Implications of a Remote Study of Children With Cerebral Visual Impairment for Conducting Virtual Pediatric Eye Care Research: Virtual Assessment Is Possible for Children With CVI

The Pandemic of 2020 impacted conducting in-person research. Our proposed project already had an asynchronous online component but was later morphed to add a synchronous online component, thereby eliminating the need for in-person assessment. The project compares the results of various tests between a group of children with Cerebral Visual Impairments (CVI) (N = 4) and an age-matched sample of children without CVI (N = 3) from a pediatric low vision clinic. This model was trialed with a small convenient sample of typically developing children in the same age range (N = 4). Given the positive feedback, recruitment for the larger study was done via encrypted e-mail rather than through traditional mailing. The asynchronous components included recruitment, pre-assessment information, the Flemish CVI questionnaire, Vineland-3 comprehensive parent questionnaire for assessment of age equivalent, and vision function tests, such as contrast sensitivity. The synchronous components were administered via Zoom telehealth provided by necoeyecare.org and included assessment of visual acuity via the Freiburg Visual Acuity and Contrast Test (FrACT) electronic software and assessment of visual perceptual batteries via the Children’s Visual Impairment Test for developmental ages 3–6-years (CVIT 3–6). Our virtual testing protocol was successful in the seven participants tested. This paper reviews and critiques the model that we utilized and discusses ways in which this model can be improved. Aside from public health considerations during the pandemic, this approach is more convenient for many families. In a broader perspective, this approach can be scaled for larger N studies of rare conditions, such as CVI without being confined by proximity to the researcher.

Demographic Characteristics and Causes of Low Vision in Children: A Hospital–Based Study from Khartoum, Sudan

Purpose: To determine the demographic characteristics and causes of low vision in children who attended Alfaisal eye center, Khartoum Sudan. Place and Duration of Study: Alfaisal eye Center, Khartoum, Sudan, from February 2018 to October 2020. Study Design: Cross sectional observational study. Methods: Clinical record of 105 patients who visited the low vision clinic were retrieved. Demographic features, history, ocular examination, cause of low vision, refractive state of the eye (by self-luminance streak retinoscope, and auto refractometer), and type of low vision devices used by the patients were noted. Data was analyzed by using SPSS software version 20. Results: Mean age was 11.70 ± 2.19. Seventy three percent patients had Visual Acuity(VA) less than 6/60. Majority (59%) were male patients. Commonest refractive error associated with low vision was myopia (65.71%). Retinitis Pigmentosa, congenital glaucoma, and albinism were other major causes of pediatric low vision (19.5%). Progressive Myopia was seen in 15%. About 9.5% of children presented with cataracts, nystagmus in 9.5%, and congenital refractive error in 9.5%.The cause of low vision among children was not statistically different between males and females P=0.890. More than half of the children 78.1% used glasses and about 21.9% were corrected by telescope. Conclusion: Retinitis pigmentosa, albinism, and congenital glaucoma were the most common causes of pediatric low vision. Common low vision devices prescribed to these children were glasses and telescopes. Key Words: Retinitis Pigmentosa, Congenital glaucoma, Albinism, Myopia, Cataract.

Acceptance of Low Vision Aids in Visually Impaired Patients Attending to Tertiary Eye Hospital, Nepal

Introduction: Vision impairment is the degree of reduction in vision that makes a remarkable effect on personality, intelligence, social, mental and economic factors of individuals. Objective To analyze the acceptance of low vision aids with their respective occupations and needs in visually impaired patients atiending to Tertiary Eye Hospital. Methodology A cross-sectional study was done at the low vision clinic of Biratnagar Eye Hospital (BEH), Biratnagar, Nepal from January to March 2018. During the study period, a total of 51 visually impaired patients were included for the study who were eligible and willing to participate. Result The most common age group visited to low vision clinic were up to 20 years (43%). Males comprised a maximum study population of (88%) and most of them were from the neighboring country India (96%). The most common disease-causing low vision was Retinal Diseases (41%). Among all occupations, students accepted more optical low vision aids for both distance(31.5%) and near (47%). The most common demand was reading and writing (86%). At distance, the telescope was prescribed to (65%) and at near, spectacle magnifiers were prescribed to (72%). Conclusion: There is more acceptance of the low vision aids among the students for both distance and near work compare to other occupation. The low vision device should be prescribed concerning the education, occupation, and needs of the patients.

A profile of patients presenting at a low vision clinic in a resource-limited setting

Background: The university-based low vision clinic is one of the few low vision clinics in South Africa.Aim: To describe demographic and clinical profiles of patients who attended this clinic from 2010 to 2017.Setting: The university low vision clinic, South Africa.Methods: The record cards of all patients seen at the low vision clinic over 8 years were examined and the following information was extracted: age, gender, presenting visual acuity (VA), VA following low vision assessment, cause of visual impairment and types of low vision devices recommended.Results: A total of 621 patients were examined, comprising 45.1% males and 55.9% females aged 36.0 ± 18.2 years (range: 4–93 years). Many of these patients (33.7%) had presenting VA worse than 1.3 logarithm of the Minimum Angle of Resolution (logMAR) ( 6/120) at 4 m in the better eye, and 196 (31.6%) had presenting VA of worse than 1.3 logMAR at near distance. Following optical low vision assessment, 62.4% had distance VA of 0.9 LogMAR (6/48) to −0.2 logMAR (6/3.8) and 58.4% had near VA of 0.9 logMAR (6/48) to −0.2 logMAR (6/3.8). Albinism (22.7%), unknown causes (18.2%), cataract (15.5%) and macular diseases (12.2%) were the most common causes of low vision. Amblyopia (80.7%) was the most common cause of low vision in patients aged 20 years and younger, followed by albinism (68.1%) and corneal diseases (41%). Cataract (78.1%), macular diseases (64.4%) and glaucoma (55.9%) were the most common causes of low vision in patients aged more than 60 years. Telescopes (33.8%) were the most commonly recommended form of intervention, followed by magnifiers (29.6%) and protective measures (24.5%).Conclusion: Albinism, cataract and macular diseases are the predominant causes of low vision in patients attending this low vision clinic. There was a significant improvement in VA after low-vision assessment, particularly for patients with presenting VA of better than 1.3 logMAR (6/120).

A Phenotypically Variable Presentation of Albinism: A Case Report

Background: Albinism refers to a group of hereditary conditions, present at birth, that are characterized by gene mutations resulting in hypopigmentation of the skin, hair, and ocular structures. There are two categories of albinism distinguished by the mode of inheritance as well as the body structures affected: Oculocutaneous Albinism and Ocular Albinism. Case Report A 10 year old Caucasian-Hispanic female was referred to the Low Vision Clinic withvision impairment secondary to albinism, a diagnosis confirmed by the Electrophysiology Department two years prior. Ancillary testing supporting albinism included Visual Evoked Potentials (VEPs) demonstrating abnormal optic nerve fiber decussation and optical coherence tomography (OCT) revealing foveal hypoplasia. Clinical findings consistent with albinism included strabismus with reduced stereopsis, mild but diffuse iris transillumination defects and blonde fundi. The patient had physical characteristics of fair skin, light brown hair, and had normal color vision, moderately reduced visual acuity, and absence of nystagmus, suggesting a mild phenotypic variation of albinism. At her low vision evaluation, the patient appreciated improvement in visual function with the following devices: a dome magnifier for magnification at near, a handheld telescope for magnification at distance, and a light grey tint to reduce photophobia indoors. Additional accommodations were recommended to the school system to employ while in the classroom setting. Conclusion: Clinicians should consider the diagnosis of albinism in patients with reduced vision even when they demonstrate mostly normal skin and ocular pigmentation. Clinical cases associated with a better acuity in albinism patients include some presence of stereoacuity, mild strabismus, absence of nystagmus and near normal levels of iris pigmentation, like the patient described in the case report. Despite the level of visual impairment, the standard of care for patients with decreased vision or visual symptoms should always be a low vision evaluation in order to maximize functional vision.