Functional outcome of the low vision aids for visual impairment secondary to central nervous system tumors in children

To assess functional outcomes of optical low vision aids(LVAs) for pediatric visual impairment due to central nervous system(CNS) tumors. A prospective case study was conducted on 15 children with history of CNS tumors with mean age of 10.47±1.85 y. Lighthouse distance, near visual acuity tests, cycloplegic refraction, reading speed measurement and visual field examination were done. Prescription of far and near LVAs followed by training sessions. LVPrasad-functional vision questionnaire was done to evaluate performance. Visual impairment was moderate(13.3%), severe(73.3%), profound(6.7%) and near blindness in 6.7%. Telescopes prescribed in 33.4%, video magnifier in 46.7%. Questionnaire scores were significantly improved for distant rather than near tasks(P≤0.05) after training. LVAs rehabilitation is an effective method of improving vision in pediatric visual defects secondary to CNS tumors.

Validity and reliability study of Turkish version on low vision with quality of life questionnaire

AIM:To adapt the low vision-related quality of life(LVQOL) instrument into Turkish language and to assess its validity and reliability.METHODS:The study was conducted in 387 patients attending the Centre of Low Vision Rehabilitation,Faculty of Medicine,Ankara University.For statistical analyses,the Spearman's correlation coefficient,Cronbach's alpha coefficient and Confirmatory Factor Analysis(CFA) were used.RESULTS:According to results of CFA,the item in the 'Adjustment' subscale because of having the factor loading below 0.40,was excluded from the questionnaire.The reliability of the questionnaire was assessed according to Cronbach's alpha coefficients.The reliability of the 'Distance Vision,Mobility,and Lighting' subscale was ?琢=0.863;of the 'Adjustment' subscale was ?琢=0.694;'Reading and Fine Work' was ?琢=0.791,and 'Activities of Daily Living' was ?琢= 0.770.So these results indicate that the questionnaire is reliable to measure the vision related quality of life of low-vision patients.The correlations between the subscales were also analyzed,and the correlation between 'Adjustment' and 'Reading and Fine Work' was found to be the lowest(rs=0.336,P <0.001),whereas the strongest correlation was found between the 'Reading and Fine Work',and 'Activities of Daily Living'.Additionally,the 'Adjustment' dimension showed the strongest correlation with only 'Distance Vision,Mobility,and Lighting' dimension.CONCLUSION:After removing the last item in the second dimension,the Turkish adaptation of all dimensions of the LVQOL has been shown to be reliable,valid and suitable for use in patients with low vision in Turkey.

AB097.Barriers and facilitators related to the use of optical low vision aids,a scoping review

Background:In recent decades,several studies have been performed in the field of(non-)use of assistive technology devices(ATs)and have found that many variables are likely to be involved in the decision-making process of whether a person with a disability uses or abandons their aids.In low vision rehabilitation,high variability rates and a variety of reasons for non-use of low vision aids has been reported.Determinants of non-use of ATs have previously been categorized into personal factors,ATs factors,environmental factors of the user,and intervention factors.It is probable that some of these factors are also associated with the use of optical low vision aids(OLVAs).Thus,using a framework about adherence with medical interventions,the aim of this scoping review was to explore barriers and facilitators related to OLVAs(non-)use.Methods:Existing guidelines of the scoping review Methods were used to examine and summarize the extent,range,and nature of findings regarding factor categories associated to OLVAs usage.Searches were conducted using the following online databases:Embase,MedLine,and ERIC without limitation on publication dates.A combination of key words and MeSH terms was used based upon the identified core concepts of the research question:(I)low vision;(II)assistive technology;and(III)adherence.A charting form,a flow chart of the study selection process,and a combination of a descriptive numerical analysis and a thematic analysis of 24 studies were performed.Results:The results of this review indicate high variability rates(range:13-50%,M=24%,SD=10%)of people possessing OLVAs but not using them.Most authors do not use a precise definition of“non-use”,and when a definition is provided,the terminology is inconsistent.As expected,the four categories of variables identified are likely to be involved in OLVAs’(non-)use:(I)the largest number of concerns were personal factors.Several aspects regarding personal characteristics were identified,such as demographic,physical,psychological,social-emotional,and occupational factors.Some variables,such as age,diagnosis and visual acuity were reported as contradictorily influencing the OLVAs’usage;(II)ATs factors were associated with quality,appearance,practical aspects of use and the very type of OLVAs;(III)environmental factors referred to social support,physical barriers,expectations of the social environment,presence of a helper,and stigmatization;(IV)finally,intervention factors consisted of taking into account user’s opinions,positive health care experiences,instruction and training,provision processes,delivery periods,and follow-up services.Conclusions:This scoping review provides the preliminary evidence that factors related to OLVAs non-use could be classified into the same four typical categories described in the theory of non-adherence.These results suggest that strategies intended to enhance adherence might be for OLVAs should focus on these four aspects of device use.

Prevalence and risk factors for eye diseases, blindness, and low vision in Lhasa, Tibet

AIM: To determine the prevalence and risk factors for eye diseases, blindness, and low vision in Tibet, and to assist the development of eye disease prevention and treatment schemes.METHODS: We carried out a survey of eye diseases among a population living at high altitude. A total of 1 115 Tibetan permanent residents aged 40 years or older from the towns and villages of Qushui County, Lhasa Prefecture, Tibet Autonomous Region, participated in this study. All participants completed a detailed questio-nnaire, and underwent presenting and pinhole visual acuity tests,and a comprehensive ophthalmic examination.RESULTS: There were 187 blind eyes (8.43%), 231 eyes with low vision (10.41% ). The leading cause of visual impairment was cataract of 55.0% (101/187) blindness and of 50.2% (116/231) low vision, followed by fundus lesions of 22.9% blindness and 23.8% low vision, while only a low prevalence of glaucoma of 9.6% blindness and 1.7% low vision was observed. The analysis of 2 219 eyes showed that the most common external eye disease was pterygium (27.2%) in Tibet.CONCLUSION: The high prevalence of blindness and low vision in the Tibetan population at high altitude is a serious public health issue. There is a need to establish and maintain an appropriate effective eye care program in Tibet.

VISUAL REHABILITATION IN LOW VISION PATIENTS WITH AGE-RELATED MACULAR DEGENERATION

Using optical visual aids, visual rehabilitation was performed in 14 low vision patients(25 eyes) with age-related macular degeneration. With distance aids, visual acuity improvement appeared in 24 eyes(95%) out of the 25 eyes. Twelve eyes(48%) obtained a visual acuity equal to or better than 0.4. With near visual aids, near acuity of all eyes(100%) was improved. Thirteen eyes(52%) got the near vision equal to or better than 0.5. Ten patients could read No.5 Chinese Reading Card. The reading success rat...

The Health and Well-Being among Children with Diabetes and Low HbA1c—A Qualitative Study in Sweden

Aims and objectives: To examine health and well-being, as well as the need for support among children and parents where the child has T1DM with low HbA1c (Introduction: Studies have shown that children with diabetes type 1 (T1DM) rate their lives as worse than healthy peer ratings. In Sweden, views have been expressed that children, as well as their parents, feel pressurized by the diabetes teams to achieve low HbA1c values, which can lead to poorer mental health for the family. Design: A qualitative study. Methods: A consecutive sample of 11 children and their parents (one father, ten mothers) was interviewed together but individually guided by a semi structured interview guide. Interviews were analyzed using thematic content analysis. Results: Four main categories were consistent across children and their parents;1) attitude to the illness, 2) sadness about diabetes, 3) the importance of the social network, and 4) the importance of the diabetes team. Worries about hyperglycemia were more prominent than worries about hypoglycemia in both children and parents. A distinguishing feature of the interviewed children was that they were responsible, strict and targeted. Many of them were competitive and took part in various sports, even at a very advanced level. Conclusions: This study shows that children with low HbA1c values experience good health and good well-being. Family support, good planning, and high acceptance of their illness contributed to this.

Low fermentable oligosaccharides, disaccharides,monosaccharides, and polyols diet in children

Irritable bowel syndrome (IBS) is a lifelong condition with a high prevalence among children and adults. As the diet is a frequent factor that triggers the symptoms, it has been assumed that by avoiding the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP), the symptoms might be improved. Therefore, in the past decade, low FODMAP diet has been intensively investigated in the management of IBS. The capacity of FODMAPs to trigger the symptoms in patients with IBS was related to the stimulation of mechanoreceptors in the small and large intestine. This stimulation appears as a response to a combination of increased luminal water (the osmotic effect) and the release of gases (carbon dioxide and hydrogen) due to the fermentation of oligosaccharides and malabsorption of fructose, lactose and polyols. Numerous studies have been published regarding the efficacy of a low FODMAP diet compared to a traditional diet in releasing the IBS symptoms in adults, but there are only a few studies in the juvenile population. The aim of this review is to analyze the current data on both low FODMAP diet in children with IBS and the effects on their nutritional status and physiological development, given the fact that it is a restrictive diet.

A near-vision chart for children aged 3-5 years old:new designs and clinical applications

AIM:To introduce a new near-vision chart for children aged 3-5 years old and its clinical applications.METHODS:Thenewnear-visionchartwhichcombined the Bailey-Lovie layout with a newly devised set of symmetry symbols was designed based on WeberFechner law.It consists of 15 rows of symmetry symbols,corresponding to a visual acuity range from 1.3 to 0.1logMAR.The optotypes were red against a white background and were specially shaped four basic geometric symbols:circle,square,triangle,and cross,which matched the preschool children’s cognitive level.A regular geometric progression of the optotype sizes and distribution was employed to arrange in 15 lines.The progression rate of the optotype size between two lines was 1.2589 and two smaller groups of optotypes ranging from 0.7 to-0.1 logMAR were included for repetitive testing.A near visual acuity was recorded in logMAR or decimal,and the testing distance was 25 cm.RESULTS:This new near-vision chart with pediatric acuity test optotypes which consists of 4 different symbols(triangle,square,cross,and circle)met the national and international eye chart design guidelines.When performing the near visual acuity assessment in preschoolers(3-5y old).It overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling’E’or Landolt’C’,which the subjects were prone to lose interest in.Near vision may be recorded in different notations:decimal acuity and logMAR.These two notations can be easily convertedeach other in the new near-vision chart.The measurements of this new chart not only showed a significant correlation and a good consistency with the Chinese national standard logarithmic near-vision chart(r=0.932,P【0.01),but also indicated good test-retest reliability(89%of retest scores were within 0.1 logMAR units of the initial test score)and a high response rate.CONCLUSION:The results of this study support the validity and reliability of near visual acuity measurements using the new near-vision chart in children aged 3-5y over a wide range of visual acuities,and the new eye chart was especially suitable for the detection of amblyopia risk factors and low vision examination in children(3-5y of age).It can be applied in routine clinical practice.

The Contrast Sensitivity Function in Low Vision

The contrast sensitivity of 51 low vision patients (95 eyes) showed a substantial decrease in all spatial frequencies. The peak contrast sensitivity was shifted to 1 C/D from the normal 3-4 C/D. The high-frequency cut off is correlated to the visual acuity positively. Of the 33 patients, the preferred eye was the eye with better peak sensitivity in 28 patients (84%), while the preferred eye was the eye with better visual acuity in 22 patients (66%). It seems that the peak sensitivity is more important t...

Quantitative Evaluation of Flicker ERG Waveforms in Low Vision Patients

Flicker electroretinograms(FERGs)of 30Hz were recorded for 46eyes(23 cases)of low vision,including 38 eyes with retinal diseases and 8eyes with optic neuropathy,and for 39 normal eyes(33 cases).The recordedwave forms were analysed by two methods:(1)to measure the peak to peakamplitude and pseudophase directly,and(2)to measure the amplitude andphase of fundamental response component(30Hz)by discrete Fourier trans-form(DFT).The abnormality ratios between these two methods were com-pared in low vision pati...

Nutritional Status of Under-five Children from Urban Low-income Families in Xiangtan and Jilin in China

There have been many studies on the nutrition and the growth status of children from rural and remote western regions of China, whereas researches on children from urban low-income families are scarce. This study aimed to investigate the growth and nutritional status of children under five years of age from urban low-income families in China. There were 169 children aged 25–60 months recruited from Xiangtan and Jilin, two cities with a population of 2.81 million and 4.26 million respectively, in China in this cluster cross-sectional study. Data were collected on demographic and socioeconomic characteristics, the feeding practices and the incidence of anemia and diarrhea. The results showed that the prevalence of low birth weight and macrosomia was 7.1% and 9.5% for the two cities, respectively, which was higher than that for other cities in China（1.5% and 5.9%）. Of all the sampled children, 14.6% and 8.2% suffered anemia and diarrhea, respectively. Multivariate analysis showed that legumes or nuts fed in a 24-h recall increased the risk of anemia（OR=4.9）. Children whose caregivers began to introduce complementary foods relatively late would have high diarrhea prevalence（OR=1.4）. In conclusion, the prevalence of anemia and diarrhea in under-five children from urban low-income families in China is relatively high. The growth and nutritional status of these children is greatly affected by feeding practices. A series of measures should be taken by relevant government departments to improve the health of these children.

Low Blood Lead Concentrations and Cognitive Development of Primary School Children from Three Areas in Malaysia

A study on to identify the relationship between blood lead and cognitive development was conducted on primary school children in Malaysia. About 413 children aged 62^/1 - 82^/1 years from urban （236）, rural （80） and industrial areas （97） were studied. Blood lead was analyzed using the Atomic Absorption Spectrophotometer （GFAAS）. Cognitive development was measured by the ＇McCarthy Scales of Children＇s Abilities Test＇ （MSCA）. Significant differences found in the mean cognitive scores between the urban （94.40）, industrial （102.90） and suburban children （101.24） （p 〈 0.001）, with the blood lead between the urban （3.66 p.g/dL）, industrial （3.54 μg/dL） and suburban children （3.04μg/dL） （p = 0.022）. Significant inverse correlations between blood lead and cognitive scores found for all groups （p 〈 0.001）, urban （p 〈 0.001） and suburban children （p 〈 0.001）. Low blood lead significantly influenced the cognitive development for all children after adjusting for confounders （p _〈 0.001）. The urban children＇s cognitive scores were significantly influenced by blood lead levels and household income （p 〈 0.001）. However, for the suburban children, the cognitive score were significantly influenced by the blood lead levels, the mothers＇ education, number of siblings, sequence in the family and the household income （p 〈 0.001 ）. Blood lead below 10μg/dL influenced the cognitive development. Urban children had higher blood lead but suburban children with lower blood lead were also vulnerable to the effect of lead on their cognitive development.

Different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children

Objective: To explore the different effects of living high - training low and living low - training low on insulin sensitivity and cytokine secretion in obese children. Methods: A total of 218 obese children who were treated in this hospital between September 2015 and February 2018 were selected and randomly divided into the living high - training low group (n=109) and living low - training low group (n=109). Living high - training low group received living high- training low intervention, living low - training low group received living low - training low intervention, and the intervention of both groups lasted for 4 weeks. The differences in serum levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines were compared between the two groups of children before intervention and after 4 weeks of intervention. Results: Before intervention, the levels of insulin sensitivity-related indexes as well as the contents of appetite-related hormones and adipocytokines in serum were not significantly different between the two groups of obese children. After 4 weeks of intervention, serum insulin sensitivity-related indexes ISI, FPIR and GDR levels of living high-training low group were higher than those of living low - training low group;appetite-related hormones CCK and PYY3-36 contents were higher than those of living low - training low group whereas Ghrelin content was lower than that of living low - training low group;adipocytokines omentin-1 and APN contents were higher than those of living low - training low group whereas chemerin and LEP contents were lower than those of living low - training low group. Conclusion: Compared with traditional living low - training low intervention, living high - training low intervention is more effective in improving the insulin sensitivity and balance the secretion of appetite-related hormones and adipocytokines in obese children.

Children's Vision

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Prevalence of Charles Bonnet syndrome in low vision:a systematic review and meta-analysis

Background:Charles Bonnet syndrome(CBS)is characterized by vivid lifelike visual hallucinations and is typically seen in individuals with visual impairment.In this systematic review,we summarize current knowledge on the prevalence of CBS in patients with low vision.Methods:We searched 11 literature databases on 21 April 2021 for studies on the prevalence of CBS in low vision populations.Our protocol was registered in the PROSPERO database(reg.No.CRD42021255021).Eligible studies were defined as those on a population of low vision patients wherein the prevalence of CBS was evaluated(without any further restriction on the method for diagnosis of CBS).No restriction was enforced on study design,but we expected observational cross-sectional studies due to the nature of our research question.Two authors independently extracted data and evaluated risk of bias of individual studies using the Agency for Healthcare Research and Quality checklist for cross-sectional studies.Studies underwent qualitative review in the text and quantitatively in a prevalence meta-analysis using the random-effects model.Sensitivity analysis was made to evaluate the robustness of the summary estimate.Results:We identified 11 studies,which summarized data on 4,521 individuals with visual impairment.Diagnosis of CBS was based on screening questions or interviews,which in positive cases often was explored in more detail with follow-up questions or interviews.Most studies either had normal mental state as a participant eligibility criterion or as a part of the diagnosis of CBS.The pooled prevalence of CBS in low vision patients aged≥40 years was 19.7%(95%CI:13.8%to 26.4%).The sensitivity analysis showed certain robustness in the summary prevalence estimate wherein prevalence estimates ranged from 16.9%to 22.5%.Conclusions:CBS is a prevalent condition in patients with low vision at a rate of approximately one in five patients.Considering that an estimated 239 million individuals have moderate visual impairment or worse,we estimate a global number of patients with CBS at approximately 47.2 million.

A Research on Harmonious Dialogues with Low Structural Materials in Regional Games for Children

The use of low structural materials can accentuate the characteristics of openness advocated by regional creation.Therefore,when selecting regional game materials,preschool teachers should focus on open and low structures as well as actively and reasonably guide the child’s game behavior,so that each child can make full and efficient use of these materials.At the same time,in a harmonious dialogue with these materials,they are given the opportunity to express what they see,hear,feel,and think in their own ways.

Responsiveness and minimal clinically important difference of the Chinese version of the Low Vision Quality of Life Questionnaire after cataract surgery

AIM: To investigate the Chinese version of the Low Vision Quality of Life Questionnaire(CLVQOL) as an instrument for obtaining clinically important changes after cataract surgery.METHODS: Patients underwent cataract surgery in Shanghai General Hospital, Shanghai Jiao Tong University, who fit the inclusion criteria were recruited. Two CLVQOLs were administered, including a preoperative CLVQOL and a CLVQOL at the end of the 3 mo follow-up period, and were completed using face-to-face interviews or phone interviews conducted by trained investigators. The minimal clinically important difference(MCID) was calculated using an anchor-based method and a distribution method. In addition, the responsiveness of the questionnaire was measured.RESULTS: A total of 155 residents were enrolled. The average visual acuity(VA) preoperatively was 0.08(SD=0.05), and it increased to 0.47(SD=0.28) at the end of followup. Statistically significant positive changes in the CLVQOL scores indicated significant improvement of vision related quality of life after cataract surgery. With the larger value between the two results as the final value, the MCID values of the CLVQOL(scores of the four scales as well as the total score) were 8.94, 2.61, 4.34, 3.10 and 17.63, respectively. The CLVQOL has both good internal and external responsiveness.CONCLUSION: CLVQOL scores are appropriate instruments for obtaining clinically important changes after cataract surgery. This study is an effective exploration for establishingcataract surgery efficacy standards, which helps clinical and scientific research workers in ophthalmology to gain a more in-depth understanding when using CLVQOL.

Low Vision Assessment: Complications from Juvenile Rheumatoid Arthritis

Background: Juvenile Rheumatoid Arthritis (JRA) is an inflammatory disease that affects the joints of children and is associated with ocular complications, like uveitis and cataract. Patients with such complications can benefit from a low vision assessment to improve their functionality and their quality of life. In this case study, the importance of early detection and management of ocular complications of JRA, as well as visual rehabilitation through a low vision assessment, are highlighted and discussed. Case Presentation: A 12-year-old female of East Indian descent presented to the Low Vision Center of the University of the West Indies Optometry Eye Unit, bilaterally aphakic (absence of crystalline lens) as a result of complications she developed secondary to a systemic condition diagnosed as JRA. She presented with a distance visual acuity of 2.30 logMAR in the RE, and 1.64 logMAR in the LE, at near she was able to read 8.0 M and 3.2 M at a distance of 8 cm for RE & LE respectively. She has a history of ocular disorder secondary to JRA such as cataract, uveitis, upon low vision assessment a new spectacle prescription and an illuminated stand magnifier of 8D was issued, the patient was satisfied with the outcome of the treatment, management and low vision device issued. Conclusion: At the end of the low vision assessment, the patient was extremely satisfied and looked forward to the prospect of returning to school. Although JRA can have severe ocular complications, with the correct management, a patient’s quality of life can be dramatically improved thus stressing the importance of these types of visual assessments.

Profile of Low Vision Patients in a Resource-Poor Underserved Setting of a Developing Country

Objectives: To identify causes of low vision among the patients in the Eye clinic of University of Nigeria Teaching Hospital (UNTH). Methods: This was a cross-sectional study of all new consecutive low vision patients seen at the eye clinic of University of Nigeria Teaching Hospital-(UNTH) Ituku-Ozalla. All patients with low vision were evaluated by the researcher and the findings entered on a research protocol. Data were analyzed using descriptive statistics to generate frequency and percentage distributions and analytical statistics to test for significance of observed inter-group differences. In all comparisons, statistical significance was indicated by p < 0.05. Results: A total of 197 patients were seen comprising of 120 males and 77 females (M:F = 1.6:1) aged 39.3 ± 22.9 SD years. The main causes of low vision in the study population were glaucoma (36.0%), followed by oculocutaneous albinism (14.7%). The mean presenting distant VA was logMAR 1.1 (95% CI), while the mean near VA is logMar 1.0 (6/60, 20/200). After refraction, the mean distant VA was logMar 1.0, using unpaired t-test, the difference between the distant presenting and refracted VA were not statistically significant. 57.9% had distant VA after optical low vision assessment of logMar 0.9 - logMar - 0.2 while the mean distant VA was logMar 0.8 which was statistically significant. Near vision after optical assessment improved with a mean of logMar 0.8, which was statistically significant. Conclusion: Glaucoma was the commonest cause of low vision in this study. Optical low vision aids improved the visual functions of majority of the patients in this study.

Addressing the public health concerns of physical inactivity, low levels of fitness, and unhealthy weight among Chinese school-aged children

In China, sports and physical activity （PA） have tradition- ally been an integral part of school curricula to promote fitness and enhance healthy growth among children and ado- lescents. Three decades of economic reforms, however, have brought major changes in social, economic.