Visual Impairment and Rehabilitation

AB100. Screening for vision and hearing loss in patients with dementia: recommendations from interviews with sensory experts

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Background: Dementia is a syndrome that affects a person’s ability to understand and express information. The higher prevalence of vision and/or hearing losses among persons with dementia in long-term care (LTC) facilities interferes with the ability of nurses to provide optimal care because communication is compromised. Therefore, the detection and screening for sensory impairment is of the utmost importance in LTC facilities; however, there is currently no agreement among nursing professionals on how to best identify such losses for the purpose of further referral, and the need for a validated screening measure suitable for nurses in LTC facilities is clear. The present project aims to close this gap by investigating the screening recommendations of vision- and hearing-care professionals working with clients affected by dementia.

Methods: Eleven experts in audiology, optometry, deafblindness, and technology participated in individual semi-structured interviews on the topic of tools and strategies that can be used to screen individuals with dementia for sensory loss. Interview transcripts were coded by two evaluators using verbal agreement and consensus building.

Results: Three main themes emerged from the interviews with experts: barriers, facilitators, and strategies. Barriers to sensory screening were often mentioned, particularly impaired communication and lack of staff cooperation. Facilitators consisted uniquely of people, such as family members, intervenors, and nurses. Strategies for sensory screening in this population consisted of improving communication through repetition and encouragements; considerations based on familiarity; and inferring an impairment on the basis of patient behaviour. Few of our interviewees were knowledgeable on the topic of screening apps.

Conclusions: Our findings, to be integrated with a similar environmental scan conducted among LTC nurses, can inform the administration of sensory impairment screening tests among a population with dementia in order to optimize care.

Visual Impairment and Rehabilitation

AB098. Perceptual, motor and cognitive factors related to braille reading performance in aging: a scoping review

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Background: A growing number of older adults with vision loss require vision rehabilitation services to address reading difficulties. Braille may be the most appropriate option for those with functional blindness, poor visual prognoses or dual sensory loss. While standardized braille assessment and training protocols are in place to guide interventions with children, there is a high degree of inconsistency and a lack of evidence-based knowledge about best practices to use with adults and seniors who require braille training. Age-related declines in tactile acuity, motor dexterity and cognition present unique barriers to braille training, but very little is known about the impact of aging on factors related to braille reading performance. The aim of this scoping review is to identify the perceptual, motor, and cognitive factors related to braille reading performance and to determine how these factors have been assessed or measured among blind adults and elderly individuals in prior studies.

Methods: Using the scoping review method, a comprehensive search was conducted in three databases: PubMed, Educational Resource Information Center (ERIC), and the Cochrane library. Two reviewers screened articles for inclusion to ensure internal agreement, based on identified exclusion criteria.

Results: The initial search resulted in 1,565 qualitative and quantitative articles. The results synthesize the perceptual, motor and cognitive factors known to predict braille reading performance, how these variables are impacted by the aging process, and how they have been measured in prior studies.

Conclusions: This scoping review is the first step in working towards the development of evidence-based assessment and training protocols to standardized practice with adult and senior clients who require braille training. It also serves to clarify where current knowledge gaps exist in order to guide future studies on braille reading and aging.

Visual Impairment and Rehabilitation

AB095. Development of an assessment system of driver visual behaviours on a car simulator

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Background: (I) To describe the development and components of the automobile simulator driving behavior evaluation system developed by CRIR-Institut Nazareth et Louis-Braille; (II) to present the preliminary results of the content evaluation of the driving behavior evaluation grid.

Methods: The evaluation system consists of five components: (I) the VS500M Car Simulator (Virage Simulation); (II) four VS500M driving scenarios, modified to minimize the occurrence of simulator sickness and expose subjects to commonly encountered driving situations on highways and city boulevards; (III) the Tobii Pro Glasses 2 eye tracking device; (IV) a car simulator driving behavior observation grid (DBOG); (V) a software application used during the behaviour evaluation phase, where synchronized video tracking, certain data from the simulator (e.g., speed) and the DBOG grid are presented. Initially, the expected safe driving behaviors were identified, including 235 of a visual nature, supported by literature data and consultation of the project steering committee and an expert in driving assessment. Driving behaviors were assessed in 22 subjects without visual impairment (mean age 55±20 years). Subsequently, the items were revised to determine their relevance based on their importance in terms of road safety or on the frequency with which behaviors were observed among participants. For analysis purpose, the items of the DBOG were grouped according to their content, by type of expected driving behavior (e.g., following a stop, look to the left and right before crossing the intersection) or element to be detected (e.g., pedestrians).

Results: Some visual behaviors are difficult to observe with the eye tracker device because they are more dependent on peripheral than central vision. Others are rarely observed, possibly because they are little or not realized in daily life or the representation of reality on the simulator does not stimulate their adoption. On the other hand, the visual detection behaviors expected in a situation where safety can be compromised are mostly carried out (e.g., detection of oncoming vehicles, side mirror verification when changing lanes).

Conclusions: This first phase of the study has made possible to better target the items to be kept in the car simulator driving behavior observation grid, and those that will have to be removed as they are too difficult to observe or too rarely adopted by the participants. Content validity and inter-rater reliability will be assessed from the simplified grid.

Original Article

Evaluation on application effect of psychological nursing intervention on patients with traumatic endophthalmitis

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Background: To explore the application effect of psychological nursing intervention in patients with traumatic endophthalmitis.

Methods: A total of 90 patients with traumatic endophthalmitis admitted to our hospital from August 2018 to April 2019 were selected as study objects and randomly divided into observation group and control group, with 45 cases in each group. The control group received routine nursing care, and the observation group performed psychological nursing intervention on the basis of the control group. The scores of self-rating anxiety scale (SAS) and self-rating depression scale (SDS) and nursing satisfaction degree were compared before and after nursing treatment in two groups.

Results: The scores of SAS and SDS of the observation group were better than those of the control group. The score of the nursing satisfaction degree of the observation group was higher than that of the control group, showing statistically significant difference (P<0.05).

Conclusions: Psychological nursing intervention can improve the physical and mental condition of patients with traumatic endophthalmitis, reduce their negative emotions such as anxiety and depression, and improve the satisfaction of nursing. It is worthy of clinical promotion.

Review Article

Refractive surgical corrective options after cataract surgery

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Abstract: Cataract surgery is one of the most commonly performed surgeries among the elderly today. The volume of cataract surgeries has dramatically increased in the past few decades due to technological advancements leading to decreased morbidity, better overall outcomes, and increased expectation for correction of refractive error and spectacle independence after cataract surgery. The number of cataract surgeries is expected to continue to rise with the increase of the elderly population. Thus, accurate predictions of intraocular lens (IOL) power and the ability to correct for any postoperative refractive errors are critical. Despite the improved ability of cataract surgeons to accurately calculate IOL power, postoperative refractive errors still do occur due to various reasons such as imperfect preoperative measurements, toric-lens misalignment, and existing or surgically-induced astigmatism. The aim of this article is to review the various surgical options, including intraocular and corneal refractive surgical approaches, to correct post-operative refractive errors after cataract surgery.

Review Article

Treatment of congenital ptosis

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Abstract: Congenital ptosis is an abnormally low position of the upper eyelid, with respect to the visual axis in the primary gaze. It can be present at birth or manifest itself during the first year of life and can be bilateral or unilateral. Additionally, it may be an isolated finding or part of a constellation of signs of a specific syndrome or systemic associations. Depending on how much it interferes with the visual axis, it may be considered as a functional or a cosmetic condition. In childhood, functional ptosis can lead to deprivation amblyopia and astigmatism and needs to be treated. However, even mild ptosis with normal vision can lead to psychosocial problems and correction is also advised, albeit on a less urgent basis. Although, patching and glasses can be prescribed to treat the amblyopia, the mainstay of management is surgical. There are several types of surgical procedure available depending on the severity and etiology of the droopy eyelid. The first part of this paper will review the different categories of congenital ptosis, including more common associated syndromes. The latter part will briefly cover the different surgical approaches, with emphasis on how to choose the correct condition. In spite of many complex factors inherent to the treatment of congenital ptosis, the overall outcomes are quite satisfactory, and most surgeons feel that ptosis management can be both challenging and rewarding at the same time.

Review Article

Socket discomfort in anophthalmic patients—reasons and therapy options

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Abstract: A smooth and timely fitting of a visually appealing, custom-made eye prosthesis after the loss of an eye is not only essential from a cosmetic point of view but above all facilitates good social and psychological rehabilitation. Cryolite glass prostheses must be replaced at least once a year, PMMA prostheses polished once a year and renewed every five years. In children, especially in growth phases, the fit of the prosthesis should be checked at least every six months and adjusted, if necessary. Ocularists and ophthalmologists should determine an individual cleaning procedure together with the patient, which depends on both the prosthesis material and external factors. Complications such as allergic, giant papillary, viral, and bacterial conjunctivitis or even blepharoconjunctivitis sicca must be detected and treated at an early stage to avoid discomfort and to maintain the ability of prosthesis wear. In the case of inflammation-induced shrinkage of the conjunctival fornices or post-enucleation socket syndrome, surgical interventions are necessary. In summary, an early supply with an eye prosthesis, adequate treatment of complications, and attention to psychological aspects, form the basis for a successful long-term rehabilitation of anophthalmic patients.

Original Article
Review Article

Dealing with pediatric glaucoma: from medical to surgical management—a narrative review

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Abstract: Pediatric glaucoma is a potentially sight-threatening disease and is considered the second leading cause of treatable childhood blindness. Pediatric glaucoma is a clinical entity including a wide range of conditions: primary congenital glaucoma, glaucoma secondary to ocular (e.g., aniridia, Peter’s anomaly), or systemic disease (e.g., Sturge Weber) and glaucoma secondary to acquired condition (pseudophakic, traumatic, uveitic glaucoma). The treatment algorithm of childhood glaucoma is a step-by-step approach, often starting with surgery, as in primary congenital glaucoma cases. Medical therapy is also crucial in the management of pediatric glaucoma. Here we reported the results of the randomized, controlled, clinical trials carried out in children treated with topical anti-glaucoma drugs. It is worth knowing that prostaglandin analogues showed an excellent systemic safety profile, while serious systemic events have been reported in children taking topical beta-blockers. Angle surgery is the first surgical option in patients diagnosed with primary congenital glaucoma, with ab interno and ab externo approaches showing similar outcomes. Trabeculectomy in children can be troublesome, as mitomycin C (MMC) can lead to bleb complications and a higher endophthalmitis rate than in adults. Glaucoma drainage devices (GDD) are no longer a last resort and can be considered a suitable option for the management of uncontrolled pediatric glaucoma after angle surgery failure.

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  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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