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Journal of Alzheimer's Disease : JAD 2019Vision impairments are prevalent, but underdiagnosed in individuals with dementia living in long-term care (LTC). Effective screening tools could identify remediable... (Review)
Review
Vision impairments are prevalent, but underdiagnosed in individuals with dementia living in long-term care (LTC). Effective screening tools could identify remediable vision problems. This scoping review was conducted to identify vision screening tests used with individuals with dementia and assesses their suitability for administration by nurses in LTC. A literature search using the Arksey and O'Malley (2005) method included research articles, conference proceedings, and dissertations. Data were included from participants over 65 years of age with a diagnosis of probable dementia. A panel of vision experts evaluated the suitability of the candidate vision tests. The search yielded 179 publications that met the inclusion criteria. Of 134 vision tests that were identified, 19 were deemed suitable for screening by nurses in LTC. Tests screened for acuity (12), visual field (1), anatomy (2), color vision (2), and general visual abilities (2). Tests were excluded because of complexity of interpretation (90), need for specialized training (83), use in research only (57), need for specialized equipment (54), not assessing visual function (44), long test duration (21), uncommonness (13), and needing an act reserved for specialists (7). Psychometric properties were not often reported for tests. Few of the tests identified had been validated for use with individuals with dementia. Based on our review, few tests were deemed suitable for use by nurses to assess this population in LTC. Identifying appropriate tools to screen vision in individuals with dementia is a necessary first step to interventions that could potentially improve functioning and quality of life.
Topics: Aged; Dementia; Humans; Long-Term Care; Vision Disorders; Vision Tests
PubMed: 30909236
DOI: 10.3233/JAD-181129 -
Translational Vision Science &... Dec 2020Visual prostheses aim to restore, at least to some extent, vision that leads to the type of perception available for sighted patients. Their effectiveness is almost...
UNLABELLED
Visual prostheses aim to restore, at least to some extent, vision that leads to the type of perception available for sighted patients. Their effectiveness is almost always evaluated using clinical tests of vision. Clinical vision tests are designed to measure the limits of parameters of a functioning visual system. I argue here that these tests are rarely suited to determine the ability of prosthetic devices and other therapies to restore vision. This paper describes and explains many limitations of these evaluations. Prosthetic vision testing often makes use of multiple-alternative forced-choice (MAFC) procedures. Although these paradigms are suitable for many studies, they are frequently problematic in vision restoration evaluation. Two main types of problems are identified: (1) where nuisance variables provide spurious cues that can be learned in repeated training, which is common in prosthetic vision, and thus defeat the purpose of the test; and (2) even though a test is properly designed and performed, it may not actually measure what the researchers believe, and thus the interpretation of results is wrong. Examples for both types of problems are presented. Additional problems arise from confounding factors in the administration of tests are pointed as limitations of current device evaluation. For example, head tracing of magnified objects enlarged to compensate for the system's low resolution, in distinction from the scanning head (camera) movements with which users of prosthetic devices expand the limited field of view. Because of these problems, the ability to perform satisfactorily on the clinical tests is necessary but insufficient to prove vision restoration, therefore, additional tests are needed. I propose some directions to pursue in such testing.
TRANSLATIONAL RELEVANCE
Numerous prosthetic devices are being developed and introduced to the market. Proving the utility of these devices is crucial for regulatory and even for post market acceptance, which so far has largely failed, in my opinion. Potential reasons for the failures despite success in regulatory testing and directions for designing improved testing are provided. It is hoped that improved testing will guide improved designs of future prosthetic systems and other vision restoration approaches.
Topics: Humans; Movement; Vision Tests; Vision, Ocular; Visual Prosthesis
PubMed: 33384886
DOI: 10.1167/tvst.9.13.32 -
JAMA Ophthalmology Mar 2021Many ophthalmology appointments have been converted to telemedicine assessments. The use of a printed vision chart for ophthalmology telemedicine appointments that can...
IMPORTANCE
Many ophthalmology appointments have been converted to telemedicine assessments. The use of a printed vision chart for ophthalmology telemedicine appointments that can be used by people who are excluded from digital testing has yet to be validated.
OBJECTIVES
To evaluate the repeatability of visual acuity measured using the Home Acuity Test (HAT) and the agreement between the HAT and the last in-clinic visual acuity.
DESIGN, SETTING, AND PARTICIPANTS
This diagnostic study was conducted from May 11 to 22, 2020, among 50 control participants and 100 adult ophthalmology outpatients who reported subjectively stable vision and were attending routine telemedicine clinics. Bland-Altman analysis of corrected visual acuity measured with the HAT was compared with the last measured in-clinic visual acuity on a conventional Early Treatment Diabetic Retinopathy Study logMAR chart.
MAIN OUTCOMES AND MEASURES
For control participants, repeatability of the HAT and agreement with standard logMAR visual acuity measurement. For ophthalmology outpatients, agreement with the last recorded in-clinic visual acuity and with the International Classification of Diseases and Related Health Problems, 11th Revision visual impairment category.
RESULTS
A total of 50 control participants (33 [66%] women; mean [SD] age, 36.0 [10.8] years) and 100 ophthalmology patients with a wide range of diseases (65 [65%] women; mean [SD] age, 55.3 [22.2] years) were recruited. For control participants, mean (SD) test-retest difference in the HAT line score was -0.012 (0.06) logMAR, with limits of agreement (LOA) between -0.13 and 0.10 logMAR. The mean (SD) difference in visual acuity compared with conventional vision charts was -0.14 (0.14) logMAR (range, -0.4 to 0.18 log MAR) (-7 letters) in controls, with LOA of -0.41 to 0.12 logMAR (-20 to 6 letters). For ophthalmology outpatients, the mean (SD) difference in visual acuity was -0.10 (0.17) logMAR (range, -0.5 to 0.3 logMAR) (1 line on a conventional logMAR sight chart), with the HAT indicating poorer visual acuity than the previous in-clinic test, and LOA of -0.44 to 0.23 logMAR (-22 to 12 letters). There was good agreement in the visual impairment category for ophthalmology outpatients (Cohen κ = 0.77 [95% CI, 0.74-0.81]) and control participants (Cohen κ = 0.88 [95% CI, 0.88-0.88]).
CONCLUSIONS AND RELEVANCE
This study suggests that the HAT can be used to measure visual acuity by telephone for a wide range of ophthalmology outpatients with diverse conditions. Test-retest repeatability is relatively high, and agreement in the visual impairment category is good for this sample, supporting the use of printed charts in this context.
Topics: Adult; Female; Humans; Male; Middle Aged; Outpatients; Printing; Reproducibility of Results; Telemedicine; Vision Disorders; Vision Screening; Vision Tests; Young Adult
PubMed: 33410910
DOI: 10.1001/jamaophthalmol.2020.5972 -
Romanian Journal of Ophthalmology 2017The aim of the study was to analyze the effects that gadgets have on eyesight quality. A prospective observational study was conducted from January to July 2016, on 60... (Observational Study)
Observational Study
The aim of the study was to analyze the effects that gadgets have on eyesight quality. A prospective observational study was conducted from January to July 2016, on 60 people who were divided into two groups: Group 1 - 30 middle school pupils with a mean age of 11.9 ± 1.86 and Group 2 - 30 patients evaluated in the Ophthalmology Clinic, "Sf. Spiridon" Hospital, Iași, with a mean age of 21.36 ± 7.16 years. The clinical parameters observed were the following: visual acuity (VA), objective refraction, binocular vision (BV), fusional amplitude (FA), Schirmer's test. A questionnaire was also distributed, which contained 8 questions that highlighted the gadget's impact on the eyesight. The use of different gadgets, such as computer, laptops, mobile phones or other displays become part of our everyday life and people experience a variety of ocular symptoms or vision problems related to these. Computer Vision Syndrome (CVS) represents a group of visual and extraocular symptoms associated with sustained use of visual display terminals. Headache, blurred vision, and ocular congestion are the most frequent manifestations determined by the long time use of gadgets. Mobile phones and laptops are the most frequently used gadgets. People who use gadgets for a long time have a sustained effort for accommodation. A small amount of refractive errors (especially myopic shift) was objectively recorded by various studies on near work. Dry eye syndrome could also be identified, and an improvement of visual comfort could be observed after the instillation of artificial tears drops. Computer Vision Syndrome is still under-diagnosed, and people should be made aware of the bad effects the prolonged use of gadgets has on eyesight.
Topics: Accommodation, Ocular; Adult; Female; Humans; Male; Myopia; Prospective Studies; User-Computer Interface; Vision Tests; Vision, Binocular; Visual Acuity; Young Adult
PubMed: 29450383
DOI: 10.22336/rjo.2017.21 -
Aerospace Medicine and Human Performance Aug 2018The aim of this study was to evaluate the ability of eight color vision tests to screen for and accurately measure hereditary color-deficiency in order to improve color...
INTRODUCTION
The aim of this study was to evaluate the ability of eight color vision tests to screen for and accurately measure hereditary color-deficiency in order to improve color vision assessment methods for aircraft pilots.
METHODS
This prospective study included 29 color-deficient subjects and 23 healthy subjects. All performed the following tests: Ishihara plates, Farnsworth D15, Lanthony desaturated 15 Hue, Munsell 100 Hue, Beyne and Fletcher-Evans CAM lanterns, Nagel anomaloscope, and the Color Assessment and Diagnosis (CAD) test. The sensitivity and specificity of color-deficiency diagnosis were evaluated for each test, as well as the test's relevance for assessing aircraft pilots.
RESULTS
The Ishihara plate test demonstrated a sensitivity of 0.97 and a specificity of 1.00 for color-deficiency screening. The CAD test and anomaloscope showed both a sensitivity and specificity of 1.00. The Beyne lantern, Fletcher lantern, Farnsworth D15, and the Lanthony 15 Hue tests all showed a specificity of 1.00 and sensitivities of, respectively, 0.69, 0.97, 0.58, and 0.79. During aircraft pilot selection tests, the CAD test classified 10% of color-deficient subjects as safe to fly, the anomaloscope 17%, and the Beyne and Fletcher lantern tests, respectively, 31% and 3%.
DISCUSSION
The discrepancy in results confirms that current color vision test protocols need to be reassessed. The CAD test could be an interesting alternative to the series of tests used to assess flight crew, but it seems more selective than current tests.Marechal M, Delbarre M, Tesson J, Lacambre C, Lefebvre H, Froussart-Maille F. Color vision tests in pilots' medical assessments. Aerosp Med Hum Perform. 2018; 89(8):737-743.
Topics: Adult; Aerospace Medicine; Color Perception Tests; Color Vision Defects; Female; Humans; Male; Pilots; Prospective Studies; Sensitivity and Specificity; Young Adult
PubMed: 30020059
DOI: 10.3357/AMHP.5009.2018 -
Eye (London, England) Dec 2023Home visual acuity tests could ease pressure on ophthalmic services by facilitating remote review of patients. Home tests may have further utility in giving service...
BACKGROUND
Home visual acuity tests could ease pressure on ophthalmic services by facilitating remote review of patients. Home tests may have further utility in giving service users frequent updates of vision outcomes during therapy, identifying vision problems in an asymptomatic population, and engaging stakeholders in therapy.
METHODS
Children attending outpatient clinics had visual acuity measured 3 times at the same appointment: Once by a registered orthoptist per clinical protocols, once by an orthoptist using a tablet-based visual acuity test (iSight Test Pro, Kay Pictures), and once by an unsupervised parent/carer using the tablet-based test.
RESULTS
In total, 42 children were recruited to the study. The mean age was 5.6 years (range 3.3 to 9.3 years). Median and interquartile ranges (IQR) for clinical standard, orthoptic-led and parent/carer-led iSight Test Pro visual acuity measurements were 0.155 (0.18 IQR), 0.180 (0.26 IQR), and 0.300 (0.33 IQR) logMAR respectively. The iSight Test Pro in the hands of parents/carers was significantly different from the standard of care measurements (P = 0.008). In the hands of orthoptists. There was no significant difference between orthoptists using the iSight Test Pro and standard of care (P = 0.289), nor between orthoptist iSight Test Pro and parents/carer iSight Test Pro measurements (P = 0.108).
CONCLUSION
This technique of unsupervised visual acuity measures for children is not comparable to clinical measures and is unlikely to be valuable to clinical decision making. Future work should focus on improving the accuracy of the test through better training, equipment/software or supervision/support.
Topics: Humans; Child; Child, Preschool; Prospective Studies; Vision Tests; Visual Acuity; Research Design
PubMed: 37328509
DOI: 10.1038/s41433-023-02597-7 -
Investigative Ophthalmology & Visual... Jan 2022To assess whether monocular contrast sensitivity and stereoacuity impairments remain when visual acuity is fully recovered in children with refractive amblyopia.
PURPOSE
To assess whether monocular contrast sensitivity and stereoacuity impairments remain when visual acuity is fully recovered in children with refractive amblyopia.
METHODS
A retrospective review of 487 patients diagnosed with refractive amblyopia whose visual acuity improved to 0.08 logMAR or better in both eyes following optical treatment was conducted. Measurements of monocular contrast sensitivity and stereoacuity had been made when visual acuity normalized. All patients had been treated with refractive correction for approximately 2 years following diagnosis. No other treatments were provided. Monocular contrast sensitivity was measured using the CSV-1000E chart for children 6 years of age or younger and a psychophysical technique called the quick contrast sensitivity function in older children. Stereoacuity was measured using the Random Dot Test that includes monocular cues and the Randot Stereoacuity Test that does not have monocular cues.
RESULTS
Statistically significant interocular differences in contrast sensitivity were observed. These differences tended to occur at higher spatial frequencies (12 and 18 cycles per degree). Stereoacuity within the age-specific normal range was achieved by 47.4% of patients for the Random Dot Test and only 23.1% of patients for the Randot Stereoacuity Test.
CONCLUSIONS
Full recovery of visual acuity following treatment for refractive amblyopia does not equalize interocular contrast sensitivity or restore normal stereopsis. Alternative therapeutic approaches that target contrast sensitivity and/or binocular vision are required.
Topics: Amblyopia; Child; Child, Preschool; Contrast Sensitivity; Depth Perception; Eyeglasses; Female; Humans; Hyperopia; Male; Myopia; Retrospective Studies; Sensory Deprivation; Vision Tests; Vision, Binocular; Visual Acuity
PubMed: 34989762
DOI: 10.1167/iovs.63.1.6 -
Journal of Vestibular Research :... 2021Clinical vestibular technology is rapidly evolving to improve objective assessments of vestibular function. Understanding the reliability and expected score ranges of...
BACKGROUND
Clinical vestibular technology is rapidly evolving to improve objective assessments of vestibular function. Understanding the reliability and expected score ranges of emerging clinical vestibular tools is important to gauge how these tools should be used as clinical endpoints.
OBJECTIVE
The objective of this study was to evaluate inter-rater and test-retest reliability intraclass correlation coefficients (ICCs) of four vestibular tools and to determine expected ranges of scores through smallest real difference (SRD) measures.
METHODS
Sixty healthy graduate students completed two 1-hour sessions, at most a week apart, consisting of two video head-impulse tests (vHIT), computerized dynamic visual acuity (cDVA) tests, and a smartphone-assisted bucket test (SA-SVV). Thirty students were tested by different testers at each session (inter-rater) and 30 by the same tester (test-retest). ICCs and SRDs were calculated for both conditions.
RESULTS
Most measures fell within the moderate ICC range (0.50-0.75). ICCs were higher for cDVA in the inter-rater subgroup and higher for vHITs in the test-retest subgroup.
CONCLUSIONS
Measures from the four tools evaluated were moderately reliable. There may be a tester effect on reliabilities, specifically vHITs. Further research should repeat these analyses in a patient population and explore methodological differences between vHIT systems.
Topics: Head Impulse Test; Humans; Reproducibility of Results; Vestibule, Labyrinth; Vision Tests; Visual Acuity
PubMed: 33646190
DOI: 10.3233/VES-201522 -
Journal of Safety Research Feb 2020The present study proposes to validate the Driver Ecological Glare Test (DEGT), a test developed to measure the benefit of a headlight glare Advanced Driver Assistance...
INTRODUCTION
The present study proposes to validate the Driver Ecological Glare Test (DEGT), a test developed to measure the benefit of a headlight glare Advanced Driver Assistance System (ADAS), by comparing it to a laboratory glare test.
METHOD
Twenty-four participants, aged from 55 to 70 years, were recruited to complete a visual examination, including monocular halo size measurement for both eyes using Vision Monitor device (MonCv3; Metrovision). An on-field evaluation took place at night at the UTAC CERAM test track to obtain disability glare measures using the DEGT.
RESULTS
A significant correlation was found between the two glare tests and Bland-Altman analysis reveals a good agreement with a bias of 73.7 arcmin between the halo size measurements obtained from the DEGT and Vision Monitor. The results of the present study demonstrate that the DEGT is a valid method to test halo size and is adapted to evaluate the benefits of an antiglare device for drivers in an ecological situation.
Topics: Aged; Automobile Driving; Female; France; Glare; Humans; Male; Middle Aged; Safety; Vision Tests; Visual Acuity
PubMed: 32199556
DOI: 10.1016/j.jsr.2019.12.007 -
Scientific Reports Apr 2024Primary congenital glaucoma is a rare disease that occurs in early birth and can lead to low vision. Evaluating affected children is challenging and there is a lack of...
Primary congenital glaucoma is a rare disease that occurs in early birth and can lead to low vision. Evaluating affected children is challenging and there is a lack of studies regarding color vision in pediatric glaucoma patients. This cross-sectional study included 21 eyes of 13 children with primary congenital glaucoma who were assessed using the Farnsworth D-15 test to evaluate color vision discrimination and by spectral domain optical coherence tomography to measure retinal fiber layer thickness. Age, visual acuity, cup-to-disc ratio and spherical equivalent data were also collected. Global and sectional circumpapillary and macular retinal fiber layer thicknesses were measured and compared based on color vision test performance. Four eyes (19%) failed the color vision test with diffuse dyschromatopsia patterns. Only age showed statistical significance in color vision test performance. Global and sectional circumpapillary and macular retinal fiber layer thicknesses were similar between the color test outcomes dyschromatopsia and normal. While the color vision test could play a role in assessing children with primary congenital glaucoma, further studies are needed to correlate it with damage to retinal fiber layer thickness.
Topics: Humans; Female; Male; Child; Cross-Sectional Studies; Tomography, Optical Coherence; Glaucoma; Child, Preschool; Color Vision; Visual Acuity; Adolescent; Color Vision Defects; Color Perception; Retina; Color Perception Tests
PubMed: 38664551
DOI: 10.1038/s41598-024-60320-2