children struggle with. It can also guide programmes of individualized habilitation strategies, which may enhance the quality of life of younger children., What This Paper Adds: Questionnaire scores demonstrate biologically plausible correlations with formal neuropsychological tests of visual function. After administration of matched practical habilitational strategies, younger children showed improvement in quality of life and functional vision scores., (© 2020 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.)

Visual prostheses aim at restoring useful vision to patients who have become blind. This useful vision should enable them to regain autonomy in society for navigation, face recognition or reading. Two retinal prostheses have already obtained market authorization for patients affected by retinal dystrophies while a new device is in clinical trials for patients affected by age-related macular degeneration. Various prostheses, in particular cortical prostheses, are currently in clinical trials for optic neuropathies (glaucoma). Optogenetic therapy, an alternative strategy, has now reached the stage of clinical trials at the retinal level while moving forward at the cortical level. Other innovating strategies have obtained proofs of concepts in rodents but require a further validation in large animals prior to their evaluation on patients. Restoring vision should therefore become a reality for many patients even if this vision will not be as extensive and perfect as natural vision., (© 2020 médecine/sciences – Inserm.)

Purpose: To evaluate see-through Augmented Reality Digital spectacles (AR DSpecs) for improving the mobility of patients with peripheral visual field (VF) losses when tested on a walking track., Design: Prospective Case Series., Participants: 21 patients with peripheral VF defects in both eyes, with the physical ability to walk without assistance., Methods: We developed the AR DSpecs as a wearable VF aid with an augmented reality platform. Image remapping algorithms produced personalized visual augmentation in real time based on the measured binocular VF with the AR DSpecs calibration mode. We tested the device on a walking track to determine if patients could more accurately identify peripheral objects., Main Outcome Measures: We analyzed walking track scores (number of recognized/avoided objects) and eye tracking data (six gaze parameters) to measure changes in the kinematic and eye scanning behaviors while walking, and assessed a possible placebo effect by deactivating the AR DSpecs remapping algorithms in random trials., Results: Performance, judged by the object detection scores, improved with the AR DSpecs (P<0.001, Wilcoxon rank sum test) with an average improvement rate of 18.81%. Two gaze parameters improved with the activated algorithm (P<0.01, paired t-test), indicating a more directed gaze on the central path with less eye scanning. Determination of the binocular integrated VF with the DSpecs correlated with the integrated standard automated perimetry (R = 0.86, P<0.001), mean sensitivity difference 0.8 ± 2.25 dB (Bland-Altman)., Conclusions: AR DSpecs may improve walking maneuverability of patients with peripheral VF defects by enhancing detection of objects in a testing environment., Competing Interests: United States Patent (“Digital Therapeutic Corrective Spectacles“, Patent No. US10386645B2) (MA) and United States Patents (Numbers: US10389989B2, US10409071B2, and US10444514B2) (MA, AS). Patents and PCT are owned by University of Miami and licensed to Horus LLC. MA is an equity holder and sits on the Board of Directors for Horus LLC. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Purpose: The integration of primary eyecare into existing primary healthcare systems requires simple yet effective tools that do not overburden the grass-root level worker. The objective of this study was to test the accuracy of a questionnaire-based tool administered by trained community-based rehabilitation volunteers (CBRVs) in identifying persons with visual disability, proportions accessing referral pathway and barriers to uptake of eyecare services., Methods: CBRVs working in the urban-slum service area of a teaching hospital were trained in administering a questionnaire-based tool derived from the World Health Organization (WHO) "Training in the community for people with disabilities" to a responsible adult member of the household. Post-training, they screened and referred adults with perceived visual problems. This tool was tested against two reference standards: (i) history of visual disability elicited by ophthalmologist; (ii) pre-set visual acuity and diagnosis criteria., Results: Ten CBRVs screened 950 individuals of whom 805 (84.7%) were examined by an optometrist and ophthalmologist. Sensitivity and specificity of this method were 75% (95% CI 72-78%), 95.8% (95% CI 94-98%) respectively, using history and 60.2% (95% CI 57-63%), 91.8% (95% CI 90-94%) using clinical criteria as reference standard. Referral pathway was used by 91/221 (41.2%) referred individuals. The commonest barriers to accessing eye care were 'did not feel the need' (32.2%) and 'busy with work/household responsibilities' (30.2%)., Conclusions: This questionnaire-based tool administered by grass-root level health workers to a responsible adult member of the family may be a promising screening method for identification and appropriate referral of persons with visual disability in the community.

We developed a new kit to assemble three-dimensional (3D) tactile maps for orientation and mobility (O&M) training provided to persons with visual impairments. This study evaluated the effects of verbal explanations combined with 3D tactile map kits in improving understanding, recall, and walking along an unfamiliar route in comparison with the effects of only verbal explanation. The 3D tactile maps provided participants having severe visual impairments and little experience with tactile maps with a better understanding and recall of the environmental information concerning the route and landmarks. Participants who used the 3D tactile maps could find specific landmarks set as tasks more accurately and arrive at the destination alone getting lost less frequently. Tactile maps composed of 3D points, lines, and areal parts are useful as a support aid for O&M training because they have high tactile readability and can provide the environmental information that individuals with visual impairment require., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and objectives: Many brain-computer interfaces (BCIs) for people with severe disabilities present stimuli in the visual modality with little consideration of the visual skills required for successful use. The primary objective of this tutorial is to present researchers and clinical professionals with basic information about the visual skills needed for functional use of visual BCIs, and to offer modifications that would render BCI technology more accessible for persons with vision impairments. Methods: First, we provide a background on BCIs that rely on a visual interface. We then describe the visual skills required for BCI technologies that are used for augmentative and alternative communication (AAC), as well as common eye conditions or impairments that can impact the user's performance. We summarize screening tools that can be administered by the non-eye care professional in a research or clinical setting, as well as the role of the eye care professional. Finally, we explore potential BCI design modifications to compensate for identified functional impairments. Information was generated from literature review and the clinical experience of vision experts. Results and conclusions: This in-depth description culminates in foundational information about visual skills and functional visual impairments that affect the design and use of visual interfaces for BCI technologies. The visual interface is a critical component of successful BCI systems. We can determine a BCI system for potential users with visual impairments and design BCI visual interfaces based on sound anatomical and physiological visual clinical science.Implications for RehabilitationAs brain-computer interfaces (BCIs) become possible access methods for people with severe motor impairments, it is critical that clinicians have a basic knowledge of the visual skills necessary for use of visual BCI interfaces.Rehabilitation providers must have a knowledge of objectively gathering information regarding a potential BCI user's functional visual skills.Rehabilitation providers must understand how to modify BCI visual interfaces for the potential user with visual impairments.Rehabilitation scientists should understand the visual demands of BCIs as they develop and evaluate these new access methods.

Purpose: To evaluate the necessity for second-eye cataract surgery in bilateral highly myopic patients with good visual acuity in the unoperated fellow eye., Materials and Methods: Seventy-five bilateral highly myopic patients who underwent uneventful sequential cataract surgery (the eye with worse visual acuity operated first) were included in this prospective study. The preoperative BCVA of the eye with better visual acuity in these patients was ≤ 0.3 (logMAR, or Snellen ≥ 20/40). Binocular single vision examinations were performed 1 month after the first-eye and second-eye surgery, respectively. The VF-14 questionnaire was completed before first-eye surgery, 1 month after the first-eye and 1 month after the second-eye surgery, respectively., Results: The first eye's postoperative SE was -3.07 ± 1.10D and the second eye's preoperative SE was -12.91 ± 5.15D. Binocular single vision functional parameters improved significantly after the second-eye cataract surgery compared with that after the first-eye surgery (all P < .001). The binocular single vision function was negatively correlated with the SE difference between the two eyes after the first-eye surgery. No difference was found between the scores of VF-14 questionnaire preoperatively and after the first-eye surgery. VF-14 score only improved significantly after the second-eye surgery compared with that after the first-eye surgery ( P < .001)., Conclusion: In bilateral highly myopic cataract patients, binocular single vision function could improve significantly after the second-eye cataract surgery compared with after the first-eye surgery. Bilateral highly myopic patients may undergo second-eye cataract surgery earlier, even if cataract in that eye is not severe enough to affect the visual acuity.

Ocular alignment defects such as strabismus affect around 5% of people and are associated with binocular vision impairments. Current nonsurgical treatments are controversial and have high levels of recidivism. In this study, we developed a rehabilitation method for ocular alignment training and examined the rate of learning, transfer to untrained alignments, and retention over time. Ocular alignment was controlled with a real-time dichoptic feedback paradigm where a static fixation target and white gaze-contingent ring were presented to the dominant eye and a black gaze-contingent ring with no fixation target was presented to the nondominant eye. Observers were required to move their eyes to center the rings on the target, with real-time feedback provided by the size of the rings. Offsetting the ring of the nondominant temporal or nasal visual field required convergent or divergent ocular deviation, respectively, to center the ring on the fixation target. Learning was quantified as the time taken to achieve target deviation of 2° (easy, E) or 4° (hard, H) for convergence (CE, CH) or divergence (DE, DH) over 40 trials. Thirty-two normally sighted observers completed two training sequences separated by one week. Subjects were randomly assigned to a training sequence: CE-CH-DE, CH-CE-DE, DE-DH-CE, or DH-DE-CE. The results showed that training was retained over the course of approximately one week across all conditions. Training on an easy deviation angle transferred to untrained hard angles within convergence or divergence but not between these directions. We conclude that oculomotor alignment can be rapidly trained, retained, and transferred with a feedback-based dichoptic paradigm. Feedback-based oculomotor training may therefore provide a noninvasive method for the rehabilitation of ocular alignment defects.