BACKGROUND: Severe fatigue is a common symptom for people with visual impairment, with a detrimental effect on emotional functioning, cognition, work capacity and activities of daily living. A previous study found that depression was one of the most important determinants of fatigue, but less is known about disease-specific factors in this patient population. This study aimed to explore the association between visual impairment severity and fatigue in adults with low vision, both directly and indirectly, with vision-specific factors and depression as potential mediators.
METHODS: Cross-sectional data were collected from 220 Dutch low vision service patients by telephone interviews. Fatigue was defined as a latent variable by severity and impact on daily life. Potential mediators included vision-related symptoms, adaptation to vision loss and depression. Hypothesized structural equation models were constructed in Mplus to test (in)direct effects of visual impairment severity (mild/moderate, severe, blindness) on fatigue through above mentioned variables.
RESULTS: The final model explained 60% of fatigue variance and revealed a significant total effect of visual impairment severity on fatigue. Patients with severe visual impairment (reference group) had significantly higher fatigue symptoms compared to those with mild/moderate visual impairment (β = -0.50, 95% bias-corrected confidence interval [BC CI] [-0.86, -0.16]) and those with blindness (β = -0.44, 95% BC CI [-0.80, -0.07]). Eye strain & light disturbance, depression and vision-related mobility mediated the fatigue difference between the severe and mild/moderate visual impairment categories. The fatigue difference between the severe visual impairment and blindness categories was solely explained by eye strain & light disturbance. Moreover, depressive symptoms (β = 0.65, p < 0.001) and eye strain & light disturbance (β = 0.19, p = 0.023) were directly associated with fatigue independent of visual impairment severity.
CONCLUSIONS: Our findings indicate an inverted-U shaped relationship between visual impairment severity and fatigue in patients with low vision. The complexity of this relationship is likely explained by the consequences of visual impairment, in particular by strained eyes and depressive mood, rather than by severity of the disability itself.

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OBJECTIVE: Evidence for occupational therapy interventions should be grounded in theory to support practitioners\' role in the rehabilitation of adults with low vision.
OBJECTIVE: To analyze the content of publications on interventions for adults with low vision to determine theories proposed or used to guide interventions and to categorize their level of evidence.
METHODS: CINAHL, Scopus, PubMed, and Embase.
METHODS: A quantitative summative content analysis of articles published from 1984 through 2021.
RESULTS: Fourteen articles provided a theoretical rationale for occupational therapy interventions for adults with low vision. Nine provided evidence for interventions supported by theory, and 3 suggested theories to support interventions. Eleven were found in peer-reviewed publications; 10 were in occupational therapy publications. Of the 14, 50% were categorized at the lowest level of evidence.
CONCLUSIONS: Few high-level studies on occupational therapy interventions for adults with low vision exist that provide a rationale for treatment based on theory. Application of theories provides clinical reasoning that distinguishes occupational therapy interventions from those of other professions serving adults with low vision. If interventions are not grounded in theory, the occupational therapy profession risks losing its distinction from other similar professions in low vision rehabilitation. Plain-Language Summary: This is the first content analysis of theories recommended and used to guide occupational therapy interventions for adults with low vision. This systematic review highlights occupational therapy\'s distinct value over other professions but also points to a dangerous gap in the literature that threatens practitioners\' role in the rehabilitation of adults with low vision.

OBJECTIVE: To estimate utility values associated with visual loss using EuroQol (EQ-5D) questionnaire, the impact of low-vision (LV) device use on utilities and the contribution of Instrumental Activities of Daily Living (IADL) score in patients attending vision rehabilitation (VR) services enrolled in the Italian Device & Aids Register (D.A.Re).
METHODS: This is a multicenter, prospective, cross-sectional study. D.A.Re. collects general and clinical information, vision-specific variables, use of electronic devices and quality of life questionnaires.
RESULTS: A total of 442 patients (75.0±16.6 years, 275 female) were included, 88 (19.9%) used specialised electronic LV devices, and 116 (26.2%) used smartphones and tablets. Users of smartphones and tablets were younger than non-users (67.5 vs. 77.6 years, p<0.001), but overall, their age ranged between 20 and 93. Stronger associations were found between vision-specific variables and IADL score compared to EQ-5D score. In multivariable age-adjusted models, the utility value of using smartphones and tablets on EQ-5D score was 0.12 (p<0.01), slightly larger than that of 1.0 logMAR difference (-0.09, p<0.01) or visual field damage within 10° of fixation (-0.10, p<0.01). Use of portable low-vision electronic devices and being employed or student (vs. retired) was also associated with better utility values (0.12 and 0.15, respectively, p<0.05).
CONCLUSIONS: Visual loss is associated with loss of utilities in Italian patients attending VR services, whereas special-purpose electronic aids, and smartphone and tablet use are associated with better utility values. We found that IADL may be more sensitive to visual loss than EQ-5D and could be a valid health-related quality of life outcome in trials on VR.

暂无摘要。

BACKGROUND: Low vision has a significant global health problem that impacts the personal, economical, psychological, and social life of an individual. Each year around 684 000 individuals die from falls, 80% of these deaths occur are in low- and middle-income countries. The risk of falling significantly increases with visual impairment. This review aimed to determine the global pooled prevalence of fall and associated factors among individuals with low vision.
METHODS: Systematic search of published studies done on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL and, Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to report the findings. Quality of studies was assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using a random-effects method using the STATA™ Version 14 software.
RESULTS: Thirty-five (35) studies from different regions involving 175,297 participants included in this meta-analysis. The overall pooled global prevalence fall among individual with low vision was17.7% (95% CI: 16.4-18.9) whereas the highest prevalence was 35.5%; (95% CI: 28.4-42.5) in Australia and the lowest was 19.7%; (95% CI: 7.6-31.8) seen in South America. Fear of falling (OR: 0.16(95%CI 0.09-0.30), and severity of visual impairment (OR: 0.27(95%CI (0.18-0.39) increases the odds of falling.
CONCLUSIONS: As one cause of accidental death, the prevalence of falls among individuals with low vision is high. Fear of falling and severity of falling increases the odds of falling. Different stakeholders should give due attention and plan effective strategies to reduce the fall among this population.

Science can often be inaccessible for people with disabilities, including those with low vision or blindness. Below, we hear from Jamie Rossjohn and Erica Tandori regarding the insights and experiences into the establishment of an internship program for people with disabilities and the evolution of Monash Sensory Science-from a one-off exhibition event for blind and low-vision communities to a national and international multisensory, accessible science initiative, championing a more inclusive approach to science communication.

CONCLUSIONS: Autonomous vehicles (AVs) have the promise to be an alternative transportation solution for those with vision loss. However, the impact of vision loss on the perceptions and concerns of AVs is unknown. This study therefore examined whether AVs are perceived differently by blind, visually impaired (VI), and normally sighted people.
OBJECTIVE: This study compared the perceptions of AVs among the blind, VI, and normally sighted.
METHODS: Participants\' opinions on four perception measures (general opinion, trust, impact on quality of life, and intention to use AVs) and nine concerns regarding AVs were measured. The survey was administered to 51 normally sighted, 68 VI, and 65 blind participants. Analyses of covariance assessed whether the four perception measures and nine concerns varied by vision status (normal vision, VI, blind) and driving status (driver, nondriver). Univariate correlations and multiple regression analyses identified associations and predictors of AV perceptions and concerns from demographic, mood, cognition, travel behavior, and vision measures, which included visual acuity, contrast sensitivity, and visual field.
RESULTS: The blind (p<0.001), VI (p<0.001), and nondrivers (p<0.001) showed a greater intention to use AVs compared with those with normal vision and drivers. Similar findings were found for the other perception measures. As visual acuity, contrast sensitivity, and visual field extent declined, positivity toward AVs increased (p<0.001). Visual field extent best predicted general opinion and trust in AVs, whereas driving measures were the best predictors of impact on quality of life and intention to use AVs. Concerns about AVs showed no differences based on vision (p=0.94) or driving (p=0.63) status.
CONCLUSIONS: Individuals with vision loss expressed more acceptance of AVs despite their concerns. How positive someone is toward AVs appears to be dependent on their visual field extent and driving status.

CONCLUSIONS: Individuals with reduced visual acuity (VA) may drive with bioptic telescopes in some jurisdictions. The effect of bioptic telescope use on on-road recognition distances is important for driving safety, as increased recognition distances increase the time available to react to road signs or driving events.
OBJECTIVE: This study aimed to investigate the impact of bioptic telescope use on visual recognition of road signs, traffic lights, and hazards in an on-road driving environment in individuals with reduced VA.
METHODS: Ten individuals (mean ± standard deviation age, 39.1 ± 19.1 years) with reduced VA (trained to use bioptic telescopes) participated in a repeated-measures on-road experiment for two viewing conditions, with and without a bioptic telescope (randomized order). Participants underwent a clinical low vision assessment, including high-contrast VA with and without the bioptic telescope aligned, visual fields, and contrast sensitivity testing. For the driving component, participants seated in the front passenger seat of a moving car reported all road signs, traffic lights, and hazards (unpredictable road events that represent a risk to driving safety including other vehicles, cyclists, pedestrians) seen along a route that included suburban roads and highways. Video cameras captured participants\' viewing behavior, verbal commentary, and the distance at which three pre-selected road signs were reported.
RESULTS: In the eye with the bioptic telescope, high-contrast VA improved from 0.75 ± 0.17 (without) to 0.25 ± 0.1 logMAR with the bioptic telescope. Bioptic telescope use did not affect the percentage of road signs, traffic lights, or hazards correctly recognized but did result in 2.6 times longer recognition distances (49 ± 23 vs. 19 ± 11 m, t9 = 5.02, p<0.001).
CONCLUSIONS: Road signs were recognized at significantly longer distances when using a bioptic telescope, confirming their positive impact on timely visual recognition of objects within the driving scene. Future work should explore whether this effect generalizes to individuals using bioptic telescopes when driving a vehicle.

CONCLUSIONS: Poor visibility of indoor features such as steps and ramps can pose mobility hazards for people with low vision. For purposes of architectural design, it is important to understand how design parameters such as the illumination level of an indoor space affect the visibility of steps and ramps.
OBJECTIVE: This study was aimed to examine the effect of typical variation in photopic illumination level in an indoor space on the visibility of steps and ramps for individuals with low vision.
METHODS: Steps and ramps were constructed in a large windowless room illuminated by overhead lights. Subjects with low vision completed a 5-alternative forced choice task to recognize the targets at three levels of photopic illumination, i.e., 800, 80, and 8 lux, and gave confidence ratings about their judgments on a 5-point scale. Acuities and contrast sensitivities of the subjects were also measured at each illumination level. For comparison, a group of normally sighted subjects with simulated acuity reduction also completed the step-and-ramp recognition task.
RESULTS: For both groups of subjects, recognition accuracy was not affected by illumination level. For subjects with low vision, however, there was a significant effect of illumination level on confidence rating: subjects became more confident about their judgments with increasing illumination. There was also a weak effect of illumination level on acuity and contrast sensitivity, both worsening with decreasing illumination. Recognition performance was best predicted by contrast sensitivity, whereas confidence was best predicted by visual acuity.
CONCLUSIONS: Illumination variation over a typical photopic range in an indoor space had minimal effect on the objective visibility of steps and ramps for people with low vision. However, illumination level affected subjects\' confidence in hazard recognition. Design decisions on parameters such as illumination should consider the consequences on both the objective and the subjective accessibility of a space.