Development of an integrated telerehabilitation model in children with cerebral visual impairment in South India during the COVID-19 pandemic – A pilot study

Purpose: Coronavirus disease 2019 (COVID?19) pandemic affected the in?person rehabilitation/habilitation services in families with children with cerebral visual impairment (CVI) in India. This study aimed to develop a structured and family?centered telerehabilitation model alongside conventional in?person intervention in children with CVI to observe its feasibility in the Indian population. Methods: This pilot study included 22 participants with a median age of 2.5 years (range: 1–6) who underwent a detailed comprehensive eye examination followed by functional vision assessment. The visual function classification system (VFCS) was administered to the children and the structured clinical question inventory (SCQI) to the parents. Every participant underwent 3 months of telerehabilitation including planning, training, and monitoring by experts. At 1 month, the parental care and ability (PCA) rubric was administered to the parents. After 3 months, in an in?person follow?up, all the measures were reassessed for 15 children. Results: After 3 months of Tele?rehabilitation there were significant improvements noted in PCA rubric scores (P<0.05). Also, statistically significant improvements were noted in functional vision measured using SCQI and VFCS scores (P<0.05) compared to baseline. Conclusion: The outcomes of the study provide the first steps towards understanding the use of a novel tele?rehabilitation model in childhood CVI along?side conventional face?to?face intervention. The added role of parental involvement in such a model is highly essential.

Visual impairment in children with multiple disabilities in schools for children with special needs in South India

Purpose: To understand/assess ocular and functional vision impairment in children with multiple disabilities with a functional vision assessment battery in addition to standard ophthalmic examinations in an outreach setting. Methods: Seven schools for children with special needs, 243 children in total, were screened for ocular disorders and functional vision impairment through school camps. Results: Among them, 37% had refractive errors needing spectacle correction. With standard ocular testing methods, the visual impairment was around 32%, but when functional vision was assessed, the functional vision impairment amounted to 70% in these children. The presence of functional vision impairment was found to be independent of the associated disability. Assessment of visual capacities such as visual closure, saccade pursuits, optic ataxia, and developmental milestones early on can help in suspecting the presence of CVI. Conclusion: Children with multiple disabilities are more at risk of functional vision impairment, which significantly impairs their ability to function in daily life. A complete functional vision assessment becomes essential to plan early intervention for these children. The significant proportion of vision impairment and functional vision loss in our study indicates the need for coordinated structured programs to address vision?related problems in children with multiple disabilities.

Research progress of functional vision assessment tools for patients with visual disorders / 中国实用护理杂志

Functional vision is the visual ability of patients with visual disorders when they participate in or complete daily activities, through early evaluation and targeted treatment, the improvement of disease prognosis can be realized. In this paper, the concept of functional vision was introduced, the evaluation content, scoring method and application status of functional vision evaluation tools for patients with visual disorders were described, and the analysis and comparison of the characteristics and shortcomings of each evaluation tool were carried out.Thus providing appropriate functional vision evaluation tools for medical staff in China and providing reference for improving the quality of functional vision evaluation for patients with visual disorders.

Understanding low functioning cerebral visual impairment: An Indian context

For several reasons, cerebral visual impairment (CVI) is emerging as a major cause of visual impairment among children in the developing world and we are seeing an increasing number of such children in our clinics. Owing to lack of early training about CVI and it being a habilitation orientated subject, we need to become equipped to optimally help the affected children. In this paper we have explained our pragmatic approach in addressing children who present with low functioning CVI. Initially we explain briefly, how vision is processed in the brain. We then present what should be specifically looked for in these children in regular clinics as a part of their comprehensive ophthalmic examination. We discuss the process of functional vision evaluation that we follow with the help of videos to explain the procedures, examples of how to convey the conclusions to the family, and how to use our findings to develop intervention guidelines for the child. We explain the difference between passive vision stimulation and vision intervention, provide some common interventions that may be applicable to many children and suggest how to infuse interventions in daily routines of children so that they become relevant and meaningful leading to effective learning experiences.

Visual function assessment, ocular examination, and intervention in children with developmental delay: A systematic approach. Part 1

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

Items of Evaluation of Functional Vision in Visually-impaired Children Based on ICF / 中国康复理论与实践

@#Based on the ICF framework and functional vision theories, some elements of an evaluation system for visually impaired children were extracted, including body structure and function, activities and participation, and environmental factors.

Functional vision barriers: a new concept analyzed in terms of human visual performance

In this work we introduce a new category of barriers that we call "functional vision barriers." This expression refers to lighting and visual elements that may complicate or hinder functional vision and may make life even more difficult for people with visual defects. These barriers appear as a consequence of certain negative effects caused by the poor design of the visual stimulus or visual environment that surrounds it in which lighting is one of the main factors. We use the term "functional vision" because this expression refers to the ability of the visual system to perform everyday tasks. We analyzed some of our previous results with regard to situations that can be considered "functional vision barriers": (1) stimuli with low luminance contrast information in which the addition of chromatic contrast improves visual performance and (2) tasks that are performed in the presence of a glare source in the visual field, diminishing visual performance and reducing brightness perception...

Visual Field Relocation and Clinical Effect of Fresnel Prism in Patients with Homonymous Hemianopsia

PURPOSE: To report the result of Fresnel prism application and adaptation for visual field relocation and functional vision improvement in homonymous hemianopsia patients. METHODS: Fifteen homonymous hemianopsia patients were prescribed Fresnel prism. To expand the visual field, Fresnel prism was placed base-out toward the defective field and patients were given an adaptation period of 1 month. The effects of the prism on field expansion was evaluated using Goldmann perimetry. In addition, the NEI-VFQ25 questionnaire was utilized asking patients regarding their subjective functional vision and satisfaction in daily life before and after using the Fresnel prism. RESULTS: After 1 month of Fresnel prism prescription, 53% of patients showed objective visual field expansion to the defective field of 12.5 degrees on average. Monocular or macular splitting hemianopsia patients showed more visual field expansion than binocular macular sparing hemianopsia patients. The NEI-VFQ25 score increased significantly and abnormal head position decreased or disappeared after 1 month of using the prism. However, 47% of patients failed to adapt to the prism. CONCLUSIONS: Using Fresnel prism in homonymous hemianopsia patients effectively expands the visual field, corrects abnormal head position, and improves functional vision. However, to improve the success rate, for certain patients the proper choice of prism application method, prism diopters, and constant management are necessary.

Assessment of Functional Vision Score and Vision-Specific Quality of Life in Individuals With Retinitis Pigmentosa

PURPOSE: To determine the relationship between the American Medical Association's (AMA) functional vision score (FVS) and vision-specific quality of life in retinitis pigmentosa (RP) patients using the National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ 25). METHODS: One hundred eight patients with RP participated in the study. We measured best-corrected visual acuity, conducted Goldmann perimetry, and collected the self-reported NEI-VFQ 25. The FVS was calculated using the functional field score (FFS) and the functional acuity score (FAS). The correlations of the VFQ composite scores to the FVS, FFS, and FAS were determined using correlation and regression analyses. RESULTS: FVS was highly correlated to the BCVA (r=0.69, p<0.001), the FFS (r=0.86, p<0.001) and the FAS (r=0.73, p<0.001). Significant correlations of the VFQ composite score to the BCVA (r=0.60, p<0.001), FFS (r=0.44, p<0.001), FAS (r=0.60, p<0.001), FVS (r=0.58, p<0.001) were also found. However, the correlation strengths of BCVA, FVS, FAS, and FFS to NEI-FVQ were not different. CONCLUSIONS: In RP patients, the vision-specific quality of life was correlated with the AMA guidelines' FVS, FFS, and FAS. Their correlation degrees to NEI-FVQ were not different. This result suggests that vision-specific quality of life can be explained by both visual acuity and visual field in RP patients.

Contrast sensitivity of aspheric and standard spherical intraocular lens after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the contrast sensitivity obtained through anterior surface modified prolate intraocular lens with the contrast sensitivity obtained through standard spherical intraocular Iens.METHODS:Patients presenting for cataract surgery in one eye were randomized to receive either the Acrysef IQ intraocular lens(AIcon)or the AR40e intraocular lens(AMO).50 eyes after phacoemulsification with IOL implantation were included,23 eyes received Acrysof IQ,and 27 eyes received AP40e intraocular lens (AMO).Contrast sensitivity testing under photopic conditions (85cd/m2)served as the prindpal outcome measure.The contrast sensitivity function was measured with CSV-1000E Vision Testing Instrument(provided by VECTOR ⅥSION COMPANY) at 30 days after surgery.RESULTS:The Acrysof IQ intraocular lens provided statistically significantly better contrast sensitivity at 6,12 and 18 cydes per degree under photopic conditions.CONCLUSION:The use of anterior surface modified prolate intraocular lens for cataract surgery has the potential to improve functional vision.

The Aasesament of Contrast Sensitivity by MCT 8000(R) in Normal Eyes and Peeudophakic Eyes

The standard vision test using Snellen acuity is not always an accurate indicat or of functional vision loss. Acuity measures optical blur, but psudophakic eyes frequently do not affect optical blur. Therefore, acuity cannot provide relevant informations on the loss of vision experienced by the patients. Contrast sensitivity, not acuity, has been shown to be effective in determining functional vision loss due to psudophakic eyes. The MCT 8000(R), glare and contrast sensitivity system. was used for measurement of contrast sensitivity in 19 pseudophakic eyes at postoperative 1 month, 18 pseudophakic eyes at post-operative 3 months and 18 normal control eyes. The results were as follows: 1) Contrast sensitivity decreased in pseudophakic eyes compared to normal eyes in four different conditions; day vision, day vision with perpheral glare, night vision and night vision with central glare. 2) In pseudophakic eyes, contrast sensitivity was not different between 1 month and 3 months postoperatively.