Physical activity practice, body image and visual impairment: a comparison between Brazilian and Italian children and adolescents

The aim of this study was to analyze the physical activity and body image of children and adolescents with visual impairment (VI) in Brazil and Italy. For this, 41 children and adolescents with VI (19 Brazilian and 22 Italian) aged 10.22 ± 2.19 years old (18 girls and 23 boys) answered the Physical Activity Questionnaire for Children (PAQ-C), the Offer Self-Image Questionnaire (OSIQ), and an instrument with information about the disability, body weight and height. We analyzed the relationship between data from PAQ-C and OSIQ, as well as the gender, level of disability (blindness or low vision) and country using independent Mann-Whitney test. Body mass index (BMI) values were higher for Brazilian youths, with more than half of them classified as overweight and obese. Italian youths exhibited values of body image that were more positive and only 27% presented overweight or obesity. Blind children and adolescents were less active than those with low vision, but no differences were found between countries or genders. In Brazil, we detected significant correlations (p>0.05) between physical activity, body image and BMI, which more active youths presenting lower values of BMI and a better perception of body image. Physical activity seems to have a positive influence on body image and BMI for children and adolescents with VI, thus it should be encouraged especially for those with higher disability degrees.

The impact of visual impairments in self-esteem and locus of control

This study investigates the differences between adults with visual impairments and sighted adults with regard to locus of control (LOC) and self-esteem. One hundred and eight adults with visual impairments (blindness or low vision) and fifty-five sighted adults took part in this study. Sighted adults showed a higher score on the self-esteem scale than either the individuals with low vision or with blindness. Moreover, analysis indicated no significant differences amongst the three groups of participants regarding LOC. Significant predictors of self-esteem were vision status and age at loss of sight. Significant predictors of LOC were vision status and independent movement. Findings are discussed with regard to their implications for parents, social workers, teachers, and rehabilitation specialists.

The identification and measurement of autistic features in children with septo-optic dysplasia, optic nerve hypoplasia and isolated hypopituitarism

This study aimed to highlight the occurrence of autism spectrum disorders (ASDs) in children with septo-optic dysplasia (SOD) and optic nerve hypoplasia (ONH). A cross-sectional study was designed, including 28 children with SOD and 14 children with ONH. Clinician diagnosis of ASD was reported in 14 children. The Social Communication Questionnaire (SCQ) reported that 23 children met the cut-off point for ASD, and 9 children met the cut-off point for autism. Greater levels of intellectual disability and visual loss were reported in children with ASD in comparison to those without ASD, but, of the two, intellectual disability was a better predictor for ASD. The SCQ lost its sensitivity and specificity in children who had greater visual loss which highlights a requirement for a measure that is sensitive to visual loss. It is also recommended that children with SOD/ONH would benefit from routine screening for ASDs.

Validity and suitability of the Bayley-III Low Motor/Vision version: a comparative study among young children with and without motor and/or visual impairments

The aim of the present study was to examine the validity of the Bayley-III Low Motor/Vision version, and its suitability for children with motor and/or visual impairment(s). This version contains accommodated items, that is, adaptations to minimize impairment bias, without altering what the test measures. We hypothesized that the accommodations would not affect the item scores of children without impairment, and that children with impairment(s) would benefit from the accommodations. We tested 41 children without impairment and 63 children with impairment with both the standard Bayley-III and the Low Motor/Vision versions, in randomly counterbalanced order. The test administrators filled in an evaluation form. Results showed that the accommodations did not affect the test scores of children without impairment and did improve the test scores of children with impairment on the Cognition scale, while no improvement was found for the other scales. The test administrators indicated that the vast majority of the children with impairment had been able to show their abilities on the test and that the accommodations were beneficial in 29 out of these 52 cases. For some children, the accommodated instrument appeared to be unsuitable because the impairment was too severe. The conclusion is that the accommodations improve the validity of the Bayley-III when used with children with mild to moderate motor and/or visual impairment, especially with regard to the Cognition scale.

Perceived social support in adolescents with and without visual impairment

The study assessed perceived availability of support from parents, peers, and teachers in adolescents with and without visual impairment. Adolescents with visual impairment perceived lower levels of parental support but higher levels of support from teachers than sighted adolescents, and these differences remained stable across a 2-year interval. There was considerable heterogeneity within the groups as adolescents with visual impairment were most often found in clusters with high levels as well as low levels of all assessed sources of support. High perceived support from all sources showed positive associations with life-satisfaction of adolescents with and without visual impairment. As lower levels of perceived parental support of students with visual impairment were based on students from residential schools, we conclude that measures would be welcomed for improvement of parent-child contacts during the school days.

A rat retinal damage model predicts for potential clinical visual disturbances induced by Hsp90 inhibitors

In human trials certain heat shock protein 90 (Hsp90) inhibitors, including 17-DMAG and NVP-AUY922, have caused visual disorders indicative of retinal dysfunction; others such as 17-AAG and ganetespib have not. To understand these safety profile differences we evaluated histopathological changes and exposure profiles of four Hsp90 inhibitors, with or without clinical reports of adverse ocular effects, using a rat retinal model. Retinal morphology, Hsp70 expression (a surrogate marker of Hsp90 inhibition), apoptotic induction and pharmacokinetic drug exposure analysis were examined in rats treated with the ansamycins 17-DMAG and 17-AAG, or with the second-generation compounds NVP-AUY922 and ganetespib. Both 17-DMAG and NVP-AUY922 induced strong yet restricted retinal Hsp70 up-regulation and promoted marked photoreceptor cell death 24h after the final dose. In contrast, neither 17-AAG nor ganetespib elicited photoreceptor injury. When the relationship between drug distribution and photoreceptor degeneration was examined, 17-DMAG and NVP-AUY922 showed substantial retinal accumulation, with high retina/plasma (R/P) ratios and slow elimination rates, such that 51% of 17-DMAG and 65% of NVP-AUY922 present at 30 min post-injection were retained in the retina 6h post-dose. For 17-AAG and ganetespib, retinal elimination was rapid (90% and 70% of drugs eliminated from the retina at 6h, respectively) which correlated with lower R/P ratios. These findings indicate that prolonged inhibition of Hsp90 activity in the eye results in photoreceptor cell death. Moreover, the results suggest that the retina/plasma exposure ratio and retinal elimination rate profiles of Hsp90 inhibitors, irrespective of their chemical class, may predict for ocular toxicity potential.

A prospective study of the bi-directional association between vision loss and depression in the elderly

BACKGROUND

Increasing visual impairment (VI) with age has been associated with mental health problems but the question of temporal direction and reverse causality has not been addressed previously. Our objective was to prospectively examine the bi-directional association of VI and visual function (VF) loss with depressive symptoms in the elderly.

METHODS

The cohort comprised 4216 participants (40.2% men) aged 65 and over with 10 years of follow-up. Near VI was defined using measured usual-corrected binocular acuity while distance VF was self-declared. Participants having a major depressive episode or a Center for Epidemiologic Studies Depression Scale score ≥ 16 were classified as having depressive symptomatology. Longitudinal analyses used mixed logistic models for repeated evaluations.

RESULTS

After adjustment for demographic factors, participants with moderate to severe near VI at baseline had increased odds of developing depressive symptomatology (Odds Ratio [OR]=1.60; 95% Confidence Interval [CI]=1.08-2.38), but after multiple adjustments the association fell below the significance level. A 2-year decrease in distance VF was associated with increased odds of depressive symptomatology during follow-up after multiple adjustments (OR=3.03; 95% CI=1.75-5.23). Baseline depressive symptomatology was not associated with incident near VI but was associated with VF loss after multivariate adjustment (OR=1.62; 95% CI=1.15-2.28).

LIMITATIONS

The causes of VI have not been recorded.

CONCLUSIONS

The relation of vision loss to onset of depressive symptomatology differs according to near VI or distance VF and declines across time. A reverse strong association was found between baseline depression and incident loss of distance VF suggesting a downward spiral of events.

Delirium superimposed on Charles Bonnet syndrome: a case study

Older adults with visual impairment may experience visual hallucinations in the setting of normal cognition and absence of psychiatric illness. This phenomenon is referred to as Charles Bonnet syndrome. Information concerning Charles Bonnet syndrome predominantly comes from case studies. Reassuring the person experiencing the hallucinations they are not suffering from psychosis constitutes the mainstay of treatment. What follows is the case of a vision impaired, older adult male with known Charles Bonnet syndrome, who, following emergency surgery and associated delirium while in the intensive care unit, experiences an aggressive change in hallucinations. Nurses need to understand the pathology and characteristics of Charles Bonnet syndrome in order to distinguish it from other pathologies underlying hallucinations. This knowledge is necessary to provide safe, patient-centered care for older adults.

Measuring reading performance

Despite significant changes in the treatment of common eye conditions like cataract and age-related macular degeneration, reading difficulty remains the most common complaint of patients referred for low vision services. Clinical reading tests have been widely used since Jaeger introduced his test types in 1854. A brief review of the major developments in clinical reading tests is provided, followed by a discussion of some of the main controversies in clinical reading assessment. Data for the Salisbury Eye Evaluation (SEE) study demonstrate that standardised clinical reading tests are highly predictive of reading performance under natural, real world conditions, and that discrepancies between self-reported reading ability and measured reading performance may be indicative of people who are at a pre-clinical stage of disability, but are at risk for progression to clinical disability. If measured reading performance is to continue to increase in importance as a clinical outcome measure, there must be agreement on what should be measured (e.g. speed or comprehension) and how it should be measured (e.g. reading silently or aloud). Perhaps most important, the methods for assessing reading performance and the algorithms for scoring reading tests need to be optimised so that the reliability and responsiveness of reading tests can be improved.

S-K Smartphone Barcode Reader for the Blind

We describe a new smartphone app called BLaDE (Barcode Localization and Decoding Engine), designed to enable a blind or visually impaired user find and read product barcodes. Developed at The Smith-Kettlewell Eye Research Institute, the BLaDE Android app has been released as open source software, which can be used for free or modified for commercial or non-commercial use. Unlike popular commercial smartphone apps, BLaDE provides real-time audio feedback to help visually impaired users locate a barcode, which is a prerequisite to being able to read it. We describe experiments performed with five blind/visually impaired volunteer participants demonstrating that BLaDE is usable and that the audio feedback is key to its usability.

Etiology of visual impairment among ophthalmic patients at Federal Medical Center, Abeokuta, Nigeria

BACKGROUND

The Nigeria national blindness survey has documented region-specific prevalence and causes of visual impairment in the country. However, there is need for local studies to ascertain specific causes of visual impairment peculiar to each community, as this varies from one locality to another.

AIM

To determine the causes of blindness and low vision among patients presenting to the Eye Clinic, Federal Medical Center Abeokuta, Nigeria.

STUDY DESIGN

A retrospective study.

MATERIALS AND METHODS

Medical records of all patients seen at the Eye Clinic, Federal Medical Center, Abeokuta, Nigeria between January 2011 and December 2012 were reviewed.

RESULTS

Out of the 5,352 patients managed during the period, 474 (8.9%) were blind, 3,178 (59.4%) had low vision while 1,700 (31.7%) had "normal vision". The risk of visual impairment increased with age. The major causes of blindness were cataract (32.5%), glaucoma (20%) and age-related macular degeneration (12.8%), while the most common causes of low vision were uncorrected refractive errors (20.5%), cataract (17.6%) and glaucoma (14.8%).

CONCLUSION

Cataract, glaucoma and uncorrected refractive errors are the leading causes of visual impairment in Abeokuta, Nigeria. Public enlightenment coupled with prompt and effective management will reduce the burden of blindness in the country.

Prevalence of eye diseases and visual impairment among the rural population - a case study of temerloh hospital

OBJECTIVE

To determine the prevalence of eye diseases and visual impairment among new patients at the eye clinic of Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang.

METHOD

In this cross-sectional prospective study, 1081 new patients were examined over a period of six months. Age, gender, ethnicity, visual acuity and diagnosis were noted from the medical records.

RESULTS

Out of 1081 examined, 607 (56.1%) were males, 783 (72.4%) were Malays. The mean age of patients was 45.2 years (ranging from one month to 91 years). Cataract (248, 22.9%) was the most common eye disease, followed by retinal diseases (124, 11.5%) and ocular trauma (106, 9.8%). Majority of the patients (48) suffering from ocular trauma had foreign body cornea. In 85 premature infants screened for retinopathy, 19 showed different stages of retinopathy of prematurity. Visual impairment was noted in 89 (8.2%) patients, severe visual impairment in 12 (1.1%) and blindness in 35 (3.2%); vision could not be determined in 85 premature infants (7.9%). Cataract was singled out as the cause of severe visual impairment in 11 out of 12 patients.

CONCLUSION

Health education at primary health centres and availability of eye specialists in all the district hospitals will facilitate the rehabilitation of visually impaired and blind persons by providing early treatment for eye problems (specifically prescription for spectacles, medical treatment and cataract surgery with intraocular lens implantation).

A 14-year-old girl who regained normal vision after bilateral visual impairment following hot water injury to the eyes

A 14-year-old girl presented with bilateral visual impairment following hot water injury to the eyes. The patient was admitted for a week and managed with guttae tropicamide 0.5% 8 h, diclofenac sodium 0.1% 4 h, and fluoroquinolone 0.3% 6 h and ointment chloramphenicol 8 h. Also, the patient was managed with capsule doxycycline 100 mg 12 h for 10 days, tablet cataflam 50 mg 12 h for 7 days and intramuscular tetanus toxoid 0.5 mg stat and dermacine cream for facial scald. The visual acuities improved from 3/60 (right eye) and 6/24 (left eye) to 6/6 in both eyes. There were resolutions of facial/eye pain, tearing, photophobia, lid edema, blepharospasm, and conjunctival hyperemia. There was complete healing of facial wounds and corneal ulcers. She was discharged from hospital on the 7th day of admission. Prompt presentation, degree of scald sustained, and appropriate medical intervention enhanced visual recovery and wound healing in the patient.

Ocular complications of severe vernal keratoconjunctivitis (VKC) in Yemen

OBJECTIVES

The objective of this study was to assess the ocular complications and visual loss among patients with severe vernal keratoconjunctivitis (VKC).

METHODS

Four hundred and thirty-one patients with VKC seen at Ibn Al-Haitham Eye Center were the study group. This is a retrospective non-comparative observational study between 01 January 2002 and 31 December 2002. Visual acuity was measured with the standard Snellen visual acuity chart and for children under 5 years of age Kay pictures were used. Visual impairment was assessed by means of the World Health Organization criteria for visual disabilities. Cases with severe VKC that developed ocular complications leading to blindness and severe visual impairment were analyzed.

RESULTS

The majority of VKC patients were males (75.9%) with a male:female ratio of 3.1:1. A total of 68 (15.7%) patients (54 boys and 14 girls) had severe VKC. The ocular findings among 20 patients with severe VKC that led to blindness and severe visual impairment included keratoconus (7); steroid-induced cataract (5), central corneal scars (5) and steroid-induced glaucoma (3). Two of the keratoconus cases developed acute hydrops.

CONCLUSION

Severe VKC in developing countries including Yemen is a potentially blinding disease. Visual loss may be due to keratoconus and corneal scars, as well as complications of the unsupervised use of topically administered corticosteroids.