Individuals with severely impaired vision can learn useful orientation and mobility skills in virtual streets and can use them to improve real street safety

Health Management Service Models for the Elderly with Visual Impairment: A Scoping Review

Background

The incidence of visual impairment(VI) in older people is gradually increasing. This review aimed to summarise the evidence on existing health management models and strategies for older adults with VI to improve health-related and vision-related quality of life (QoL) in older people.

Methods

Based on the framework of the scoping review methodology of Arksey and O'Malley (2005), a comprehensive literature search of relevant literature published between January 2010 and June 2022 in PubMed, CINAHL, EMBASE, Web of Science, Cochrane Library, CNKI, VIP, Wanfang database, Sinomed and the grey literature.

Results

Finally, 31 articles were included. The health management model had a multidisciplinary team low vision rehabilitation model, medical consortium two-way management model, low vision community comprehensive rehabilitation model, medical consortium-family contract service model, screening-referral-follow-up model, and three-level low vision care model. The health management strategy covers nine aspects, the combination of multi-element strategies is feasible, and network information technology has also shown positive results.

Conclusion

In the future, under the Internet and hierarchical management model, we should provide demand-based personalized support to rationalize and scientifically achieve hierarchical management and improve resource utilization efficiency and eye health outcomes.

PTVR - A software in Python to make virtual reality experiments easier to build and more reproducible

Researchers increasingly use virtual reality (VR) to perform behavioral experiments, especially in vision science. These experiments are usually programmed directly in so-called game engines that are extremely powerful. However, this process is tricky and time-consuming as it requires solid knowledge of game engines. Consequently, the anticipated prohibitive effort discourages many researchers who want to engage in VR. This paper introduces the Perception Toolbox for Virtual Reality (PTVR) library, allowing visual perception studies in VR to be created using high-level Python script programming. A crucial consequence of using a script is that an experiment can be described by a single, easy-to-read piece of code, thus improving VR studies' transparency, reproducibility, and reusability. We built our library upon a seminal open-source library released in 2018 that we have considerably developed since then. This paper aims to provide a comprehensive overview of the PTVR software for the first time. We introduce the main objects and features of PTVR and some general concepts related to the three-dimensional (3D) world. This new library should dramatically reduce the difficulty of programming experiments in VR and elicit a whole new set of visual perception studies with high ecological validity.

Self-Reported Visual Ability Versus Task Performance in Individuals With Ultra-Low Vision

Purpose

Visual functioning questionnaires are commonly used as patient-reported outcome measures to estimate visual ability. Performance measures, on the other hand, provide a direct measure of visual ability. For individuals with ultra-low vision (ULV; visual acuity (VA) <20/1600), the ultra-low vision visual functioning questionnaire (ULV-VFQ) and the Wilmer VRI-a virtual reality-based performance test-estimate self-reported and actual visual ability, respectively, for activities of daily living. But how well do self-reports from ULV-VFQ predict actual task performance in the Wilmer VRI?

Methods

We administered a subset of 10 matching items from the ULV-VFQ and Wilmer VRI to 27 individuals with ULV. We estimated item measures (task difficulty) and person measures (visual ability) using Rasch analysis for ULV-VFQ and using latent variable signal detection theory for the Wilmer VRI. We then used regression analysis to compare person and item measure estimates from self-reports and task performance.

Results

Item and person measures were modestly correlated between the two instruments, with r2 = 0.47 (P = 0.02) and r2 = 0.36 (P = 0.001), demonstrating that self-reports are an imperfect predictor of task difficulty and performance.

Conclusions

While self-reports impose a lower demand for equipment and personnel, actual task performance should be measured to assess visual ability in ULV.

Translational Relevance

Visual performance measures should be the preferred outcome measure in clinical trials recruiting individuals with ULV. Virtual reality can be used to standardize tasks.

A systematic review of extended reality (XR) for understanding and augmenting vision loss

Over the past decade, extended reality (XR) has emerged as an assistive technology not only to augment residual vision of people losing their sight but also to study the rudimentary vision restored to blind people by a visual neuroprosthesis. A defining quality of these XR technologies is their ability to update the stimulus based on the user's eye, head, or body movements. To make the best use of these emerging technologies, it is valuable and timely to understand the state of this research and identify any shortcomings that are present. Here we present a systematic literature review of 227 publications from 106 different venues assessing the potential of XR technology to further visual accessibility. In contrast to other reviews, we sample studies from multiple scientific disciplines, focus on technology that augments a person's residual vision, and require studies to feature a quantitative evaluation with appropriate end users. We summarize prominent findings from different XR research areas, show how the landscape has changed over the past decade, and identify scientific gaps in the literature. Specifically, we highlight the need for real-world validation, the broadening of end-user participation, and a more nuanced understanding of the usability of different XR-based accessibility aids.

A systematic review: Virtual-reality-based techniques for human exercises and health improvement

Virtual Reality (VR) has emerged as a new safe and efficient tool for the rehabilitation of many childhood and adulthood illnesses. VR-based therapies have the potential to improve both motor and functional skills in a wide range of age groups through cortical reorganization and the activation of various neuronal connections. Recently, the potential for using serious VR-based games that combine perceptual learning and dichoptic stimulation has been explored for the rehabilitation of ophthalmological and neurological disorders. In ophthalmology, several clinical studies have demonstrated the ability to use VR training to enhance stereopsis, contrast sensitivity, and visual acuity. The use of VR technology provides a significant advantage in training each eye individually without requiring occlusion or penalty. In neurological disorders, the majority of patients undergo recurrent episodes (relapses) of neurological impairment, however, in a few cases (60-80%), the illness progresses over time and becomes chronic, consequential in cumulated motor disability and cognitive deficits. Current research on memory restoration has been spurred by theories about brain plasticity and findings concerning the nervous system's capacity to reconstruct cellular synapses as a result of interaction with enriched environments. Therefore, the use of VR training can play an important role in the improvement of cognitive function and motor disability. Although there are several reviews in the community employing relevant Artificial Intelligence in healthcare, VR has not yet been thoroughly examined in this regard. In this systematic review, we examine the key ideas of VR-based training for prevention and control measurements in ocular diseases such as Myopia, Amblyopia, Presbyopia, and Age-related Macular Degeneration (AMD), and neurological disorders such as Alzheimer, Multiple Sclerosis (MS) Epilepsy and Autism spectrum disorder. This review highlights the fundamentals of VR technologies regarding their clinical research in healthcare. Moreover, these findings will raise community awareness of using VR training and help researchers to learn new techniques to prevent and cure different diseases. We further discuss the current challenges of using VR devices, as well as the future prospects of human training.

Measuring visual information gathering in individuals with ultra low vision using virtual reality

People with ULV (visual acuity ≤ 20/1600 or 1.9 logMAR) lack form vision but have rudimentary levels of vision that can be used for a range of activities in daily life. However, current clinical tests are designed to assess form vision and do not provide information about the range of visually guided activities that can be performed in daily life using ULV. This is important to know given the growing number of clinical trials that recruit individuals with ULV (e.g., gene therapy, stem cell therapy) or restore vision to the ULV range in the blind (visual prosthesis). In this study, we develop a set of 19 activities (items) in virtual reality involving spatial localization/detection, motion detection, and direction of motion that can be used to assess visual performance in people with ULV. We estimated measures of item difficulty and person ability on a relative d prime (d') axis using a signal detection theory based analysis for latent variables. The items represented a range of difficulty levels (- 1.09 to 0.39 in relative d') in a heterogeneous group of individuals with ULV (- 0.74 to 2.2 in relative d') showing the instrument's utility as an outcome measure in clinical trials.

Orientation and mobility remote instruction during COVID-19: Best practices, liability, and ethics

This research evaluated the impact of COVID-19 on orientation and mobility (O&M) services for school-aged students, families, and service providers. The survey asked O&M specialists about their instructional practices and decision-making processes regarding remote instruction service provisions, allowances, and district guidelines. The online survey collected data from October to November 2020, with open-ended responses from 166 O&M specialists. A thematic analysis was used to examine and code qualitative responses. Respondents were found to divide remote instruction into two categories, foundational skills and high-level travel skills. A preference for teaching foundational skills during remote instruction was also identified, with concerns for student safety and practitioner liability reported as the deciding factors. Field-specific guidelines and potential legal vulnerabilities regarding remote instruction are considered, with an analysis of negligence and professional liability. Practices used during COVID are also examined according to the COMS Code of Ethics and Scope of Practice. The findings demonstrate the need for field-specific guidance and research-based instructional methods regarding remote instruction. O&M specialists should continue to conduct a thorough risk assessment before utilizing new and unresearched remote instructional methods as a means of acting in the best interest of the student.

A Training Smartphone Application for the Simulation of Outdoor Blind Pedestrian Navigation: Usability, UX Evaluation, Sentiment Analysis

Training blind and visually impaired individuals is an important but often neglected aspect of Assistive Technology solutions (ATs) that can benefit from systems utilizing multiple sensors and hardware devices. Training serves a dual purpose as it not only enables the target group to effectively utilize the ATs but, also, helps in improving their low acceptance rate. In this paper, we present the design, implementation, and validation of a smartphone-based training application. It is a form of immersive system that enables users to learn the features of an outdoor blind pedestrian navigation application and, simultaneously, to help them develop long-term Orientation and Mobility (O&M) skills. The system consists of an Android application leveraging, as data sources, an external high-accuracy GPS sensor for real-time pedestrian mobility tracking, a second custom-made device attached to traffic lights for identifying their status, and an ultra-sonic sensor for detecting near-field obstacles on the navigation path of the users. The training version running as an Android application employs route simulation with audio and haptic feedback, is functionally equivalent to the main application, and was used in the context of specially designed user-centered training sessions. A Usability and User Experience (UX) evaluation revealed the positive attitude of the users towards the training version as well as their satisfaction with the skills acquired during their training sessions (SUS = 69.1, UEQ+ = 1.53). Further confirming the positive attitude was the conduct of a Recursive Neural Network (RNN)-based sentiment analysis on user responses with a score of 3 on a scale from 0 to 4. Finally, we conclude with the lessons learned and the proposal of general design guidelines concerning the observed lack of accessibility and non-universal interfaces.

Safe access to road crossings and the issue of quiet vehicles in relation to pedestrians with a vision impairment: A literature review

This New Zealand study explored the research literature about quiet motor vehicles, like electric and hybrid cars, and the safety of pedestrians with vision impairment when making road-crossing decisions through an integrative literature review. A search of four research databases, two public library databases, and the New Zealand and the United States’ Departments of Transport online resources, as well as three relevant journals was conducted using key words. A rapid critical appraisal tool was used to assess whether the 38 found articles were valid and important, provided any answers to the research questions, and met the study’s inclusion criteria. A thematic analysis of 25 studies, which were included in this study, was completed to answer the following research questions: (1) What does the current literature say, as a whole, about the potential effects of ‘quiet vehicles’ on road-crossing procedures for pedestrians with a vision impairment? and (2) what remedies may exist to alleviate these effects, including possible changes to orientation and mobility (O&M) practice? Five emerging themes were found in the research: (1) crossing the road as a pedestrian with a vision impairment with quiet cars; (2) O&M instruction needs to change; (3) environmental access to road crossings; (4) developing and adapting technology and car sounds; and (5) rights of people with a vision impairment, policy, and legislation. The literature also confirmed that road crossings, when quiet vehicles are present, are dangerous for pedestrians with a vision impairment because such pedestrians rely on vehicular sounds for safe crossings. However, the review concluded that further research is needed in order to answer the research questions in this study. There were no studies about road-crossing procedures and quiet cars, and little research about possible remedies and O&M practice.

Orientation and mobility for children with visual impairments during COVID-19: Responses from O&M professionals to a disruption of traditional services

After lockdowns and school closings associated with COVID-19 began throughout the United States and Canada in March 2020, this research was completed to explore how the pandemic affected access to orientation and mobility (O&M) services. Using qualititave responses from a mixed methodology study, this article reports the findings from 318 individuals, including both O&M specialists and dually certified teachers of students with visual impairments (TVIs) and O&M specialists. Four major themes emerged through data analysis, including (1) prioritization of O&M goals for students with visual impairments, (2) personal factors affecting access to O&M training, (3) access to O&M services through virtual learning, and (4) creative approaches to O&M instruction during the pandemic. Within these themes, professionals, students, and families alike were asked to assume roles that went beyond traditional expectations. Questions and concerns that professionals in the field need to consider when looking at the future of O&M services were raised as part of this research, including a number of ideas for future studies.

Virtual Reality Systems as an Orientation Aid for People Who Are Blind to Acquire New Spatial Information

This research aims to examine the impact of virtual environments interface on the exploration process, construction of cognitive maps, and performance of orientation tasks in real spaces by users who are blind. The study compared interaction with identical spaces using different systems: BlindAid, Virtual Cane, and real space. These two virtual systems include user-interface action commands that convey unique abilities and activities to users who are blind and that operate only in these VR systems and not in real space (e.g., teleporting the user’s avatar or pointing at a virtual object to receive information). This research included 15 participants who are blind, divided into three groups: a control group and two experimental groups. Varied tasks (exploration and orientation) were used in two virtual environments and in real spaces, with both qualitative and quantitative methodologies. The results show that the participants were able to explore, construct a cognitive map, and perform orientation tasks. Participants in both virtual systems used these action commands during their exploration process: all participants used the teleport action command to move their avatar to the starting point and all Virtual Cane participants explored the environment mainly by using the look-around mode, which enabled them to collect spatial information in a way that influenced their ability to construct a cognitive map based on a map model.

Virtual Reality and Augmented Reality in Ophthalmology: A Contemporary Prospective

PURPOSE

Most published systematic reviews have focused on the use of virtual reality (VR)/augmented reality (AR) technology in ophthalmology as it relates to surgical training. To date, this is the first review that investigates the current state of VR/AR technology applied more broadly to the entire field of ophthalmology.

METHODS

PubMed, Embase, and CINAHL databases were searched systematically from January 2014 through December 1, 2020. Studies that discussed VR and/or AR as it relates to the field of ophthalmology and provided information on the technology used were considered. Abstracts, non-peer-reviewed literature, review articles, studies that reported only qualitative data, and studies without English translations were excluded.

RESULTS

A total of 77 studies were included in this review. Of these, 28 evaluated the use of VR/AR in ophthalmic surgical training/assessment and guidance, 7 in clinical training, 23 in diagnosis/screening, and 19 in treatment/therapy. 15 studies used AR, 61 used VR, and 1 used both. Most studies focused on the validity and usability of novel technologies.

CONCLUSIONS

Ophthalmology is a field of medicine that is well suited for the use of VR/AR. However, further longitudinal studies examining the practical feasibility, efficacy, and safety of such novel technologies, the cost-effectiveness, and medical/legal considerations are still needed. We believe that time will indeed foster further technological advances and lead to widespread use of VR/AR in routine ophthalmic practice.

Two Decades of Touchable and Walkable Virtual Reality for Blind and Visually Impaired People: A High-Level Taxonomy

Although most readers associate the term virtual reality (VR) with visually appealing entertainment content, this technology also promises to be helpful to disadvantaged people like blind or visually impaired people. While overcoming physical objects’ and spaces’ limitations, virtual objects and environments that can be spatially explored have a particular benefit. To give readers a complete, clear and concise overview of current and past publications on touchable and walkable audio supplemented VR applications for blind and visually impaired users, this survey paper presents a high-level taxonomy to cluster the work done up to now from the perspective of technology, interaction and application. In this respect, we introduced a classification into small-, medium- and large-scale virtual environments to cluster and characterize related work. Our comprehensive table shows that especially grounded force feedback devices for haptic feedback (‘small scale’) were strongly researched in different applications scenarios and mainly from an exocentric perspective, but there are also increasingly physically (‘medium scale’) or avatar-walkable (‘large scale’) egocentric audio-haptic virtual environments. In this respect, novel and widespread interfaces such as smartphones or nowadays consumer grade VR components represent a promising potential for further improvements. Our survey paper provides a database on related work to foster the creation process of new ideas and approaches for both technical and methodological aspects.

X-Road

Orientation and Mobility (O8M) classes teach people with visual impairments how to navigate the world; for instance, how to cross a road. Yet, this training can be difficult and dangerous due to conditions such as traffic and weather. Virtual Reality (VR) can overcome these challenges by providing interactive controlled environments. However, most existing VR tools rely on visual feedback, which limits their use with students with visual impairment. In a collaborative design approach with O8M instructors, we designed an affordable and accessible VR system for O8M classes, called X-Road. Using a smartphone and a Bespoke headmount, X-Road provides both visual and audio feedback and allows users to move in space as in the real world. In a study with 13 students with visual impairments, X-Road proved to be an effective alternative to teaching and learning classical O8M tasks, and both students and instructors were enthusiastic about this technology. We conclude with design recommendations for inclusive VR systems.

Data Acquisition, Processing, and Reduction for Home-Use Trial of a Wearable Video Camera-Based Mobility Aid

Purpose

Evaluating mobility aids in naturalistic conditions across many days is challenging owing to the sheer amount of data and hard-to-control environments. For a wearable video camera-based collision warning device, we present the methodology for acquisition, reduction, review, and coding of video data for quantitative analyses of mobility outcomes in blind and visually impaired participants.

Methods

Scene videos along with collision detection information were obtained from a chest-mounted collision warning device during daily use of the device. The recorded data were analyzed after use. Collision risk events flagged by the device were manually reviewed and coded using a detailed annotation protocol by two independent masked reviewers. Data reduction was achieved by predicting agreements between reviewers based on a machine learning algorithm. Thus, only those events for which disagreements were predicted would be reviewed by the second reviewer. Finally, the ultimate disagreements were resolved via consensus, and mobility-related outcome measures such as percentage of body contacts were obtained.

Results

There were 38 hours of device use from 10 participants that were reviewed by both reviewers, with an agreement level of 0.66 for body contacts. The machine learning algorithm trained on 2714 events correctly predicted 90.5% of disagreements. For another 1943 events, the trained model successfully predicted 82% of disagreements, resulting in 81% data reduction.

Conclusions

The feasibility of mobility aid evaluation based on a large volume of naturalistic data is demonstrated. Machine learning–based disagreement prediction can lead to data reduction.

Translational Relevance

These methods provide a template for determining the real-world benefit of a mobility aid.

Low vision rehabilitation for better quality of life in visually impaired adults

BACKGROUND

Low vision rehabilitation aims to optimise the use of residual vision after severe vision loss, but also aims to teach skills in order to improve visual functioning in daily life. Other aims include helping people to adapt to permanent vision loss and improving psychosocial functioning. These skills promote independence and active participation in society. Low vision rehabilitation should ultimately improve quality of life (QOL) for people who have visual impairment.

OBJECTIVES

To assess the effectiveness of low vision rehabilitation interventions on health-related QOL (HRQOL), vision-related QOL (VRQOL) or visual functioning and other closely related patient-reported outcomes in visually impaired adults.

SEARCH METHODS

We searched relevant electronic databases and trials registers up to 18 September 2019.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) investigating HRQOL, VRQOL and related outcomes of adults, with an irreversible visual impairment (World Health Organization criteria). We included studies that compared rehabilitation interventions with active or inactive control.

DATA COLLECTION AND ANALYSIS

We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included 44 studies (73 reports) conducted in North America, Australia, Europe and Asia. Considering the clinical diversity of low vision rehabilitation interventions, the studies were categorised into four groups of related intervention types (and by comparator): (1) psychological therapies and/or group programmes, (2) methods of enhancing vision, (3) multidisciplinary rehabilitation programmes, (4) other programmes. Comparators were no care or waiting list as an inactive control group, usual care or other active control group. Participants included in the reported studies were mainly older adults with visual impairment or blindness, often as a result of age-related macular degeneration (AMD). Study settings were often hospitals or low vision rehabilitation services. Effects were measured at the short-term (six months or less) in most studies. Not all studies reported on funding, but those who did were supported by public or non-profit funders (N = 31), except for two studies. Compared to inactive comparators, we found very low-certainty evidence of no beneficial effects on HRQOL that was imprecisely estimated for psychological therapies and/or group programmes (SMD 0.26, 95% CI -0.28 to 0.80; participants = 183; studies = 1) and an imprecise estimate suggesting little or no effect of multidisciplinary rehabilitation programmes (SMD -0.08, 95% CI -0.37 to 0.21; participants = 183; studies = 2; I2 = 0%); no data were available for methods of enhancing vision or other programmes. Regarding VRQOL, we found low- or very low-certainty evidence of imprecisely estimated benefit with psychological therapies and/or group programmes (SMD -0.23, 95% CI -0.53 to 0.08; studies = 2; I2 = 24%) and methods of enhancing vision (SMD -0.19, 95% CI -0.54 to 0.15; participants = 262; studies = 5; I2 = 34%). Two studies using multidisciplinary rehabilitation programmes showed beneficial but inconsistent results, of which one study, which was at low risk of bias and used intensive rehabilitation, recorded a very large and significant effect (SMD: -1.64, 95% CI -2.05 to -1.24), and the other a small and uncertain effect (SMD -0.42, 95%: -0.90 to 0.07). Compared to active comparators, we found very low-certainty evidence of small or no beneficial effects on HRQOL that were imprecisely estimated with psychological therapies and/or group programmes including no difference (SMD -0.09, 95% CI -0.39 to 0.20; participants = 600; studies = 4; I2 = 67%). We also found very low-certainty evidence of small or no beneficial effects with methods of enhancing vision, that were imprecisely estimated (SMD -0.09, 95% CI -0.28 to 0.09; participants = 443; studies = 2; I2 = 0%) and multidisciplinary rehabilitation programmes (SMD -0.10, 95% CI -0.31 to 0.12; participants = 375; studies = 2; I2 = 0%). Concerning VRQOL, low-certainty evidence of small or no beneficial effects that were imprecisely estimated, was found with psychological therapies and/or group programmes (SMD -0.11, 95% CI -0.24 to 0.01; participants = 1245; studies = 7; I2 = 19%) and moderate-certainty evidence of small effects with methods of enhancing vision (SMD -0.24, 95% CI -0.40 to -0.08; participants = 660; studies = 7; I2 = 16%). No additional benefit was found with multidisciplinary rehabilitation programmes (SMD 0.01, 95% CI -0.18 to 0.20; participants = 464; studies = 3; I2 = 0%; low-certainty evidence). Among secondary outcomes, very low-certainty evidence of a significant and large, but imprecisely estimated benefit on self-efficacy or self-esteem was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -0.85, 95% CI -1.48 to -0.22; participants = 456; studies = 5; I2 = 91%). In addition, very low-certainty evidence of a significant and large estimated benefit on depression was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -1.23, 95% CI -2.18 to -0.28; participants = 456; studies = 5; I2 = 94%), and moderate-certainty evidence of a small benefit versus usual care (SMD -0.14, 95% CI -0.25 to -0.04; participants = 1334; studies = 9; I2 = 0%). ln the few studies in which (serious) adverse events were reported, these seemed unrelated to low vision rehabilitation.

AUTHORS' CONCLUSIONS

In this Cochrane Review, no evidence of benefit was found of diverse types of low vision rehabilitation interventions on HRQOL. We found low- and moderate-certainty evidence, respectively, of a small benefit on VRQOL in studies comparing psychological therapies or methods for enhancing vision with active comparators. The type of rehabilitation varied among studies, even within intervention groups, but benefits were detected even if compared to active control groups. Studies were conducted on adults with visual impairment mainly of older age, living in high-income countries and often having AMD. Most of the included studies on low vision rehabilitation had a short follow-up, Despite these limitations, the consistent direction of the effects in this review towards benefit justifies further research activities of better methodological quality including longer maintenance effects and costs of several types of low vision rehabilitation. Research on the working mechanisms of components of rehabilitation interventions in different settings, including low-income countries, is also needed.

Enhanced Depth Navigation Through Augmented Reality Depth Mapping in Patients with Low Vision

Patients diagnosed with Retinitis Pigmentosa (RP) show, in the advanced stage of the disease, severely restricted peripheral vision causing poor mobility and decline in quality of life. This vision loss causes difficulty identifying obstacles and their relative distances. Thus, RP patients use mobility aids such as canes to navigate, especially in dark environments. A number of high-tech visual aids using virtual reality (VR) and sensory substitution have been developed to support or supplant traditional visual aids. These have not achieved widespread use because they are difficult to use or block off residual vision. This paper presents a unique depth to high-contrast pseudocolor mapping overlay developed and tested on a Microsoft Hololens 1 as a low vision aid for RP patients. A single-masked and randomized trial of the AR pseudocolor low vision aid to evaluate real world mobility and near obstacle avoidance was conducted consisting of 10 RP subjects. An FDA-validated functional obstacle course and a custom-made grasping setup were used. The use of the AR visual aid reduced collisions by 50% in mobility testing (p = 0.02), and by 70% in grasp testing (p = 0.03). This paper introduces a new technique, the pseudocolor wireframe, and reports the first significant statistics showing improvements for the population of RP patients with mobility and grasp.

Hungry Cat—A Serious Game for Conveying Spatial Information to the Visually Impaired

Navigation is done through obtaining spatial information from the environment and forming a spatial map about it. The visually impaired rely mainly on orientation and mobility training by a certified specialist to acquire spatial navigation skills. However, it is manpower intensive and costly. This research designed and developed a serious game, Hungry Cat. This game can convey spatial information of virtual rooms to children with visual impairment through game playing. An evaluation with 30 visually impaired participants was conducted by allowing them to explore each virtual room in Hungry Cat. After exploration, the food finding test, which is a game mode available in Hungry Cat, was conducted, followed by the physical wire net test to evaluate their ability in forming the spatial mental maps of the virtual rooms. The positive results of the evaluation obtained demonstrate the ability of Hungry Cat, in conveying spatial information about virtual rooms and aiding the development of spatial mental maps of these rooms through game playing.

A 5-year retrospective record review of hospital-based low-vision rehabilitation in Thailand

PURPOSE

To investigate the quality-of-life-related goals of low-vision patients, the causes of visual impairment, and the low-vision rehabilitation services at a Thai national tertiary referral center.

SUBJECTS AND METHODS

A review was conducted on the medical records of patients attending the Low Vision Rehabilitation Clinic, Siriraj Hospital, Bangkok, Thailand, between 2012 and 2016.

RESULTS

A total of 992 patient records were included, comprising of 760 adults (aged over 15 years) and 232 children (aged ≤15), with a mean age of 52.2 and 5.4 years, respectively. The retina was the most common anatomic site of visual impairment. Among the adults, the most common ocular condition was retinitis pigmentosa (28.3%), followed by age-related macular degeneration (10.3%), glaucoma (10.0%), and diabetic retinopathy (9.6%). As for the children, the most common ocular conditions were cortical visual impairment (17.7%), optic nerve hypoplasia (13.4%), and retinopathy of prematurity (9.5%). More patients had low vision (a visual acuity of <6/18-3/60) than blindness (a visual acuity below 3/60). The most commonly stated goals among the adults were reading, writing, and performing near tasks (34.7%), and independent mobility (21.3%), whereas for children, the most frequently indicated goal was visual and developmental stimulation (38.4%). The services most often provided for the adults were the prescribing of visual aid devices (51.8%) and orientation and mobility training (40.7%), while the children most often received visual and developmental stimulation provided by a multidisciplinary team (33.8%). The Thai Government's Universal Health Care Coverage scheme was the most commonly used medical insurance.

CONCLUSION

Data from this study can be used to improve low-vision patient care and rehabilitation services, and as input to the further development of national health care policies for low-vision patients.