The Efficacy of Visuomotor Compensatory Training for Individuals with Visual Field Defects

Several approaches have been developed to help patients with partial visual field defects to cope with their visual loss, and the most effective are those that encourage the person to move their eyes more efficiently. This thesis sought to examine the efficacy of a multiplatform compensatory training called Durham Reading and Exploration (DREX) in the rehabilitation of these individuals. Overall, the thesis focuses on two primary aims which include establishing whether the DREX training app completed on either a computer or a touchscreen tablet can be an effective treatment for homonymous visual field defects (HVFDs) caused by brain injury, as well as validating the assessment tasks that have been incorporated into the app. The results from Studies 1 to 3 show that DREX training is clinically effective for HVFD rehabilitation, and the training effect in patients trained using a touchscreen tablet is equivalent to patients trained with a computer, with a meaningful improvement in the quality of life which remains stable over a period of three months. In Studies 4 to 6, the built-in assessments tasks are found to be reliable and valid and can be used confidently to monitor the training progression and outcomes. Study 7 explores the novel observation that DREX training is also beneficial for patients with other types of partial visual field defects like tunnel vision and central visual field loss, demonstrating that this training could potentially be offered to a wider low vision population. Finally, studies 8 and 9 explore whether the blurring of vision, a common comorbid visual impairment in patients with visual field defect, could affect the visual exploration performance and the outcomes of visual exploration training. From these results it is clear that blurring of vision did reduce the search efficacy, but searching behaviour can still be improved with the training. Taken together, the findings from this suite of studies indicate that DREX is an effective and inexpensive treatment for visual field defects in a variety of etiologies, however the comorbid impairments that could affect the rehabilitation should be identified to maximise efficacy of this treatment

The effects of induced optical blur on visual search performance and training

Visual Search is a task often used in the rehabilitation of patients with cortical and non-cortical visual pathologies such as visual field loss. Reduced visual acuity is often co-morbid with these disorders and it remains poorly defined how low visual acuity may impact upon a patient’s ability to recover visual function through visual search training. The two experiments reported here investigated whether induced blurring of vision (from 6/15 to 6/60) in a neurotypical population differentially affected various types of feature search task, if there is a minimal acceptable level of visual acuity required for normal search performance, and whether these factors affected the degree to which participants could improve with training. From the results it can be seen that reducing visual acuity did reduce search speed, but only for tasks where the target was defined by shape or size (not colour), and only when acuity was worse than 6/15. Furthermore, searching behaviour was seen to improve with training in all three feature search tasks, irrespective of the degree of blurring that was induced. The improvement also generalised to a non-trained search task indicating that an enhanced search strategy had been developed. These findings have important implications for the use of visual search as a rehabilitation aid for partial visual loss, indicating that individuals with even severe comorbid blurring should still be able to benefit from such training

Comparison of surgically induced astigmatism (SIA) values using three Holladay incorporated method SIA calculators

Postoperative residual astigmatism is one of the unsatisfying visual outcomes of phacoemulsification resulting from surgically induced astigmatism (SIA). Various SIA calculators have been introduced to assist surgeons in calculating SIA for toric intraocular lens (IOL) determination. The aim of this study was to compare SIA values calculated using three different Holladay incorporated method SIA calculators. A data set of 80 eyes from 72 subjects who had undergone uneventful phacoemulsification using less than 3 mm clear corneal incision technique were included in the study. The preoperative and postoperative K-readings were computed into the three online Holladay incorporated method SIA calculators which were the SIA Calculator version 1.1 (SIAC1.1); Single Case SIA Calculator (SCSIAC); and Panacea SIA Calculator version 8(6.0) (Panacea). The mean individual SIA values obtained from each calculator were compared. There were no significant differences in mean individual SIA between the calculators (p > 0.05). Pearson’s correlation coefficients for all compared calculators achieved 0.99. The ranges of 95% limit of agreement between calculators were too small and tight, ranged from -0.012 to 0.012 only. In conclusion, the SIAC1.1, SCSIAC and Panacea produced a comparable SIA value among calculators. Hence, either one can be used interchangeably

Knowledge, attitude and practice (KAP) towards visual impairment and visual rehabilitation among teachers in Malaysia

Introduction: Visual impairment is one of the biggest public health concerns globally. It gives greater consequences to the children and their family members mainly on their education, employment, personal and social-emotional status. If the emphasis on the appropriate vision care and rehabilitation services are not rendered, the number of blind children is expected to rise significantly every year. Aim: This study aimed to assess the knowledge, attitude, and practice (KAP) towards visual impairment and visual rehabilitation among school teachers in Malaysia. Methodology: A total of 384 respondents were recruited in this study, and all the respondents completed the validated and reliable self-administered questionnaires on their KAP towards visual impairment and visual rehabilitation. Results: Most respondents (92.4%) have good KAP on visual impairment and visual rehabilitation despite only 4.2% of them had attended formal low vision course or training. There was a significant association between attending low vision training and high KAP among the teachers. Conclusion: The study gives an insight into the need for low vision course in the teacher’s curriculum in order to improve their learning experience and academic performance

Implementing primary eye care in private practises in Malaysia: the challenges faced by optometrists

Objective: In Malaysia, optometrists' role in the private sector is limited compared to their counterparts elsewhere. Primary eye care (PEC) is still not widely offered in private practises despite its demand to reduce the public's eye morbidity. This study aims to explore the challenges perceived by the private sector optometrists in implementing PEC in Malaysia. Materials and Methods: In-depth interview using semistructured open-ended questions were designed to explore the challenges of implementing PEC. Fifteen private optometrists across Malaysian were interviewed via purposive sampling until the data were saturated. The interviews were audio-recorded, transcribed and analysed. Results: Four major themes emerged: working environment, support and recognition, self-sufficiency and customer influence. The first major theme identified a lack of time and equipment in the workplace as a barrier to PEC implementation. The second major theme acknowledges the lack of support and recognition for PEC practise from financial bodies, the government, Malaysian Optical Council (MOC) and other eye professionals. Meanwhile, some practising optometrists faced significant challenges due to their lack of self-sufficiency regarding skills, knowledge and confidence. The final major theme, customer influence, reflects the customer's role in shaping eye care delivery through their perception and acceptance of PEC. Conclusion: Each of the issues identified played a significant impact in impeding PEC implementation in Malaysia. This study is the first step toward developing tailored interventions to improve eye care delivery in Malaysi

Safe operating procedure for administration of Intravenous (bolus) medications

This guideline will be useful for nurses in the clinical field who need to perform and master in this procedure especially for the privileging process. It not only protects patient and the health facility by lowering the risk of medical errors that may be caused by incompetent healthcare providers but also enhances the reputation and credibility of the health facility and the health care communit