Background: The ORVIS infrastructure aims to facilitate the development and availability of valid and adapted tools that will allow functional, perceptual, cognitive and psychological evaluation of low vision clients by researchers and clinicians who work in low vision and visual impairment rehabilitation.
Methods: The tools developed or documented within ORVIS Infrastructure are tests or questionnaires which allow, or will allow to assess—in an accurate and reliable manner—characteristics related to visual impairment. The tools in development are: (I) questionnaire de repérage des hallucinations visuelles liées au syndrome de Charles-Bonnet (QR-SCB); (II) repérage des personnes agées présentant des INDices de déficience VISUELle (IndiVisuel); (III) mesure de l’impact de la déficience visuelle dans les activités quotidiennes (MIDVAQ) and (IV) M’EYE read test. The directory documents 14 tools and offers—within a descriptive sheet—characteristics, components and metrological properties as supported by cited scientific studies.
Results: The ORVIS Infrastructure, which aims at the development and availability of assessment tools, fills researchers’ and clinicians’ needs for measurement tools that are valid, effective and appropriate for use with a visually impaired clientele. Such tools are, especially in French, little known and hard to find, and represent a precious resource for those who want to evaluate the efficacy of treatments or interventions.
Conclusions: ORVIS is available at www.orvis.vision. Between November 2015 and September 2017, the directory has been accessed 1,383 times by 952 unique visitors.
Background: With the arrival of a new standardized tool and considering the multiple disadvantages of the actual method used for assesses lighting needs, the goal of the study was to compare the actual lighting assessment method used by the clinicians working in a rehabilitation center with the use of the LuxIQTM. As reading is found to be the main difficulty mentioned by the majority of the clients at the rehabilitation centre and that past studies have shown the impact of lighting on improving reading speed and deceasing print size, the hypothesis stated that the use of the standardized tool would be statistically significantly superior than the use of the standard method on the variables on reading speed, print size, ocular fatigue, application of the recommendations and satisfaction of the length of time read.
Methods: Three clinicians proceeded to home lighting assessments for 28 participants aged from 19 to 100 years (mean =75, SD =27) old diagnosed with age-related macular degeneration or glaucoma. The study evaluated and compared pre and post results between the two methods.
Results: The intervention did not have a statistically significant impact on any of the variables mentioned. The lighting assessment itself, with either the standard method or using the LuxIQ, statistically significantly decreased print size for reading (P<0.001, ω2 =0.47).
Conclusions: Lighting has a significant impact on reading print size. Participants value the assessment but encounter various obstacles that prevent them from applying the lighting recommendations. Considering the positive impact of lighting, finding a solution so participants may profit from the benefits of this intervention is crucial.
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.
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.
Background: The oxygen induced retinopathy rodent model is widely used, notably for the assessment of developmental dystrophies in preclinical studies of vascular retinal diseases. Typically, the quantification of vessel tufts and avascular regions is computed manually from flat mounted retinas imaged using fluorescent probes that highlight the vascular network. However, such manual measurements are time-consuming and hampered by user variability and bias, thus a rapid and objective alternative is required.
Methods: We employ a machine learning approach to segment and characterize vascular tufts. The proposed quantitative retinal vascular assessment (QuRVA) technique uses quadratic discrimination analysis and morphological techniques to provide reliable measurements of vascular density and pathological vascular tuft regions, devoid of user intervention within seconds. Our algorithms allow also delineating the whole vasculature network, and identifying and analyzing avascular regions.
Results: Our first experiment shows the high degree of error and variability of manual segmentations. In consequence, we developed a set of algorithms to perform this task automatically. We benchmark and validate the results of our analysis pipeline using the consensus of several manually curated segmentations using commonly used computer tools. We describe the method, provide details for reproducing the algorithm, and validate all aspects of the analysis.
Conclusions: Manual and semi-automated procedures for tuft detection present strong fluctuations among users, demonstrating the need for fast and unbiased tools in this highly active research field with tremendous implications for basic research and industry.
Abstract: Pediatric neuro-ophthalmology is a subspecialty within neuro-ophthalmology. Pediatric neuro-ophthalmic diseases must be considered separate from their adult counterparts, due to the distinctive nature of the examination, clinical presentations, and management choices. This manuscript will highlight four common pediatric neuro-ophthalmic disorders by describing common clinical presentations, recommended management, and highlighting recent developments. Diseases discussed include pediatric idiopathic intracranial hypertension (IIH), pseudopapilledema, optic neuritis (ON) and optic pathway gliomas (OPG). The demographics, diagnosis and management of common pediatric neuro-ophthalmic disease require a working knowledge of the current research presented herein. Special attention should be placed on the differences between pediatric and adult entities such that children can be appropriately diagnosed and treated.
Abstract: To describe the current aging population in China and globally, especially as it applies to age-related macular degeneration (AMD). To review the current standards of care for treating both wet (exudative) eAMD and dry (atrophic) aAMD. And to introduce a model for experimentation that is based on the Age-Related Eye Disease Study (AREDS) using eye bank tissue. A literature search that outlines current aging populations, standards of clinical treatment as defined by large, multicenter, randomized clinical trials that present level-I data with a low risk for bias. An experimental model system of AMD is presented that enables scientific analysis of AMD pathogenesis by applying grading criteria from the AREDS to human eye bank eyes. Analysis includes proteomic, cellular, and functional genomics. The standard of care for the treatment of eAMD is currently defined by the use of several anti-vascular endothelial growth (anti-VEGF) agents alone or in combination with photodynamic therapy. Monotherapy treatment intervals may be monthly, as needed, or by using a treat-and-extend (TAE) protocol. There are no proven therapies for aAMD. AMD that is phenotypically defined at AREDS level 3, should be managed with the use of anti-oxidant vitamins, lutein/zeaxanthin and zinc (AREDS-2 formulation). By understanding the multiple etiologies in the pathogenesis of AMD (i.e., oxidative stress, inflammation, and genetics), the use of human eye bank tissues graded according to the Minnesota Grading System (MGS) will enable future insights into the pathogenesis of AMD. Initial AMD management is with lifestyle modification such as avoiding smoking, eating a healthy diet and using appropriate vitamin supplements (AREDS-2). For eAMD, anti-VEGF therapies using either pro re nata (PRN) or TAE protocols are recommended, with photodynamic therapy in appropriate cases. New cellular information will direct future, potential therapies and these will originate from experimental models, such as the proposed eye bank model using the MGS, that leverages the prospective AREDS database.
Abstract: In a rapidly changing world, there is an increased need to cultivate ophthalmologists who are not only technically capable but also possess the leadership skills required to be at the forefront of change. Ophthalmologists make daily frontline decisions that determine the quality and efficiency of care based on their leadership qualities. However, they also educate, advocate, perform research, run departments and work in practices—all of which require the practice of effective leadership. Although the need for ophthalmic leadership has been recognised, few training programs offer leadership skills as a component of their core curricula, focussing on clinical knowledge with less emphasis on teaching of non-clinical professional competencies. Clinicians who participate in leadership development are more likely to feel empowered to provide patient-centred care, develop a greater self-awareness and confidence to initiate positive change and promote better team alignment. In turn, the ophthalmic profession collectively benefits from effective leadership as organizations are better run, issues are advocated more globally and challenges are address holistically by ophthalmologists who are not merely technically capable surgeons or researchers, but effective communicators and collaborators. In this paper, we explore the role of leadership in the spheres of healthcare and ophthalmology. We discuss the value of leadership across clinical, educational and organisational levels, with specific emphasis on the current state of development and conclude with a series of recommendations to ensure the continued development of effective ophthalmic leaders into the future.
