Functional visual fields: A cross-sectional UK study to determine which visual field paradigms best reflect difficulty with mobility function

Objectives: To develop an appropriate method of assessing visual field (VF) loss which reflects its functional consequences, this study aims to determine which method(s) of assessing visual fields best reflect mobility difficulty. Setting: This cross-sectional observational study took place within a single primary care setting. Participants attended a single session at a University Eye Clinic, Cambridge, UK, with data collected by a single researcher (HS), a qualified optometrist. Participants: 50 adult participants with peripheral field impairment were recruited for this study. Individuals with conditions not primarily affecting peripheral visual function, such as macular degeneration, were excluded from the study. Primary and secondary outcome measures: Participants undertook three custom and one standard binocular VF tests assessing visual field to 60 degrees, and also integrated monocular threshold 24-2 visual fields (IVF). Primary VF outcomes were average mean threshold, percentage of stimuli seen, and VF area. VF outcomes were compared to self-reported mobility function assessed with the Independent Mobility Questionnaire, and time taken and patient acceptability were also considered. Receiver Operating Characteristic (ROC) curves determined which tests best predicted difficulty with mobility tasks. Results: Greater VF loss was associated with greater self-reported mobility difficulty with all field paradigms (R2 0.38-0.48, all p<0.001). All four binocular tests were better than the IVF at predicting difficulty with at least three mobility tasks in ROC analysis. Mean duration of the tests ranged from 1min 26sec (±9sec) for kinetic assessment to 9min 23sec (±24 sec) for IVF. Conclusions: The binocular VF tests extending to 60 deg eccentricity all relate similarly to self-reported mobility function, and slightly better than integrated monocular VFs. A kinetic assessment of VF area is quicker than and as effective at predicting mobility function as static threshold assessment

The effect of retinal image slip on peripheral visual acuity

Retinal image slip promoted by fixational eye movements prevents image fading in central vision. However, in the periphery a higher amount of movement is necessary to prevent this fading. We assessed the effect of different levels of retinal image slip in peripheral vision by measuring peripheral visual acuity (VA), with and without crowding, while modulating retinal image slip by using gaze-linked stimuli. Measurements were carried out at four isoeccentric positions at 5 and at 10 degrees eccentricity. Gaze position was monitored throughout using an infrared eyetracker. The target was presented for up to 500 msec, either with no retinal image slip, with reduced retinal slip, or with increased retinal image slip. Without crowding, peripheral visual acuity improved with increased retinal image slip compared with the other two conditions. In contrast to the previous result, under crowded conditions, peripheral visual acuity decreased markedly with increased retinal image slip. Therefore, the effects of increased retinal image slip are different for simple (noncrowded) and more complex (crowded) visual tasks. These results provide further evidence for the importance of fixation stability on complex visual tasks when using the peripheral retina.This study was supported by a grant from Fundação para a Ciência e a Tecnologia (FCT), Portugal, POCTI 2010 & FSE, SRFD/BD/27975/2006

Electronic books as low vision aids

Every year, around 34 000 people in England and Wales are newly registered as sight impaired or severely sight impaired, the majority of whom have some residual vision.1 In order to read books, people with low vision will generally rely on large print books and supplementary optical2 or electronic3 magnifiers. Only about 1.5% of the approximately two million books currently in print are available in large print format.4 Recently, several electronic book readers have become commercially available.5 These consist of a low glare electronic paper screen and internal memory, which can typically hold the full text of between 150 and 2000 full-length novels. Electronic paper has a wide viewing angle of

Investigating unstable fixation in patients with macular disease

To assess the effect on visual acuity of compensating fixation instability by controlling retinal image motion in people with macular disease. METHODS: Ten patients with macular disease participated in this study. Crowded and noncrowded visual acuity were measured using an eye tracking system to compensate for fixation instability. Four conditions, corresponding to four levels of retinal image motion, were tested: no compensation (normal motion), partial compensation (reduced motion), total compensation (no motion), and overcompensation (increased motion). Fixation stability and the number of preferred retinal loci were also measured. RESULTS: Modulating retinal image motion had the same effect on crowded and noncrowded visual acuity (P = 0.601). When fixation instability was overcompensated, acuity worsened by 0.1 logMAR units (P < 0.001) compared with baseline (no compensation) and remained equal to baseline for all other conditions. CONCLUSIONS: In people with macular disease, retinal image motion caused by fixation instability does not reduce either crowded or noncrowded visual acuity. Acuity declines when fixation instability is overcompensated, showing limited tolerance to increased retinal image motion. The results provide evidence that fixation instability does not improve visual acuity and may be a consequence of poor oculomotor control.Fundação para a Ciência e a Tecnologia (FCT), Portugal, POCTI 2010 & FSE, SRFD/BD/27975/2006 (AFM)

Are wearable electronic vision enhancement systems (wEVES) beneficial for people with age-related macular degeneration? A scoping review

INTRODUCTION: Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the United Kingdom. It has a wide-ranging detrimental impact on daily living, including impairment of functional ability and quality of life. Assistive technology designed to overcome this impairment includes wearable electronic vision enhancement systems (wEVES). This scoping review assesses the usefulness of these systems for people with AMD. METHODS: Four databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science and Cochrane CENTRAL) were searched to identify papers that investigated image enhancement with a head-mounted electronic device on a sample population that included people with AMD. RESULTS: Thirty-two papers were included: 18 studied the clinical and functional benefits of wEVES, 11 investigated use and usability and 3 discussed sickness and adverse effects. CONCLUSIONS: Wearable electronic vision enhancement systems provide hands-free magnification and image enhancement producing significant improvements in acuity, contrast sensitivity and aspects of laboratory-simulated daily activity. Adverse effects were infrequent, minor and spontaneously resolved with the removal of the device. However, when symptoms arose, they sometimes persisted with continued device usage. There are multi-factorial influences and a diversity of user opinions on promotors to successful device use. These factors are not exclusively driven by visual improvement and incorporate other issues including device weight, ease of use and inconspicuous design. There is insufficient evidence of any cost-benefit analysis for wEVES. However, it has been shown that a user's decision to make a purchase evolves over time, with their estimates of cost falling below the retail price of the devices. Additional research is needed to understand the specific and distinct benefits of wEVES for people with AMD. Further patient-centred research should assess the benefits of wEVES in user-led activities when directly compared with alternative coping strategies, allowing professionals and users to make better prescribing and purchasing decisions

The development of an automated sentence generator for the assessment of reading speed

Reading speed is an important outcome measure for many studies in neuroscience and psychology. Conventional reading speed tests have a limited corpus of sentences and usually require observers to read sentences aloud. Here we describe an automated sentence generator which can create over 100,000 unique sentences, scored using a true/false response. We propose that an estimate of the minimum exposure time required for observers to categorise the truth of such sentences is a good alternative to reading speed measures that guarantees comprehension of the printed material. Removing one word from the sentence reduces performance to chance, indicating minimal redundancy. Reading speed assessed using rapid serial visual presentation (RSVP) of these sentences is not statistically different from using MNREAD sentences. The automated sentence generator would be useful for measuring reading speed with button-press response (such as within MRI scanners) and for studies requiring many repeated measures of reading speed

Everyday visual demands of people with low vision:A mixed methods real-life recording study

Research has demonstrated that low vison aids (LVAs) can have a positive impact on the functional sight of those living with sight loss. Step changes in technology are now enabling new wearable LVAs with greater potential than those available previously. For these novel devices to receive increased acceptance and therefore adoption by those with sight loss, visual task demands have to be understood more clearly in order to enable better alignment between device design and user requirements. The aim of this study was to quantify these requirements. Thirty-two participants aged 18 to 87 wore a spectacle-mounted video camera to capture and narrate all everyday situations in which they would use a "perfect" sight aid during 1 week. Captured scenes were analyzed through categorization and computational image analysis. Results showed large variation in activities and lifestyles. Participants reported no available sight aid or coping strategy for 57% of the recorded activities. Reading made up 49% of all recorded tasks, the other half comprising non-textual information. Overall, 75% of captured activities were performed ad hoc (duration of 0-5 minutes), 78% occurred indoors, 58% occurred at home, 48% were lit by natural light, 68% included the object of interest within reach, and 69% required a single focus plane only. Around half of captured objects of interest had a size of 2 degrees visual angle (2.08 logarithm of the minimum angle of resolution [logMAR]) or smaller. This study highlights the need for a sight aid that can make both textual and non-textual scenes accessible while offering flexibility to accommodate individual lifestyles

Can children measure their own vision? A comparison of three new contrast sensitivity tests

PURPOSE: To investigate the feasibility of children measuring their own contrast sensitivity using a range of tablet- and paper-based tests. METHODS: Forty children aged 5-15 years with amblyopia (N = 10), bilateral vision impairment (N = 10) or good vision (N = 20) measured their own vision on a screen-based optotype test (Manifold), a gamified vision test (PopCSF) and a paper-based test (Spotchecks) in a laboratory with minimal supervision. Completion rate, test-retest repeatability, test duration and participants' preferences were recorded for each test. RESULTS: Most participants (36/40) were able to perform all three tests. All tests were correlated with clinically measured visual acuity and contrast sensitivity (p < 0.001). The 95% coefficient of repeatability was 0.30 dB for Manifold, 0.29 dB for PopCSF and 0.13 dB for Spotchecks. All tests differentiated between children with reduced contrast sensitivity and control participants. PopCSF and Spotchecks were also able to differentiate between children with amblyopia and those with good vision. Median test time was 152, 130 and 202 s for Manifold, PopCSF and Spotchecks, respectively. Twenty-two participants preferred the PopCSF test, 10 preferred Spotchecks and 6 preferred Manifold. Thirty-nine out of the 40 children (98%) said they would measure their own vision at home using at least one of these tests every month. CONCLUSIONS: Children and young people can test their own contrast sensitivity with repeatable results. Of these three tests, the most repeatable was Spotchecks, the quickest was PopCSF and participants' favourite was PopCSF. Nearly all of the participants said they would be willing to use at least one of the three tests at home

Peromyscus as a Mammalian Epigenetic Model

Deer mice (Peromyscus) offer an opportunity for studying the effects of natural genetic/epigenetic variation with several advantages over other mammalian models. These advantages include the ability to study natural genetic variation and behaviors not present in other models. Moreover, their life histories in diverse habitats are well studied. Peromyscus resources include genome sequencing in progress, a nascent genetic map, and >90,000 ESTs. Here we review epigenetic studies and relevant areas of research involving Peromyscus models. These include differences in epigenetic control between species and substance effects on behavior. We also present new data on the epigenetic effects of diet on coat-color using a Peromyscus model of agouti overexpression. We suggest that in terms of tying natural genetic variants with environmental effects in producing specific epigenetic effects, Peromyscus models have a great potential