Performance of Real-world Functional Tasks Using an Updated Oral Electronic Vision Device in Persons Blinded by Trauma.

There is an immediate need for noninvasive therapies to improve the functional abilities of persons blinded by traumatic injury. The BrainPort Vision Pro, an updated hands-free oral electronic vision device, enables perception of visual information using the tongue as a substitute for the eye. PURPOSE: The purpose of this study was to evaluate the impact of the BrainPort Vision Pro on real-world functional task performance in persons who are profoundly blind (light perception or worse) due to traumatic injury (ocular or cortical). METHODS: This was a prospective, within-subjects, repeated-measures study. Participants received ten hours of device training and were required to use the device independently for 1 year. Functional performance measures of object identification, orientation and mobility, word identification, and environmental awareness were assessed at baseline, post-device training, and quarterly throughout the year. RESULTS: Seventeen profoundly blind adults were enrolled in the study. No clinically significant device-related adverse events were reported, demonstrating minimal risks associated with the BrainPort Vision Pro. None of the participants could successfully perform any of the functional tasks at baseline, without the device. After 1 year of independent device use, all participants could identify objects, and 41% identified words beyond chance level while using the device. Forty-one percent of participants could locate a sign, 94% followed a line without veering off, 71% avoided obstacles, 71% walked through a doorway without collision, 100% of participants recognized a door, and 71% identified a window. CONCLUSIONS: Results demonstrate significant improvements in real-world functional task performance in skill areas important to everyday life. The BrainPort Vision Pro offers a nonsurgical method for improving visual function in persons blinded by trauma. The device can enhance independence and support the successful integration of profoundly blind persons, including veterans and returning service members, into community life.

An Integrated Approach for Cosmetic Rehabilitation of a Patient with Atrophia bulbi.

Atrophia bulbiis a small, shrunken, non-functional eye, most commonly due to trauma. It represents an ocular end-stage disease characterized by atrophy, shrinkage, and disorganization of the eyeball and intraocular contents, demonstrating the result of failed previous ocular therapy in which restoration of the morphologic and functional integrity of the eye is not possible. Majority of the patients with Atrophia bulbi eventually become blind and cosmetically unacceptable. The rehabilitation of such patients presents a challenging clinical situation, as the patient has already been clouded by the psychological distress. This paper demonstrates a case of 35-year male with Atrophia bulbi, who was successfully rehabilitated with precisely fabricated ocular prosthesis fitted over the atrophic eye.

Adult white New Zealand rabbit as suitable model for corneal endothelial engineering.

BACKGROUND: Corneal endothelium engineering is focused in producing transplantable cell sheets to overcome the shortage of corneal graft tissue donors for the treatment of corneal blindness. For this purpose, the use of a proper animal model plays a key role. Corneal parameters of White New Zealand rabbits such as endothelial cell density, central corneal thickness, and corneal diameter decrease with age, similarly as in humans. However, as opposed to humans, they retain the ability to restore their corneal endothelium after injury. Therefore, they are considered as an inappropriate corneal endothelial wound healing model. FINDINGS: Here we analyze the corneal endothelium mitotic ability of White New Zealand rabbits aged 3, 6, 12 and 18 months, 36 and 72 hours after thermal injury. The highest mitotic activity was observed in the 3-month rabbits 36 h after wounding. Rabbits of 12 months registered decreased mitotic activity and those of 18 months did not show mitotic activity 72 h after injury. CONCLUSIONS: These results propose that rabbits of 18 months represent a suitable model for human corneal endothelium engineering research.

Prótese ocular bilateral - relato de caso / Bilateral ocular prosthesis - case report

O presente trabalho visa apresentar um caso clínico de perda bilateral do globo ocular, descrevendo a técnica utilizada na confecção de prótese ocular realizada por graduandos em Odontologia da Escola Bahiana de Medicina e Saúde Pública-EBMSP. A face possui enorme valor estético e expressivo para as pessoas bem como para suas relações em sociedade. Alterações na face geradas pela perda ou atrofia ocular decorrente de traumatismo podem estar relacionadas a diferentes causas e apresentar variados graus de severidade. Os autores apresentam um caso de perda ocular bilateral em um adulto de 57 anos de idade, cujo globo ocular direito apresenta-se atrofiado e o esquerdo havia sido enucleado, ambos decorrentes de trauma. Pacientes portadores de deformidade ocular sofrem de distúrbios funcionais, estéticos e psicológicos. A prótese bucomaxilofacial procura minimizar tais distúrbios com a reabilitação protética, além de reintegrar o indivíduo na sociedade.

This study presents a case of bilateral loss of the eyeball, describing the technique used in the production of ocular prostheses made by dental students at the Medicine and Public Health School of Bahia (Brazil)-EBMSP. The face has great aesthetic and expressive value for people and their relations in society. Alterations in the face as a result of loss or atrophy due to ocular trauma have varied degrees of severity and may be related to different causes. The authors present a case of a 57 years old patients whose right eye was atrophied and the left had been enucleated, due to a trauma. Patients with ocular deformity suffer from functional, aesthetic, and psychological disorders. The bucomaxillofacial prosthesis can be considered an alternative to minimize these disorders with prosthetic rehabilitation, and help to reinstate the individual in society.

Predictive factors of open globe injury in patients requiring vitrectomy.

BACKGROUND: To determine the outcomes and predictive factors of patients with open globe injury requiring pars plana vitrectomy (PPV). METHODS: The medical records of 114 patients age 10 years or older who had undergone PPV due to ocular trauma, with at least 6 months follow up, were retrospectively reviewed. RESULTS: The mean age of the patients was 42 (SD14) years, with males accounting for 89% of the cases. Penetrating eye injury was the most common injury mechanism (43%) with most injuries occurring secondary to work related incidents (54%). After surgical interventions, 78% of the patients had visual improvement of one or more Snellen lines, while no light perception occurred in 10%. Anatomical attachment was achieved in 87% of eyes at the final follow up. Logistic regression analysis showed that the presence of a relative afferent pupillary defect (RAPD) was a significant predictive factor of visual outcome, while initial retinal detachment was a significant predictor of anatomical outcome. CONCLUSIONS: Pupillary reaction is an important presenting ocular sign in estimating the post-vitrectomy poor visual outcome for open globe injury. Vision was restored and improved in more than half of the patients in this study; however, long-term sequelae should be monitored.

[Capabilities of physiotherapy for orbital trauma].

The article describes the results of conservative treatment of 78 patients with injuries of ocular adnexa (isolated fractures of orbital walls as well as cicatrical deformities of orbits and eyelids). Ophthalmological assessment was made both in the early and the late periods following blunt trauma. All patients underwent a standard assessment of functional ability of the eye and, additionally, an orbital computed tomography scan to characterize the fractures. In all cases physiotherapy (endonasal electrophoresis with proteolytic enzymes) was carried out to resolve the orbital hemorrhage. Binocular vision evaluation was done to control the effectiveness of the treatment. For that, the extent of diplopia in the central field and the total area of peripheral double vision were measured and the vertical edges of the diplopia zone were defined.

Corneal inlay implantation in a young pseudophakic patient.

UNLABELLED: We describe the surgical correction of a 32-year-old pseudophakic patient with the Kamra corneal inlay. To our knowledge, this is the youngest patient to have such a procedure. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Psychosocial impact on anophthalmic patients wearing ocular prosthesis.

The aim of this study was to assess the improvement in psychosocial awareness of anophthalmic patients wearing ocular prostheses and its relationship with demographic characteristics, factors of loss/treatment, social activity, and relationship between professional and patient. Surveys including a form for evaluation of psychosocial pattern were conducted with 40 anophthalmic patients rehabilitated with ocular prosthesis at the Center of Oral Oncology in the authors' dental school from January 1998 to November 2010. The improvement in psychosocial awareness was assessed by comparing the perception of some feelings reported in the period of eye loss and currently. Wilcoxon tests were applied for comparison of patients' perception between the periods. χ(2) tests were used to assess the relationship between the improvement in psychosocial awareness and the variables of the study. In addition, the logistic regression model measured this relationship with the measure of odds ratio. The feelings of shame, shyness, preoccupation with hiding it, sadness, insecurity and fear were significant for improvement in psychosocial awareness. It was concluded that the anophthalmic patients wearing an ocular prosthesis has significant improvement in psychosocial awareness after rehabilitation.

[Comparative estimation of rehabilitative abilities after organ preserving operations for severe eye damages].

Postoperative analysis of rehabilitative potentialities in 59 patients operated on occasion of severe eye trauma with the use of various methods of ophthalmosurgery has been presented. It has been demonstrated that the method of organ preserving complex vitreoretinal surgery provided evading enucleation and retaining the damaged eyeball in 96.4% of cases. In 82.1% of cases it has been succeeded in retaining some vision functions and raising considerably the indices of life quality. It has been determined that properly made silicone tamponade provides the support of the necessary ophthalmotone and prevention of progressive growing of posttraumatic eyeball subatrothy--the most frequent outcome of a severe eye trauma.

Rehabilitación en pacientes con trauma ocular / Rehabilitation of ocular trauma patients

La rehabilitación en oftalmología tiene como función fundamental lograr el máximo aprovechamiento posible del resto visual. El traumatismo ocular es considerado una de las entidades nosológicas frecuentes que conllevan a una rehabilitación visual. Las causas que provocan este tipo de trauma son variadas y dentro de estas, las agresiones con intención de provocar daños con secuelas son muy frecuentes. Es objetivo de esta revisión puntualizar la importancia de la rehabilitación en pacientes con traumatismo ocular e incentivar el buen accionar de todos los oftalmólogos en cuanto a su atención(AU)

The main goal of rehabilitation in ophthalmology is to use as much as possible the residual vision. Ocular trauma is considered one of the common diseases that imply visual rehabilitation. The causes of eye injuries are varied; among them assaults with intent to cause damage are the most common. The objective of this article was to point out the importance of rehabilitation in patients with ocular trauma and to encourage all the ophthalmologists to act accordingly(AU)

Rehabilitación protésica por pérdida ocular traumática / Prosthetic rehabilitation for the traumatic ocular loss

Se describe el protocolo para la atención del paciente con trauma en el servicio de urgencias con diagnóstico de pérdida del globo ocular por cualquier etiología. Para esto se realizó una revisión sobre trauma ocular y rehabilitacion ocular por prótesis en internet y de la literatura impresa nacional e internacional. El esquema de tratamiento de rehabilitación se realiza en estos pacientes desde que termina la cirugía con la utilización del conformador, la protesis ocular definitiva hasta el seguimiento por el departamento de prótesis. Comenzar el tratamiento de forma inmediata es importante para lograr la excelencia en la adaptación de la prótesis ocular definitiva(AU)

This paper described the protocol for the care of trauma patients at the emergency service with diagnosis of loss of the eyeball for any cause. To this end, a review of ocular trauma and ocular rehabilitation by using prosthesis was made on Internet and on the national and international printed literature. The rehabilitation treatment program is applied to these patients from the end of the surgery, aided by the contourer and the definitive ocular prosthesis, to the follow-up process carried out by the prosthetic department. The early start of treatment is important to fully succeed in tailoring the final ocular prosthesis(AU)

[Psychosocial aspects in the rehabilitation of patients with anophthalmic socket: implications of the use of ocular prosthesis]. / Aspectos psicossociais envolvidos na reabilitação de pacientes com cavidade anoftálmica: implicações do uso de prótese ocular.

UNLABELLED: Facial integrity is a condition which interferes in the daily life of the individual. The loss of an eyeball has psychological impact, requiring adaptation. Interventions such as prosthetic repair seem to lead to emotional and behavioral change. PURPOSE: The objective of this study was to identify the psychosocial aspects related to unilateral anophthalmic socket and evaluate patient adaptation to prosthesis. METHODS: All participants responded to a semi-structured interview. This was composed of two parts, the first regarding the general data of patient identification and socioeconomic aspects. The second part included information about eye loss and rehabilitation, with 31 questions. Twenty-eight volunteers were interviewed. RESULTS: Most were male (53.57%). Ages ranged between 11 and 67. Trauma was the prevalent etiological factor (60.71%). A significant statistical difference (p<0.05) was found between the scores of the feelings of loss before and after prosthesis (z Wilcoxon=-4.41; p<0.001). CONCLUSIONS: The data showed emotional difficulties in the initial contact with the loss of an eye and the role of the prosthesis as an element of social inclusion, stressing the importance of teamwork and access to fitting services in adapting these patients.

Aspectos psicossociais envolvidos na reabilitação de pacientes com cavidade anoftálmica: implicações do uso de prótese ocular / Psychosocial aspects in the rehabilitation of patients with anophthalmic socket: implications of the use of ocular prosthesis

A integridade da face é condição que interfere no cotidiano do indivíduo sendo que a perda do globo ocular tem um impacto psicológico, demandando uma condição de adaptação. Intervenções como a reparação protética parecem produzir mudanças nos âmbitos emocional e comportamental. Objetivo: Identificar os aspectos psicossociais relacionados à ausência unilateral do globo ocular e avaliar a adaptação dos pacientes usuários de prótese ocular. Métodos: Para realização da pesquisa foi utilizado como instrumento de coleta de dados um roteiro de entrevista adaptado aos objetivos desse trabalho. Este foi composto por duas partes, a primeira referente a dados gerais de identificação do paciente e aspectos socioeconômicos. A segunda parte incluiu dados específicos sobre a perda e reabilitação ocular com 31 questões. Vinte e oito pacientes voluntários foram entrevistados. Resultados: A maioria era do gênero masculino (53,57 por cento). A idade variou entre 11 e 67 anos. O trauma foi o fator etiológico prevalente (60,71 por cento). Foi encontrada diferença estaticamente significativa (p<0,05) entre os escores dos sentimentos da época da perda e atualmente (z Wilcoxon=-4,41; p<0,001). Conclusão: Os dados evidenciaram dificuldades emocionais no processo inicial de contato com a condição de perda do olho e o papel da prótese como elemento de inclusão social, ressaltando a relevância do trabalho em equipe e do acesso a serviços de protetização para a adaptação desses pacientes.

Facial integrity is a condition which interferes in the daily life of the individual. The loss of an eyeball has psychological impact, requiring adaptation. Interventions such as prosthetic repair seem to lead to emotional and behavioral change. Purpose: The objective of this study was to identify the psychosocial aspects related to unilateral anophthalmic socket and evaluate patient adaptation to prosthesis. Methods: All participants responded to a semi-structured interview. This was composed of two parts, the first regarding the general data of patient identification and socioeconomic aspects. The second part included information about eye loss and rehabilitation, with 31 questions. Twenty-eight volunteers were interviewed. Results: Most were male (53.57 percent). Ages ranged between 11 and 67. Trauma was the prevalent etiological factor (60.71 percent). A significant statistical difference (p<0.05) was found between the scores of the feelings of loss before and after prosthesis (z Wilcoxon=-4.41; p<0.001). Conclusions: The data showed emotional difficulties in the initial contact with the loss of an eye and the role of the prosthesis as an element of social inclusion, stressing the importance of teamwork and access to fitting services in adapting these patients.

Uso de prótese ocular expansora em criança com perda de globo ocular: caso clínico / Use of expander eye prosthesis in children with eye loss: clinical case

A perda ocular apresenta etiologia congênita ou adquirida, devido a traumas ou patologias. A prevenção e/ou intervenção precoce minimiza seqüelas e os distúrbios de crescimento orbital. A reabilitação, na instalação de uma prótese ocular, visa favorecer o desenvolvimento harmonioso da região. grande incidência das perdas do globo ocular em crianças de 0 a 11 anos é por trauma.Relato do caso: em alguns casos, onde o intervalo entre a cirurgia e a reabilitação protética é prolongada a cavidade orbital apresenta-se atrésica, não permitindo a reabilitação imediata através de prótese ocular individualizada. Nestes casos é indicada uma prótese expansora a fim de devolver o volume necessário para uma perfeita reabilitação. Este trabalho apresenta tal técnica através de um caso clínico.Conclusão: é importante frisar que a boa condução do caso clínico permite crescimento e desenvolvimento normal dos pacientes acometidos...

The eye loss has congenital or acquired etiology due to trauma or diseases. The prevention or early intervention minimizes sequelae and disturbances in orbital growth. Rehabilitation in the installation of an ocular prosthesis intends to promote the harmonious development of the region, the higher incidence of eye losses in children from 0 to 11 years is due to trauma.Case report: in some cases, where the interval between surgery and prosthetic rehabilitation is prolonged orbital cavity becomes atresic, not allowing immediate rehabilitation through individualized prosthesis. In these cases a prosthetic expander is recommended in order to obtain the volume needed for a full rehabilitation.Conclusion: this paper presents such technique on a clinical case. It is important to highlight that a proper conduction of the clinical case allows normal growth and development of affected patients...

Chemical eye injuries 2: management and nursing care to promote visual rehabilitation.

This second in a two-part unit examines treatment and nursing management of chemical eye injuries. Part 1 described the different chemical agents and types of injury. This part outlines the various treatment options, the management protocol used at the Birmingham and Midland Eye Centre, and nursing management of eye injuries.

Eye and visual function in traumatic brain injury.

Combat blast is an important cause of traumatic brain injury (TBI) in the Department of Veterans Affairs polytrauma population, whereas common causes of TBI in the civilian sector include motor vehicle accidents and falls. Known visual consequences of civilian TBI include compromised visual acuity, visual fields, and oculomotor function. The visual consequences of TBI related to blast remain largely unknown. Blast injury may include open globe (eye) injury, which is usually detected and managed early in the rehabilitation journey. The incidence, locations, and types of ocular damage in eyes without open globe injury after exposure to powerful blast have not been systematically studied. Initial reports and preliminary data suggest that binocular function, visual fields, and other aspects of visual function may be impaired after blast-related TBI, despite relatively normal visual acuity. Damage to the ocular tissues may occur from blunt trauma without rupture or penetration (closed globe injury). Possible areas for research are development of common taxonomy and assessment tools across services, surgical management, and outcomes for blast-related eye injury; the incidence, locations, and natural history of closed globe injury; binocular and visual function impairment; quality of life in affected service members; pharmacological and visual therapies; and practice patterns for screening, management, and rehabilitation.

[Ipsilateral autorotational keratoplasty and cataract extraction in patients with trachoma and trauma in Oman. Report on visual rehabilitation]. / Ipsilaterale Autorotationskeratoplastik und Kataraktextraktion bei Patienten mit vernarbendem Trachom in Oman. Ein Erfahrungsbericht zur optischen Rehabilitation.

AIM: To report on the results of visual rehabilitation by ipsilateral rotational keratoplasty (IRK) and cataract extraction in 17 patients with trachoma and with trachoma and trauma in Oman over 3 years. PATIENTS: Of 25 patients operated from 2001-2004 with IRK, extracapsular cataract extraction, and intraocular lens implantation, 17 eyes of 17 patients with cicatricial trachoma (WHO stage CO) could be followed up after 1 year. Group 1 comprised 11 eyes with ciatricial trachoma. In group 2, six eyes had additional traumatic corneal scars. METHODS: Surgery was performed using a motor trephine Keratron (Geuder), the Accurus 800 (Alcon) phacovitrectomy machine, and calculation for intraocular lens implantation (IOL: MZ60BD, Alcon) with a topography (Atlas, Humphrey Zeiss)-supported SRK II formula (OcuScanRxP, Alcon). RESULTS: Although only four of 17 patients had preoperative visual acuity (VA) at 5 m and one of 17 had VA at 1 m, postoperatively seven of 17 patients gained VA at 5 m and six of 17 at 1 m. Ambulatory vision was regained in 13 of 17 (78%) patients. Patients with trachoma and trauma benefited more from the surgery [vision increase in trachoma: eight of 11 eyes (73%); trachoma and trauma: five of five eyes (100%)]. Postoperative spherical refraction was -12.0D to +4.0D (median:+4.0D), and astigmatism ranged from 10D to 0.3D (median 5.35D). One eye was lost because of uncontrolled keratitis. CONCLUSIONS: IRK with cataract extraction may provide ambulatory vision in patients with cicatricial trachoma and secondary dry eye syndrome living in developing countries where donor grafts are difficult to obtain and where postoperative follow-up of high-risk keratoplasty is impaired.

Reabilitação visual com lentes de contato após trauma ocular: [revisão] / Visual rehabilitation with contact lenses after ocular trauma: [review]

Trauma ocular é causa importante de baixa de acuidade visual em todos os países do mundo. A integridade do bulbo ocular é primordial para recuperação visual nesses pacientes. Acidentes domésticos, automobilísticos, esportivos, além de queimaduras químicas e térmicas são as principais causas de trauma em nosso meio. O uso de lentes de contato é indicado para a reabilitação visual em casos de astigmatismos regulares ou irregulares de córnea, anisometropias, afacias, opacidades paracentrais superficiais ou profundas na córnea decorrentes do trauma ocular. As lentes de contato podem ser utilizadas no pós-trauma com finalidade terapêutica ou para correção visual. As lentes mais utilizadas para correção visual pós-trauma são as lentes de contato rígidas gás permeáveis, com alto coeficiente de permeabilidade. As lentes de contato gelatinosas podem ser usadas imediatamente após o trauma ocular com finalidade terapêutica e mais tardiamente para correção óptica em afacias e anisometropias traumáticas. A lente de contato é parte importante no tratamento tardio do trauma ocular, propiciando melhora significativa da acuidade visual na maioria dos casos.

Ocular trauma is an important cause of visual acuity loss worldwide. Visual recovery is related to anatomical integrity. The main causes of trauma are domestic and automobilist accidents, sports practice and chemical or thermic burns. Contact lens is indicated for visual rehabilitation in cases of corneal regular and irregular astigmatisms, anisometropic and aphakic patients and in cases of deep or superficial corneal opacities that do not affect the visual axis. Contact lens can be used in the post- trauma period for therapeutic and optical purposes. Rigid gas permeable contact lens, with a high permeability index, is the most used for optical purpose. Soft contact lens can be used immediately after trauma as therapy or later for optical correction in aphakic and anisometropic patients. In most cases contact lens is an important part of trauma treatment improving visual acuity in the majority of cases.