Eye-Hand Coordination Impairment in Glaucoma Patients

Treadmill-walking impairs visual function in early glaucoma and elderly controls

AIMS

Impaired vision is an additional risk factor in elderly for falls. We investigated the hypothesis that treadmill (TM) walking affects visual function in both healthy elderly and those with early-moderate visual dysfunction due to glaucoma.

METHODS

Thirty healthy controls (HC) aged 64-83 years and 18 glaucoma patients (GLA) aged 62-82 years participated in this cross-sectional study. The impact of TM-walking on visual function was assessed binocularly for (i) best-corrected visual acuity (BCVA) with and without crowding effect, (ii) contrast sensitivity (CS), and (iii) and visual field (mean deviation, VF-MD). Visual function was tested while participants were standing or during TM-walking for 2 speed conditions: (i) fast walking at their preferred speed and (ii) walking at a fixed speed of 3.5 km/h.

RESULTS

GLA, most with early-moderate VF loss, performed equally well as HC. Independent of GROUP, an impact of SPEED on visual functions was statistically evident with large statistical effect size for (i) both types of BCVA with a mean loss of 0.02-0.05 logMAR (η2 = 0.41) and (ii) VF-MD with mean loss of 1 dB (η2 = 0.70), but not for CS.

CONCLUSIONS

Here, we introduce a paradigm for the assessment of visual function during walking. We provide proof-of-concept that our approach allows for the identification of walking induced visual function loss, i.e., a deterioration of BCVA and VF-sensitivity during TM-walking in both groups. It is therefore of promise for the investigation of the relation of vision impairment and mobility, ultimately the increased frequency of falls in advanced glaucoma.

Democratizing Health Care in the Metaverse: How Video Games can Monitor Eye Conditions Using the Vision Performance Index: A Pilot Study

Objective

In a world where digital media is deeply engrained into our everyday lives, there lies an opportunity to leverage interactions with technology for health and wellness. The Vision Performance Index (VPI) leverages natural human-technology interaction to evaluate visual function using visual, cognitive, and motor psychometric data over 5 domains: field of view, accuracy, multitracking, endurance, and detection. The purpose of this study was to describe a novel method of evaluating holistic visual function through video game-derived VPI score data in patients with specific ocular pathology.

Design

Prospective comparative analysis.

Participants

Patients with dry eye, glaucoma, cataract, diabetic retinopathy (DR), age-related macular degeneration, and healthy individuals.

Methods

The Vizzario Inc software development kit was integrated into 2 video game applications, Balloon Pop and Picture Perfect, which allowed for generation of VPI scores. Study participants were instructed to play rounds of each video game, from which a VPI score was compiled.

Main Outcome Measures

The primary outcome was VPI overall score in each comparison group. Vision Performance Index component, subcomponent scores, and psychophysical inputs were also compared.

Results

Vision Performance Index scores were generated from 93 patients with macular degeneration (n = 10), cataract (n = 10), DR (n = 15), dry eye (n = 15), glaucoma (n = 16), and no ocular disease (n = 27). The VPI overall score was not significantly different across comparison groups. The VPI subcomponent "reaction accuracy" score was significantly greater in DR patients (106 ± 13.2) versus controls (96.9 ± 11.5), P = 0.0220. The VPI subcomponent "color detection" score was significantly lower in patients with DR (96.8 ± 2.5; p=0.0217) and glaucoma (98.5 ± 6.3; P = 0.0093) compared with controls (101 ± 11). Psychophysical measures were statistically significantly different from controls: proportion correct (lower in DR, age-related macular degeneration), contrast errors (higher in cataract, DR), and saturation errors (higher in dry eye).

Conclusions

Vision Performance Index scores can be generated from interactions of an ocular disease population with video games. The VPI may offer utility in monitoring select ocular diseases through evaluation of subcomponent and psychophysical input scores; however, future larger-scale studies must evaluate the validity of this tool.

Financial Disclosures

Proprietary or commercial disclosure may be found after the references.

Implicating Causal Brain Magnetic Resonance Imaging in Glaucoma Using Mendelian Randomization

Background

Glaucoma is hypothesized to originate in the brain but manifests as an eye disease as it possesses the common features of neurodegeneration diseases. But there is no evidence to demonstrate the primary brain changes in glaucoma patients. In the present study, we have used Mendelian randomization (MR) to understand the causal effect of brain alterations on glaucoma.

Methods

Our MR study was carried out using summary statistics from genome-wide associations for 110 diffusion tensor imaging (DTI) measurements of white matter (WM) tracts (17,706 individuals), 101 brain region-of-interest (ROI) volumes (19,629 individuals), and glaucoma (8,591 cases, 210,201 control subjects). The causal relationship was evaluated by multiplicative random effects inverse variance weighted (IVW) method and verified by two other MR methods, including MR Egger, weighted median, and extensive sensitivity analyses.

Results

Genetic liability to fornix fractional anisotropy (FX.FA) (OR = 0.71, 95%CI = 0.56–0.88, P = 2.44 × 10^–3), and uncinate fasciculus UNC.FA (OR = 0.65, 95%CI = 0.48–0.88, P = 5.57 × 10^–3) was associated with a low risk of glaucoma. Besides, the right ventral diencephalon (OR = 1.72, 95%CI = 1.17–2.52, P = 5.64 × 10^–3) and brain stem (OR = 1.35, 95%CI = 1.08–1.69, P = 8.94 × 10^–3) were associated with the increased risk of glaucoma. No heterogeneity and pleiotropy were detected.

Conclusion

Our study suggests that the fornix and uncinate fasciculus degenerations and injures of the right ventral diencephalon and brain stem potentially increase the occurrence of glaucoma and reveal the existence of the brain-eye axis.

Physical Activity Is Associated with Improved Visuomotor Processing in Older Adults with Moderate and Advanced Glaucomatous Visual Field Defect: A Cross-Sectional Study

Glaucoma affects a wide spectrum of daily essential activities in older adults. This study examined whether older adults with moderate and advanced stages of glaucoma exhibit differences in visuomotor task performance compared with age- and gender-matched ophthalmologically healthy control subjects and estimated the effects of physical activity (PA) levels, age, and severity of visual impairment on patients' visuomotor task performance. Sixty older adults with moderate glaucoma, advanced glaucoma, and normal sight participated in the study. Visuomotor processing was assessed using laboratory-based simple and complex visuomotor reaction tasks. Monocular Humphrey Visual Field and binocular Humphrey Esterman Visual Field tests were used to estimate visual field defect severity. The International Physical Activity Questionnaire was used to assess PA levels. Participants with glaucoma had poorer scores in visuomotor tasks compared to participants with normal sight. Glaucoma patients' PA levels, age, and binocular visual field defect explained 54% of the variation in complex reaction time. Low PA levels were identified as a risk factor for visuomotor processing decline. Compensatory mechanisms to improve the efficiency of visual field scanning in patients with more severe visual field defects may exist.

GlauCUTU: Virtual Reality Visual Field Test

This study proposed a virtual reality (VR) head-mounted visual field (VF) test system, or also known as the GlauCUTU VF test, for a reaction time (RT) perimetry with moving visual stimuli that progressively increase in intensity. The test entailed 24-2 VF protocol and was examined on 2 study groups, controls with normal fields and subjects with glaucoma. To collect reaction times, participants were urged to respond to the stimulus by pressing on the clicker as fast as possible. Performance of the GlauCUTU VF test was compared to the gold standard Humphrey Visual Field Analyzer (HFA). The HFA showed a significant difference between the GlauCUTU and HFA with mean duration of 254.41 and 609, respectively [t(16) = 15.273, p<0.05]. Likewise, our system also effectively differentiated glaucomatous eyes from normal eyes for the left eye and right eye, respectively. When compared to the HFA, the GlauCUTU test produced a significantly shorter average test duration by 354 seconds which reduced test-induced eye fatigue. The portable and inexpensive GlauCUTU perimetry system proves to be a promising method for increasing accessibility to glaucoma screening.Clinical relevance- GlauCUTU, an automated head-mounted VR perimetry device for VF test, is portable, cost-effective, and suitable for low resource settings. Unlike the conventional HFA test, GlauCUTU VF test reports in terms of subjects RT which is reportedly higher in glaucoma patients.

Outdoor Playground Design Criteria Development for Early Childhood Development: A Delphi Study from the Perspective of Fundamental Movement Skills and Perceptual-Motor Skills

The purpose of this research is to discover adequate and environmental outdoor playground design criteria based on the collected opinions of experts. Taking the case of South Korea into account, this research focuses on the development of a new outdoor playground design criteria that could offset the limited motor activities and environmental use which has been restricted by the current regulations. In particular, this research approaches the issue from the perspective of children’s fundamental movement skills and the development of their perceptual-motor abilities. The research conducted three rounds of a Delphi survey and held a consensus of experts in child development, child physical education, and playground designs. The research achieved results defining 9 categories and 23 items within the categories of design criteria for outdoor playgrounds. Significantly, the discussions were not limited to children’s holistic development—from motor and physical development to attaining mental, social, and cognitive skills—but also included discussions of children’s dynamic interaction with the surrounding nature and environment, especially in challenge making and risk taking.

The Consequences of Glaucoma on Mobility and Balance Control in the Older Adults: A Cross-Sectional Study

The aim of the study was to explore the functional impairments and related factors in older adults with moderate to advanced stages of glaucoma. Nineteen patients with glaucoma and 19 participants with no ocular disease performed step test and balance control tasks with analysis of overall stability index and fall risk index. Monocular and binocular Humphrey Visual Field tests were used to estimate visual field defect severity. The International Physical Activity Questionnaire was used to measure physical activity level. Patients with glaucoma showed poorer values for most of the mobility and balance control parameters with medium and large effect sizes (0.3-0.5). Mobility scores in patients were partly associated with their monocular visual field defect (rs = .507, p < .05). Low physical activity was identified as a risk factor for falls (rs = -.453, p < .05) and postural instability (rs = -.457, p < .05). Functional declines in dynamic tasks were not related to glaucoma severity. Older adults with glaucoma display impairment with mobility and balance control compared to controls, associated with the degree of monocular visual field loss and lower daily physical activity.