AB032. Exploring the effects of a retinal prosthesis on visual hallucinations related to Charles Bonnet syndrome

Background:A first occurrence in the province of Quebec(Canada)of the use of a retinal prosthesis system(RPS)by a patient with a Charles Bonnet syndrome(CBS)provides a rare opportunity to explore the effects of this system on visual hallucinations(VH)related to CBS.Considering that the RPS artificially induces a visual perception and that VH related to CBS occur in cases of significant vision loss,this study aimed to explore whether the recovery of a visual perception could affect the nature and frequency of VH related to CBS.Methods:This is a case study with time series and repeated experimentation:a pre-intervention measure to establish the baseline level,two implant activation periods(A1 and A2)and a post-intervention measure(3 for each activation).The study is based on a 65-year-old man with retinitis pigmentosa.He has been functionally blind for about ten years and was completely blind at the time of the study.He began to perceive VH corresponding to the CBS after a significant decrease of his visual fields.At the time of the study,these VH were frequent and often disturbing.After receiving the Argus II RPS,he participated,along with INLB staff,in an intensive rehabilitation program aiming at optimizing the use of the system.To explore the effects of the RPS,we collected visual,cognitive,and mood-related data and documented the VH using the Charles Bonnet Syndrome Screening Questionnaire(Cantin et al.,2018).Results:The visual acuity and visual field measurements show a significant improvement with the use of the RPS(visual acuity of 2.3 logMAR and visual fields of 12 degrees).Measurements of cognitive functions have shown high,stable,and close to the maximum performances.Mood data revealed low and relatively stable depression and anxiety scores over the course of the study.The documented VH showed the characteristic features of CBS.The nature and frequency of VH have varied widely over the study period.Conclusions:The RPS improved the visual perceptions of the study participant and VH that were observed correspond to the CBS definition.Despite the partial recovery of some form of visual perception induced by the RPS,the variations in the nature and frequency of the VH have occurred independently of the use of the system:therefore,they cannot be linked.While it is true that the Argus II RPS allows blind users to recover some form of visual perception,it remains very limited and the implanted subject remains functionally blind.It is then legitimate to assume that the visual perceptions generated by the implant may be insufficient to have an effect on VH related to CBS.Further studies are needed to support the conclusions of this innovative study.

AB103.Comparative study on the actual lighting assessment method and the use of a standardized tool(LuxIQTM)

Background:With the arrival of a new standardized tool and considering the multiple disadvantages of the actual method used for assesses lighting needs,the goal of the study was to compare the actual lighting assessment method used by the clinicians working in a rehabilitation center with the use of the LuxIQTM.As reading is found to be the main difficulty mentioned by the majority of the clients at the rehabilitation centre and that past studies have shown the impact of lighting on improving reading speed and deceasing print size,the hypothesis stated that the use of the standardized tool would be statistically significantly superior than the use of the standard method on the variables on reading speed,print size,ocular fatigue,application of the recommendations and satisfaction of the length of time read.Methods:Three clinicians proceeded to home lighting assessments for 28 participants aged from 19 to 100 years(mean=75,SD=27)old diagnosed with age-related macular degeneration or glaucoma.The study evaluated and compared pre and post results between the two methods.Results:The intervention did not have a statistically significant impact on any of the variables mentioned.The lighting assessment itself,with either the standard method or using the LuxIQ,statistically significantly decreased print size for reading(P<0.001,ω2=0.47).Conclusions:Lighting has a significant impact on reading print size.Participants value the assessment but encounter various obstacles that prevent them from applying the lighting recommendations.Considering the positive impact of lighting,finding a solution so participants may profit from the benefits of this intervention is crucial.

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.

AB098.Perceptual,motor and cognitive factors related to braille reading performance in aging:a scoping review

Background:A growing number of older adults with vision loss require vision rehabilitation services to address reading difficulties.Braille may be the most appropriate option for those with functional blindness,poor visual prognoses or dual sensory loss.While standardized braille assessment and training protocols are in place to guide interventions with children,there is a high degree of inconsistency and a lack of evidence-based knowledge about best practices to use with adults and seniors who require braille training.Age-related declines in tactile acuity,motor dexterity and cognition present unique barriers to braille training,but very little is known about the impact of aging on factors related to braille reading performance.The aim of this scoping review is to identify the perceptual,motor,and cognitive factors related to braille reading performance and to determine how these factors have been assessed or measured among blind adults and elderly individuals in prior studies.Methods:Using the scoping review method,a comprehensive search was conducted in three databases:PubMed,Educational Resource Information Center(ERIC),and the Cochrane library.Two reviewers screened articles for inclusion to ensure internal agreement,based on identified exclusion criteria.Results:The initial search resulted in 1,565 qualitative and quantitative articles.The results synthesize the perceptual,motor and cognitive factors known to predict braille reading performance,how these variables are impacted by the aging process,and how they have been measured in prior studies.Conclusions:This scoping review is the first step in working towards the development of evidence-based assessment and training protocols to standardized practice with adult and senior clients who require braille training.It also serves to clarify where current knowledge gaps exist in order to guide future studies on braille reading and aging.

AB094.Development and validation of a screening questionnaire for the Charles Bonnet syndrome

Background:The purpose of this study is to develop a screening questionnaire for the Charles Bonnet syndrome(CBS)that is valid,particularly in terms of specificity and sensitivity,and that allows to examine certain dimensions of these hallucinatory manifestations,to better assess the needs of people who live with the CBS.Methods:Interviews with clients of the Institut Nazareth et Louis-Braille who experienced visual hallucinations,supported by scientific literature and expert experience,guided the development of the questionnaire.Its content was first validated by six experts who assessed the questions developed,organized in seven subscales:(I)unusual perceptions;(II)contact with reality;(III)discriminatory screening;(IV)adaptation strategies;(V)psychological impact;(VI)description of the context of occurrence and(VII)characteristics.In a second step,a clinical study involving 76 people with visual impairment made it possible to determine the sensitivity and specificity of the instrument according to a criterion validity methodology,namely the clinical impression of a psychologist and/or an optometrist specialized in visual impairment,based on specific examinations and clinical tests.Subjects who appeared to have a CBS following the scouting done by subscale 1(Unusual Perceptions)completed the rest of the questionnaire.Results:(I)The analyzes revealed a sensitivity of 1.00 and a specificity that varies from of 0.42 to 0.77 for the identification of CBS with the“Unusual Perceptions”subscale;(II)the administration of the questionnaire to the 76 study participants revealed that the wording of some questions needs to be improved;(III)the responses to the other 6 subscales of the questionnaire given by the 21 participants with SCB,show among others that most have simple rather than complex hallucinations and that these occur daily for 50%of them.Hallucinations do not negatively affect their mood,although they are experienced as disturbing by half of the participants with CBS.Only 11 participants with CBS have already talked about their hallucinations to a relative or a health professional,and only 5 have heard about CBS before.Conclusions:The CBS screening questionnaire has an excellent sensitivity,and an acceptable specificity.The CBS“Unusual Perceptions”subscale should include additional items.Further studies are needed for this purpose.In addition,the rest of the questionnaire reveals clinically important information about various aspects of these individuals’hallucinations,such as the fact that many are disturbed by their hallucinations and have never heard of CBS.This questionnaire will help to better assess their needs and better plan interventions.

AB036.An interview based assessment’s sensitivity and specificity for identifying dual vision and hearing loss in older adults with and without risk of Mild Cognitive Impairment

Background:Dual vision and hearing loss or dual sensory impairment(DSI)negatively impacts a person’s ability to communicate,acquire information,and perform daily activities.Because the incidence of DSI is higher in older adults(65+),and the fact that most developed countries are aging,there is expected increase in DSI prevalence.The detection and evaluation of DSI is of utmost importance because several aspects of health care delivery,and communication with health professionals,depend on it.Identifying DSI in older adults can be more difficult when they present with mild cognitive impairment(MCI),which may limit their ability to report sensory loss,potentially resulting on medical professionals failing to detect DSI.The interRAI CHA is the only standardized interview instrument for adults(18+)that helps first-line health care providers to identify and assess DSI.This study evaluated this instrument’s sensitivity and specificity for detecting vision and or hearing loss in older adults with and without risk of MCI.Methods:The study sample consisted of 200 adults aged 64+that were receiving rehabilitation services for either vision loss only,hearing loss only,or DSI.Two measurements were collected:(I)interRAI CHA,which consists of roughly 150 closed-ended questions,two of which are used to identify DSI;(II)Montreal Cognitive Assessment(MoCA),a 10-minute screening test that assess cognitive function and identifies individuals at risk of MCI.The interRA CHA sensitivity and specificity for identifying DSI was calculated in comparison to gold standard objective measurements of vision and hearing obtained from participants’medical records.Sensitivity and specificity results were stratified based on risk of MCI,as assessed by the MoCA.Results:Sensitivity for DSI was slightly better for respondents that were not at risk of MCI(97.4%)compared to those who were at risk of MCI(96.2%).Likewise,sensitivity for HL only was slightly better for respondents that were not at risk of MCI(97.4%)compared to those who were at risk of MCI(96.8%).Because sensitivity was 100%for VL only,the potential impact of MCI risk on the interRAI CHA’s sensitivity for detecting VL only cannot be studied in this sample.Specificity for DSI and HL were higher for participants not at risk of MCI(HI:96.2%,DSI:94.8%),compared to those at risk of MCI(HI:90.2%,DSI:91.1%).Dissimilar to this,in the VI group specificity was slightly better in participants at risk of MCI(100%),compared to those not at risk of MCI(98.7%).This was due to a single participant not at risk of MCI who was not classified as VL by the medical record,yet did report difficulties with vision when responding to the interRAI CHA question on vision.Conclusions:The interRAI CHA’s sensitivity and specificity for detecting DSI was lower for older adults at risk of MCI,compared to those not at risk of MCI.Future research should investigate strategies to improve identification of DSI in persons at risk of MCI.

AB100.Screening for vision and hearing loss in patients with dementia:recommendations from interviews with sensory experts

Background:Dementia is a syndrome that affects a person’s ability to understand and express information.The higher prevalence of vision and/or hearing losses among persons with dementia in long-term care(LTC)facilities interferes with the ability of nurses to provide optimal care because communication is compromised.Therefore,the detection and screening for sensory impairment is of the utmost importance in LTC facilities;however,there is currently no agreement among nursing professionals on how to best identify such losses for the purpose of further referral,and the need for a validated screening measure suitable for nurses in LTC facilities is clear.The present project aims to close this gap by investigating the screening recommendations of vision-and hearing-care professionals working with clients affected by dementia.Methods:Eleven experts in audiology,optometry,deafblindness,and technology participated in individual semi-structured interviews on the topic of tools and strategies that can be used to screen individuals with dementia for sensory loss.Interview transcripts were coded by two evaluators using verbal agreement and consensus building.Results:Three main themes emerged from the interviews with experts:barriers,facilitators,and strategies.Barriers to sensory screening were often mentioned,particularly impaired communication and lack of staff cooperation.Facilitators consisted uniquely of people,such as family members,intervenors,and nurses.Strategies for sensory screening in this population consisted of improving communication through repetition and encouragements;considerations based on familiarity;and inferring an impairment on the basis of patient behaviour.Few of our interviewees were knowledgeable on the topic of screening apps.Conclusions:Our findings,to be integrated with a similar environmental scan conducted among LTC nurses,can inform the administration of sensory impairment screening tests among a population with dementia in order to optimize care.

AB104.Validation of the international reading speed texts in a Canadian sample

Background:The International Reading Speed Texts(IReST)were developed in Europe as a standardized measure to assess continuous reading in normally sighted and visually impaired individuals.The IReST is used throughout the United States and Canada to assess reading speed;however,the normative values may not be valid in North America(NA).Additionally there are no normative values for individuals with visual impairments.The aim of this study was to validate the IReSTs in a normally sighted English-speaking NA sample with and without a simulated reduction in visual acuity.Methods:Fifty undergraduate students from Concordia University participated in this study.Participants were systematically assigned to a counterbalanced order of testing conditions and were asked to read all 10 IReSTs aloud.The normal and impaired vision conditions were counterbalanced such that the first set of five IReSTs were read with either the participants normal/corrected-to-normal vision or with a simulated 20/80 visual impairment.Results:Multiple two-sample dependent t-tests using a Holm-Bonferroni correction for multiple comparisons were used to compare the IReST values(means and standard deviations)to the current sample;the results showed statistically significant differences between the current samples mean reading speed and the values provided by the IReSTs.In all cases,P were equal to or less than 0.005.Mean difference scores ranged from 14.87 to 30.05 wpm,with 95%confidence intervals ranging from 4.82 to 43.32.Measures of effect size using bias corrected Hedge’s g*ranged from 0.83 to 1.32,with 95%confidence intervals ranging from 0.25 to 1.93.Multiple two-sample dependent t-tests using a Holm-Bonferroni correction for multiple comparisons were used to compare the mean reading speed in wpm of the normal and impaired vision conditions;the results showed statistically significant differences between the mean reading speeds of the normal vision condition and the simulated impairment condition on the IReSTs.In all cases,the P were less than 0.001.Mean difference scores ranged from 25.44 to 41.8 wpm,with 95%confidence intervals ranging from 21.66 to 46.Measures of effect size using bias corrected Hedge’s g*ranged from 2.74 to 3.81,with 95%confidence intervals ranging from 1.97 to 4.74.Further Bayesian analyses revealed BF10 factors ranging from 1.277×107 to 7.334×1011,indicating decisive evidence for the research.Conclusions:There are statistically significant differences in reading speed between the NA English sample and the normative values established by the IReST;such that reading speeds of the NA English sample are slower than the normative values of the IReST.Additionally,participants in the simulated impairment condition read the IReSTs significantly slower than the normal vision condition.

AB106. ORVIS: a directory of tools for vision rehabilitation

Background:The ORVIS infrastructure aims to facilitate the development and availability of valid and adapted tools that will allow functional,perceptual,cognitive and psychological evaluation of low vision clients by researchers and clinicians who work in low vision and visual impairment rehabilitation.Methods:The tools developed or documented within ORVIS Infrastructure are tests or questionnaires which allow,or will allow to assess-in an accurate and reliable manner-characteristics related to visual impairment.The tools in development are:(I)questionnaire de repérage des hallucinations visuelles liées au syndrome de Charles-Bonnet(QR-SCB);(II)repérage des personnesâgées présentant des INDices de déficience VISUELle(IndiVisuel);(III)mesure de l’impact de la déficience visuelle dans les activités quotidiennes(MIDVAQ)and(IV)M’EYE read test.The directory documents 14 tools and offers-within a descriptive sheet-characteristics,components and metrological properties as supported by cited scientific studies.Results:The ORVIS Infrastructure,which aims at the development and availability of assessment tools,fills researchers’and clinicians’needs for measurement tools that are valid,effective and appropriate for use with a visually impaired clientele.Such tools are,especially in French,little known and hard to find,and represent a precious resource for those who want to evaluate the efficacy of treatments or interventions.Conclusions:ORVIS is available at www.orvis.vision.Between November 2015 and September 2017,the directory has been accessed 1,383 times by 952 unique visitors.

AB101.Portable closed-circuit TV versus iPad in spot reading tasks

Background:Spot reading,the ability to obtain short pieces of visual information,can easily be rehabilitated with magnification devices,such as loupes or portable closed-circuit TVs(CCTVs).However,they have limitations such as screen size and price and have previously been shown to be stigmatizing when used in public.The arrival of tablet computers provides an alternative with greater magnification at a reduced price.We present preliminary results on the objective and subjective comparison of the iPad and a portable CCTV for spot-reading tasks.Methods:Twenty-three men and 30 women aged 19-93 years,with impaired visual acuity(<20/60)due to central visual impairment,were asked to complete spot-reading tasks involving three common objects(TV cable bill,nutrition info on food package,box of eye drops)using the iPad and a portable CCTV in randomized order.We measured their ability to complete each task and the time it took,in addition to their subjective device assessment and preference.Results:A Bayes Factor and effect size analysis showed no statistically significant differences between the device conditions in the time to complete each task[BF01>4.05,median=−0.043,95%credible interval(−0.21,0.234)].Choosing one device over the other may simply depend on preference which,in our cohort,was divided(39.6%iPad,56.6%CCTV,3.8%neither)and which could be influenced by factors such as device size,usability or stigmatization.Conclusions:The data indicate that,for certain spot reading tasks and levels of difficulty,the use of a tablet computer may be as efficient and effective as a traditional device such as a portable CCTV.Future investigations will further examine device preference as we predict that it may influence device success and continuation of use.

AB096.Neurophysiological measures of stigma stereotypes

Background:The perceptions surrounding assistive technology have been shown to be increasingly stigmatizing in older adult populations.This stigmatization can lead individuals to the abandonment of the assistive device.Until now,the methods of identifying or predicting the stigma surrounding assistive technology has mostly been qualitative in nature.Here we present a novel quantitate and qualitative research study that uses neuro-cognitive(psychophysics and EEG)and eye tracking technology,in addition to a new questionnaire to investigate the stigma associated with assistive devices.Therefore,this approach plays a major role in understanding and predicting the neural and physiological correlates associated to stigma.Methods:Thirty-four older adults(>50 years)took part in the study.To determine the psychophysiological predictors of stigma surrounding assistive technologies,we monitored brain activity using EEG,heart rate and eye movements using an eye-tracker while participants viewed a series of images containing either an older or younger individual in different social scenarios(e.g.,talking to doctor,at coffee shop).In each scenario,the individual uses either no assistive device,a low stigmatizing device(e.g.,iPad),or a high stigmatizing device(e.g.,electronic magnifier).Results:Here we present preliminary analysis of the eye movement data.Analysis shows that in comparison to images that contained a low stigmatizing device,in images that contain high stigmatizing devices,the latency to fixate the device is shorter,first fixation duration is longer,and the total number of fixations on the device are higher.The environment that the devices is used in has no effect on eye movement metrics.Conclusions:Although the sample size is small,and based on a healthy older-adult population,these initial observations would indicate that latency to fixate and first fixation duration are predictors of stigma associated with assistive devices.Future research should expand this prediction to those actively using assistive devices,and how the measures predict abandonment over time.