Navigating the Unseen City: Town Planners, Architects, Ophthalmic Professionals, and Charity Opinions on Navigating of the Built Environment with a Visual Impairment

People with a visual impairment often find navigating around towns and cities difficult. Streetscape features such as bollards, street cafés, and parked cars on pavements are some of the most common issues. in this paper semi-structured interviews were conducted with stakeholders including built environment professionals, visually impaired individuals, ophthalmic professionals, and sight loss charities. All stakeholders felt there were barriers and enablers to navigating streets with a visual impairment. Stakeholders agreed these can have an impact on the daily lives of those with a visual impairment. While built environment professionals knew of policies and guidance around accessibility for people with a visual impairment, there was a lack of professional knowledge about the spectrum of visual impairment. Despite this, stakeholders felt these small changes could have a positive impact, making accessible cities for all. A collaborative approach to streetscape design and further education could help create better environments for all

The Integration of Diabetic Eye Screening into Haemodialysis Units in Northern Ireland

BACKGROUND: Diabetes is rising globally and is the most common cause of both end-stage renal disease and blindness. People on hemodialysis have to attend several dialysis appointments per week, which can affect their attendance at diabetic eye screening. In addition, previous literature suggests patients on hemodialysis are more likely to have sight-threatening diabetic eye disease. This study aims to determine attendance at the Diabetic Eye Screening Program in Northern Ireland, diabetic retinopathy severity, and use of handheld retinal imaging in people with diabetes attending hemodialysis units in Northern Ireland. METHODS: All patients with diabetes attending hemodialysis clinics regionally were screened and graded by the Diabetic Eye Screening Program in Northern Ireland using a handheld and/or conventional nonmydriatic fundus camera. RESULTS: All eligible people (N=149) were offered a Diabetic Eye Screening Program in Northern Ireland appointment, 132 attended, 34% of whom had not been seen in >3 years and 15% of whom had never attended the Diabetic Eye Screening Program in Northern Ireland despite multiple previous appointments. Altogether, 13% required urgent referral to hospital eye services, which is significantly higher than the national average of 0.4%. CONCLUSIONS: Those on hemodialysis are at high risk for sight-threatening diabetic retinopathy. Implementing the Diabetic Eye Screening Program in Northern Ireland in hemodialysis clinics enables timely diagnosis and referral

Influences on technology use and interpretation among young people living with type 1 diabetes

Abstract Aims To characterise continuous glucose monitor and flash glucose monitor use and related issues (both positive and negative) in the population of children and young people living with type 1 diabetes in the Southern Health and Social Care Trust (SHSCT), Northern Ireland. Methods Four focus groups were conducted in the SHSCT with people with type 1 diabetes and their families, to assess opinions of diabetes technology. In addition, questionnaires were distributed to diabetes specialist nurses (DSNs), young people and their families about use and access to diabetes technology. Results Questionnaires were completed by 68 children, young people (0–18 years) and their parents/guardians. Nearly all (98.5%) had access to their own diabetes related data, and 70.6% used diabetes data systems, for example, Libreview. Most of those using these systems found them beneficial and easy for daily use and clinical review. Most DSNs (83.9%) agreed that the systems were easy to use, and 82.3% were confident in interpreting the data accurately. DSNs felt virtual review was beneficial in over half of young people with 62.9% advising changes to diabetes management based on the data. Focus groups participants deemed diabetes technology a ‘gamechanger’ and ‘lifechanging’. Some drawbacks included ‘disruptive’ alarms, self‐confidence issues, visible diabetes technology and problems in school. Conclusions Most young people, their families and healthcare professionals reported they were confident in interpreting diabetes data and technology was easy to use. Diabetes technology could improve access to care through virtual clinics, improve clinical outcomes and enhance quality of life

The NaviSight study: investigating how diabetic retinopathy and retinitis pigmentosa affect navigating the built environment

Background: Visual impairment is a global problem and, regardless of the cause, it substantially impacts people’s daily lives. Navigating towns and cities can be one of the most difficult tasks for someone with a visual impairment. This is because our streetscapes are often inaccessible for navigating safely and independently by people with a visual impairment. Barriers include street clutter, bollards, pavement parking, and shared spaces. Methodology: Participants with varying levels of diabetic retinopathy (DR) and retinitis pigmentosa (RP) were recruited. Each participant completed a clinical visit and a 1-mile walk. Participants discussed confidence, anxiety, difficulty, and any barriers encountered while completing the walkaround. Participants completed quality of life (RetDQol), diabetes distress scales, and a study questionnaire. They also underwent retinal imaging and visual function testing. Retinal imaging and visual function results were compared with confidence, difficulty, and anxiety levels during the walkaround using Spearman’s correlation. Results: Thirty-three participants took part in the study, 22 with diabetes and 11 with RP. Results showed that average confidence was correlated with visual acuity, RetDQol, mean visual fields, and vertical peripheral diameter visual fields. Average difficulty was associated with visual acuity, RetDQol, dark adaptation, mean visual fields, percentage of the retina, and both horizontal and vertical diameter visual fields. In addition, some of the barriers discussed were pavement issues, bollards, parked cars, uneven pavements, alfresco dining, light levels, and street features such as tree roots, poles, A-boards, and street clutter. Conclusions: People with RP and treated DR faced common barriers while navigating the walkaround. The removal of these common barriers would make our streetscapes more accessible for all and will allow for more independence in those with visual impairments.<br/