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Daich Varela M, Sanders Villa A, Pontikos N, Crossland MD, Michaelides M. Digital health and wearable devices for retinal disease monitoring. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06634-3. [PMID: 39297890 DOI: 10.1007/s00417-024-06634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/30/2024] [Accepted: 08/29/2024] [Indexed: 09/21/2024] Open
Abstract
Digital health is wielding a growing influence across all areas of healthcare, encompassing various facets such as telemedicine, artificial intelligence (AI), and electronic healthcare records. In Ophthalmology, digital health innovations can be broadly divided into four categories: (i) self-monitoring home devices and apps, (ii) virtual and augmented reality visual aids, (iii) AI software, and (iv) wearables. Wearable devices can work in the background, collecting large amounts of objective data while we do our day-to-day activities, which may be ecologically more valid and meaningful to patients than that acquired in traditional hospital settings. They can be a watch, wristband, piece of clothing, glasses, cane, smartphone in our pocket, earphones, or any other device with a sensor that we carry with us. Focusing on retinal diseases, a key challenge in developing novel therapeutics has been to prove a meaningful benefit in patients' lives and the creation of objective patient-centred endpoints in clinical trials. In this review, we will discuss wearable devices collecting different aspects of visual behaviour, visual field, central vision, and functional vision, as well as their potential implementation as outcome measures in research/clinical trial settings. The healthcare landscape is facing a paradigm shift. Clinicians have a key role of collaborating with the development and fine-tuning of digital health innovations, as well as identifying opportunities where they can be leveraged to enhance our understanding of retinal diseases and improve patient outcomes.
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Affiliation(s)
- Malena Daich Varela
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Alejandro Sanders Villa
- Facultad de Enfermería y Obstetricia, Universidad Nacional Autónoma de México, Mexico City, México
- Primero Salud, Mexico City, México
| | - Nikolas Pontikos
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Michael D Crossland
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Michel Michaelides
- Moorfields Eye Hospital, London, UK.
- UCL Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, UK.
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Miller A, Macnaughton J, Crossland MD, Latham K. "I'm like something out of star wars": a qualitative investigation of the views of people with age-related macular degeneration regarding wearable electronic vision enhancement systems. Disabil Rehabil 2024; 46:4476-4485. [PMID: 37933205 DOI: 10.1080/09638288.2023.2278179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This study explores the initial views of people with age-related macular degeneration towards wearable electronic vision enhancement systems. METHODS Ten adults with age-related macular degeneration participated in semi-structured interviews, which were analysed using reflexive thematic analysis. RESULTS Four themes were identified. Firstly, participants spoke of the wide-ranging impact of sight loss and how current helpful coping strategies still had significant limitations, affecting their desire to seek new solutions. The second theme showed that "other people" offered welcomed support with existing electronic coping solutions and are needed to provide suitable advice and training. However, "other people" limited the acceptability of using new solutions in public places. The third theme captured participants' desire for a wearable aid providing image magnification and enhancement over a range of distances. The final theme covered the reality of some current wearable technology, perceived as heavy, enclosing, or strange in appearance. Appearance caused some to lose interest in use, although others reframed the devices' desired usefulness to solo and sedentary activities. CONCLUSION This population are interested in the potential benefits of wearable electronic vision enhancement systems. More work is needed to understand the suitability of current solutions due to participant concerns about training, appearance and performance.
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Affiliation(s)
- Andrew Miller
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Jane Macnaughton
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Michael D Crossland
- NIHR Moorfields Biomedical Research Centre and UCL Institute of Ophthalmology, London, UK
| | - Keziah Latham
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
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Cottingham E, Burgum F, Gosling S, Woods L, Tandon A. Assessment of the Impact of a Head-mounted Augmented Reality Low Vision Aid on Vision and Quality of Life in Children and Young People with Visual Impairment. Br Ir Orthopt J 2024; 20:57-68. [PMID: 38274242 PMCID: PMC10809860 DOI: 10.22599/bioj.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Electronic head-mounted low vision aids (LVAs) can help children and young people (CYP) to access schoolwork and leisure activities which they would otherwise struggle to be able to do with traditional optical or hand held LVAs. SightPlus uses a smartphone mounted in a virtual reality headset controlled using a Bluetooth joystick. It offers users 0.7-24.3× magnification alongside enhanced modes to maximise vision. Methods Eighteen participants aged 8-16 years with reduced vision were given SightPlus to use at home for four weeks. Visual acuity was assessed with and without SightPlus along with reading performance, contrast sensitivity, functional vision and quality of life questionnaires. Results Clinically significant improvements in distance vision (0.633logMAR SD ± 0.359), near vision (0.411logMAR SD ± 0.368), reading acuity (0.454LlogMAR SD ± 0.406) and critical print size (0.285logMAR ± 0.360) were seen when testing with SightPlus.However, there was a mean decrease in contrast sensitivity and reading speed when using SightPlus. Despite this, nine out of the 14 patients included for analysis indicated a preference to continue to use SightPlus. Of note, younger participants were more likely to show a preference for using SightPlus. All seven CYP aged 10 or under wanted to continue to use SightPlus; in contrast, only two of the seven participants aged 11 or over wanted to continue. Conclusions Like the results in adult populations, SightPlus has been found to improve CYP visual functions. Older participants were less likely to want to continue to use SightPlus, potentially suggesting they have found other methods for managing sight loss.
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Wolffsohn JS. 2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management. Optom Vis Sci 2024; 101:12-24. [PMID: 38350054 DOI: 10.1097/opx.0000000000002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
ABSTRACT Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.
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Pundlik S, Shivshanker P, Luo G. Impact of Apps as Assistive Devices for Visually Impaired Persons. Annu Rev Vis Sci 2023; 9:111-130. [PMID: 37127283 DOI: 10.1146/annurev-vision-111022-123837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The pervasiveness of mobile devices and other associated technologies has affected all aspects of our daily lives. People with visual impairments are no exception, as they increasingly tend to rely on mobile apps for assistance with various visual tasks in daily life. Compared to dedicated visual aids, mobile apps offer advantages such as affordability, versatility, portability, and ubiquity. We have surveyed hundreds of mobile apps of potential interest to people with vision impairments, either released as special assistive apps claiming to help in tasks such as text or object recognition (n = 68), digital accessibility (n = 84), navigation (n = 44), and remote sighted service (n = 4), among others, or marketed as general camera magnification apps that can be used for visual assistance (n = 77). While assistive apps as a whole received positive feedback from visually impaired users, as reported in various studies, evaluations of the usability of every app were typically limited to user reviews, which are often not scientifically informative. Rigorous evaluation studies on the effect of vision assistance apps on daily task performance and quality of life are relatively rare. Moreover, evaluation criteria are difficult to establish, given the heterogeneity of the visual tasks and visual needs of the users. In addition to surveying literature on vision assistance apps, this review discusses the feasibility and necessity of conducting scientific research to understand visual needs and methods to evaluate real-world benefits.
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Affiliation(s)
- Shrinivas Pundlik
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA;
| | - Prerana Shivshanker
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA;
| | - Gang Luo
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA;
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Oikonomidis K, Almpanidou S, Talimtzi P, Kakavouti-Doudou A, Metaxas SM, Karampatakis V. Compliance With the Use of Low-Vision Aids in a Greek Population: An Explorative Study. Cureus 2023; 15:e42730. [PMID: 37529808 PMCID: PMC10388667 DOI: 10.7759/cureus.42730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/03/2023] Open
Abstract
The aim of this study is to investigate the compliance with low-vision aids (LVAs) among patients with low vision (LV) in a Greek population. An explorative study was conducted in a sample of patients with LV attending our outpatient unit at the School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. Patients' demographics and daily visual demands were recorded, and they were administered with the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) at baseline. Participants were trained in the use of a wide range of LVAs before their prescription. Evaluation of the use of the LVAs was conducted at one year after the baseline using a structured phone survey. A total of 100 LV patients were included, with 68% of them being older than 65 years and 50 being males. The main cause of LV (57.0%) was age-related macular degeneration, and the mean VFQ-25 score at baseline was 49.2 (SD= 17.8). Overall, 75 patients had been prescribed LVAs, with 76.0% of these patients preferring an optical aid. The vast majority (98.7%) of these patients stated using the LVA one year after the baseline, and 62.1% of them reported using the aid often to very often. Significantly, 76% of these patients reported that their quality of life was positively affected by the use of the aid, and 97.3% would recommend the use of LVA to another individual with the same problem. Providing appropriate training before the prescription is of high significance to improve the rate of compliance with the use of LVAs. These results can be used to develop appropriate strategies in this field.
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Affiliation(s)
- Konstantinos Oikonomidis
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Stavroula Almpanidou
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Persefoni Talimtzi
- Laboratory of Experimental Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Angeliki Kakavouti-Doudou
- 1st Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Spyridon M Metaxas
- 2nd Department of Otorhinolaryngology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vasileios Karampatakis
- Laboratory of Experimental Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Miller A, Crossland MD, Macnaughton J, Latham K. Are wearable electronic vision enhancement systems (wEVES) beneficial for people with age-related macular degeneration? A scoping review. Ophthalmic Physiol Opt 2023. [PMID: 36876427 DOI: 10.1111/opo.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the United Kingdom. It has a wide-ranging detrimental impact on daily living, including impairment of functional ability and quality of life. Assistive technology designed to overcome this impairment includes wearable electronic vision enhancement systems (wEVES). This scoping review assesses the usefulness of these systems for people with AMD. METHODS Four databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science and Cochrane CENTRAL) were searched to identify papers that investigated image enhancement with a head-mounted electronic device on a sample population that included people with AMD. RESULTS Thirty-two papers were included: 18 studied the clinical and functional benefits of wEVES, 11 investigated use and usability and 3 discussed sickness and adverse effects. CONCLUSIONS Wearable electronic vision enhancement systems provide hands-free magnification and image enhancement producing significant improvements in acuity, contrast sensitivity and aspects of laboratory-simulated daily activity. Adverse effects were infrequent, minor and spontaneously resolved with the removal of the device. However, when symptoms arose, they sometimes persisted with continued device usage. There are multi-factorial influences and a diversity of user opinions on promotors to successful device use. These factors are not exclusively driven by visual improvement and incorporate other issues including device weight, ease of use and inconspicuous design. There is insufficient evidence of any cost-benefit analysis for wEVES. However, it has been shown that a user's decision to make a purchase evolves over time, with their estimates of cost falling below the retail price of the devices. Additional research is needed to understand the specific and distinct benefits of wEVES for people with AMD. Further patient-centred research should assess the benefits of wEVES in user-led activities when directly compared with alternative coping strategies, allowing professionals and users to make better prescribing and purchasing decisions.
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Affiliation(s)
- Andrew Miller
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | | | - Jane Macnaughton
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Keziah Latham
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
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Gothwal VK, Sharma S. What are the reasons for abandonment of low vision devices prescribed in a large tertiary eye care centre? Ophthalmic Physiol Opt 2023; 43:17-24. [PMID: 36161721 DOI: 10.1111/opo.13055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate abandonment rates of near-vision low vision devices (LVDs) and factors that influence abandonment among patients attending a tertiary low vision rehabilitation centre in South India. METHODS Two hundred and eighty-six adults with low vision completed the modified device abandonment survey 1 year following device prescription. The survey included six questions: possession of device, timing of last use, reasons for abandonment, tasks for which the device was used, payment type and change in quality of life (QoL) from device use. The primary outcome measure was abandonment. Multivariate logistic regression analysis was used to investigate factors for abandonment. RESULTS Three hundred and twelve near-vision devices were prescribed (mean, 1.09 device per patient.) Stand magnifiers (35%) followed by hand-held magnifiers (24%) were most frequently prescribed. Mean logMAR visual acuity (Snellen) in the better-seeing eye was 0.80 (6/38). Of the prescribed near-vision devices, 22% (95% CI, 17 to 27) were abandoned. Patients who abandoned the device were significantly older than those who did not (49.3 ± 17.2 vs. 43.5 ± 18.1 years; p = 0.03). In multivariable analysis, patients reporting no change in their QoL from device use had higher odds of abandoning the device (OR: 63.97; 95% CI, 23.77 to 172.12). Device-related (31%) and psychological (30%) factors were the most frequent reasons for abandonment. Among device-related issues, the most frequent reason was that patients felt the device was too complex to use (50%) followed by being too cumbersome to use (25%). CONCLUSION The abandonment rate for near-vision LVDs in South India was comparable with that reported in high-income countries. Patients reporting no change in their QoL had a higher likelihood of abandoning the device compared with those who reported some change. Device-related and psychological factors were the most frequent reasons for abandonment. These results can be used to develop strategies to improve compliance with use of devices.
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Affiliation(s)
- Vijaya K Gothwal
- Meera and L B Deshpande Centre for Sight Enhancement, Institute for Vision Rehabilitation, Hyderabad, India.,Brien Holden Eye Research Centre - Patient Reported Outcomes Unit, Hyderabad, India
| | - Sujata Sharma
- VST Centre for Glaucoma Care, L V Prasad Eye Institute, Hyderabad, India
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Bartolomei F, Biagini I, Sato G, Falchini E, Di Simone A, Mastrantuono C, Micarelli S, Virgili G. Low-vision rehabilitation in Italy: Cross-sectional data from the Device and Aids Registry (D.A.Re). Eur J Ophthalmol 2022; 32:1942-1946. [PMID: 35369783 DOI: 10.1177/11206721221091367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We are reporting on the characteristics of low-vision adults attending large rehabilitation services which provide data to D.A.Re (Devices & Aids REgister) in Italy. D.A.Re aims to gather information about low-vision aids owned by Italian patients with visual impairment. METHODS We included consecutive patients attending low-vision rehabilitation centres providing data to D.A.Re from 2019 to July 2021. Demographic features, self-reported use of technology and aids, vision performance, and the Instrumental Activity of Daily Living (IADL) score were collected. RESULTS 720 patients were included in the D.A.Re. About half of the patients were affected by Age-related Macular Degeneration (389, 54.9%). Patients reported a long interval between onset of vision disability and access to low-vision rehabilitation, which was over two years in almost 30% of cases. Blindness registration status was almost complete when reported, but almost 40% were unable to report on this. IADL scores were higher for younger people and those with better visual acuity and critical print size (CPS), and lower for visual field restriction (p < 0.01 for all predictors). Of interest, better IADL scores were recorded for those with computer knowledge who used optical aids and software in univariate analyses and multivariate analyses, adjusting for level of visual disability and employment status (p < 0.01 for all predictors). CONCLUSIONS We report on the profile of low-vision patients using rehabilitation services in Italy. Longitudinal data during and after vision rehabilitation were collected. Our results support the validity of the D.A.Re to monitor the use of low-vision devices in Italy.
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Affiliation(s)
| | - Ilaria Biagini
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence and AOU Careggi, Firenze, Italy
| | - Giovanni Sato
- Centro Oculistico S. Paolo Hospital, S. Antonio Padova, Italy
| | - Elisabetta Falchini
- Centro integrato per la Riabilitazione Visiva 'Carlo Monti', AOU Careggi, Firenze, Italy
| | | | | | - Silvia Micarelli
- Azienda Servizi alla Persona disabile visiva S. Alessio - Margherita di Savoia, Rome, Italy
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence and AOU Careggi, Firenze, Italy.,Centre for Public Health, Queen's University of Belfast, Belfast, Northern Ireland (UK)
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Somani N, Beukes E, Latham K, Andersson G, Allen PM. Designing an internet-based intervention for improving wellbeing in people with acquired vision loss: A Delphi consensus study. Ophthalmic Physiol Opt 2021; 41:971-984. [PMID: 34392552 DOI: 10.1111/opo.12849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Vision impairment (VI) may impact a person's functional ability resulting in a loss of independence, anxiety, depression, social isolation and reduced quality of life. Caregivers also experience similar problems due to the increased burden placed on them. Support to address these difficulties encountered by those with VI and their caregivers may not always be accessible. An internet-based intervention may provide more accessible support. The aim of this study was to obtain consensus regarding the content and accessibility features required to design an internet-based intervention to promote wellbeing for people with VI and their caregivers. METHOD A three-round Delphi review was conducted with a panel of 30 stakeholders. Three stakeholder groups were included, namely individuals with vision loss, experts in the field of vision loss and mental health and carers of individuals with vision loss. Conceptual wellbeing ideas were examined in round 1, the intervention modules and module content were proposed in round 2 and refined in round 3. RESULTS Consensus of 75% or more was reached to include 18 modules into the intervention. These were divided into seven sections: understanding vision loss, emotional wellbeing, functional wellbeing, social wellbeing, physical wellbeing, wellbeing for carers and maintaining wellbeing. The accessibility features deemed most important were font size, colour and contrast options, compatibility with low vision aids and layout of the intervention. CONCLUSIONS The Delphi process positively informed the design of an internet-based intervention for individuals with acquired VI and their caregivers. Suggestions provided by stakeholders should now be incorporated into the intervention. Future evaluation of efficacy and cost-effectiveness of such an intervention are necessary.
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Affiliation(s)
- Nurbanu Somani
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Eldre Beukes
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Keziah Latham
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter M Allen
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
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