Recomendações para um sistema de sinalização tátil a partir de abordagens ergonômicas e da percepção do deficiente visual para o Campus Parnamirim do IFRN

This study reports recommendations for a tactile and graphic wayfinding system aiming to offer more orientability and mobility for visually impaired people (blindness and low vision) at Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Norte (IFRN), Parnamirim Campus. It was necessary to focus on visual impaired people and approach concepts like orientation and accessibility at the built environment. In order to provide the comprehension of a complex social phenomenon and preserve the meaningful characteristics of the events, this research has developed a single case study in which elements of Post Occupation Evaluation have been used. Its purpose was to allow not only a technical analysis, but also the user perception about the space in use. The chosen tool to collect the user’s opinions and considerations was the Walk Together Method. The collected and analyzed information has demonstrated that, although Parnamirim Campus has implemented some interventions in relation to the spatial accessibility, they are still not enough to create an environment which arranges safety and autonomy for the visual impaired people and the other ones who attend there. This study suggests that it happened because the engineering interventions at the Campus have been based on Brazilian technical standards NBR 9050:2004, which is proper for the physical impaired people, but it does not offer enough information to respond to all the specific needs demanded by all the classifications of visual impairment.

The relationship between fusion, suppression, and diplopia in amblyopia

Purpose: Traditionally, it has been thought that no binocular combination occurs in amblyopia. However, there is a growing body of evidence that there are intact binocular mechanisms in amblyopia rendered inactive under normal viewing conditions due to imbalanced monocular inputs. Georgeson and Wallis (2014) recently introduced a novel method to investigate fusion, suppression and diplopia in normal population. We have modified this method to assess binocular interactions in amblyopia. Methods: Ten amblyopic and ten control subjects viewed briefly-presented (200 ms) pairs of dichoptically separated horizontal Gaussian blurred edges. Subjects reported one central edge, one offset edge, or a double edge as the vertical disparity was manipulated. The experiment was conducted at a range of spatial scales (blur widths of 4, 8, 16, and 32 arc min) and contrasts. Our model, based Georgeson and Wallis (2014), converted subjects’ responses into probabilities of fusion, suppression, and diplopia. Results: When the normal participants were presented equal contrast to each eye the probability of fusion gradually decreased with increasing disparity, as the probability of diplopia gradually increased. In only a small proportion of the trials, normal participants experienced suppression. The pattern was consistent across all edge blurs. Interestingly, the majority of amblyopes had a comparable pattern of fusion, i.e. decreasing probability with increasing disparity. However, with increasing disparity the amblyopes tended to suppress the amblyopic eye, experiencing diplopia only in a small proportion of trials particularly at large blurs. Increasing the interocular contrast offset favouring the amblyopic eye normalized the pattern of data in a way similar to normal participants. There were some interesting exceptions: strong suppressors for which our contrast range was inadequate and one case in which diplopia dominated. Conclusions: This task is suitable for assessing binocular interactions in amblyopic participants and providing a way to quantify the relationship between fusion, suppression and diplopia. In agreement with previous studies, our data indicate the presence of binocular mechanisms in amblyopia. A contrast offset favouring the amblyopic eye normalizes the measured binocular interactions in the amblyopic visual system.

Can aberrometry provide rapid and reliable measures of subjective depth of focus following multifocal intraocular lens implantation?

Purpose: To determine whether the ‘through-focus’ aberrations of a multifocal and accommodative intraocular lens (IOL) implanted patient can be used to provide rapid and reliable measures of their subjective range of clear vision. Methods: Eyes that had been implanted with a concentric (n = 8), segmented (n = 10) or accommodating (n = 6) intraocular lenses (mean age 62.9 ± 8.9 years; range 46-79 years) for over a year underwent simultaneous monocular subjective (electronic logMAR test chart at 4m with letters randomised between presentations) and objective (Aston open-field aberrometer) defocus curve testing for levels of defocus between +1.50 to -5.00DS in -0.50DS steps, in a randomised order. Pupil size and ocular aberration (a combination of the patient’s and the defocus inducing lens aberrations) at each level of blur was measured by the aberrometer. Visual acuity was measured subjectively at each level of defocus to determine the traditional defocus curve. Objective acuity was predicted using image quality metrics. Results: The range of clear focus differed between the three IOL types (F=15.506, P=0.001) as well as between subjective and objective defocus curves (F=6.685, p=0.049). There was no statistically significant difference between subjective and objective defocus curves in the segmented or concentric ring MIOL group (P>0.05). However a difference was found between the two measures and the accommodating IOL group (P<0.001). Mean Delta logMAR (predicted minus measured logMAR) across all target vergences was -0.06 ± 0.19 logMAR. Predicted logMAR defocus curves for the multifocal IOLs did not show a near vision addition peak, unlike the subjective measurement of visual acuity. However, there was a strong positive correlation between measured and predicted logMAR for all three IOLs (Pearson’s correlation: P<0.001). Conclusions: Current subjective procedures are lengthy and do not enable important additional measures such as defocus curves under differently luminance or contrast levels to be assessed, which may limit our understanding of MIOL performance in real-world conditions. In general objective aberrometry measures correlated well with the subjective assessment indicating the relative robustness of this technique in evaluating post-operative success with segmented and concentric ring MIOL.

Saint, martyr, killer of Christ? The legend of Longinus in medieval Irish tradition

This dissertation is the first comprehensive and synthetic study of the Irish presentation and legends of Longinus. Longinus was the soldier at the crucifixion who pierced Christ with a spear, who believed and, according to some texts, was healed of his blindness by the blood and water issuing from the wound, and who later was martyred for his belief. In my thesis I survey the knowledge and use of the legend of Longinus in Ireland over genres and over time. Sources used for the analyses include iconographic representations of the spear-bearer in manuscripts, metalwork and stone and textual representations of the figure of Longinus ranging over the history of Irish literature from the early medieval to the early modern period, as well as over Irish and HibernoLatin texts. The thesis consists of four core chapters, the analyses of the presentations of Longinus in early-medieval Irish texts and in the iconographic tradition (I,II), the editions of the extant Irish and the earliest surviving Latin texts of the Passion of Longinus and of a little-known short tract describing the healing of Longinus from Leabhar Breac (III), and the discussion of the later medieval Irish popular traditions (IV). Particular attention is given to the study of two intriguing peculiarities of the Irish tradition. Most early Irish Gospel books feature an interpolation of the episode of the spear-thrust in Matthew 27:49, directly preceding the death of Christ, implying its reading as the immediate cause of death. The image of Longinus as 'iugulator Christi' ('killer of Christ') appears to have been crucial for the development of the legend. Also, the blindness motif, which rarely features in other European popular traditions until the twelfth century, is attested as early as the eighth century in Ireland, which has led some scholars to suggest a potential Irish origin.

Risk factors and biomarkers of age-related macular degeneration

A biomarker can be a substance or structure measured in body parts, fluids or products that can affect or predict disease incidence. As age-related macular degeneration (AMD) is the leading cause of blindness in the developed world, much research and effort has been invested in the identification of different biomarkers to predict disease incidence, identify at risk individuals, elucidate causative pathophysiological etiologies, guide screening, monitoring and treatment parameters, and predict disease outcomes. To date, a host of genetic, environmental, proteomic, and cellular targets have been identified as both risk factors and potential biomarkers for AMD. Despite this, their use has been confined to research settings and has not yet crossed into the clinical arena. A greater understanding of these factors and their use as potential biomarkers for AMD can guide future research and clinical practice. This article will discuss known risk factors and novel, potential biomarkers of AMD in addition to their application in both academic and clinical settings.

Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial

Background
Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, lens extraction might be a useful initial treatment.

Methods
From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in five countries. Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607.

Findings
Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. The mean health status score (0·87 [SD 0·12]), assessed with the European Quality of Life-5 Dimensions questionnaire, was 0·052 higher (95% CI 0·015–0·088, p=0·005) and mean intraocular pressure (16·6 [SD 3·5] mm Hg) 1·18 mm Hg lower (95% CI –1·99 to –0·38, p=0·004) after clear-lens extraction than after standard care. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care. Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. No patients had serious adverse events.

Interpretation
Clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy, and should be considered as an option for first-line treatment.

Bidragande faktorer som påverkar patientens följsamhet i ögondroppsbehandlingen vid glaukomsjukdom – en litteraturstudie

Bakgrund: Glaukom är en kronisk progressiv ögonsjukdom och en av den främsta orsaken till blindhet i världen. Intraockulärt trycksänkande ögondroppar är den vanligaste behandlingsmetoden och följsamhet är mycket viktigt för att minska progression av sjukdomen och risken att bli blind. Tidigare studier har visat att det finns en bristande följsamhet hos patienter med denna behandling. Syfte: Att belysa de faktorer som påverkar patientens följsamhet så att sjuksköterskan ska få en bättre förståelse och kunna vägleda patienten till en bättre följsamhet. Metod: En systematisk litteraturstudie genomfördes baserad på 14 vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. Resultat: Det finns många olika faktorer som påverkar patientens följsamhet i behandlingen med ögondroppar. Det kan vara faktorer som är orsakade av sjukvårdspersonal, av patienten själv samt av miljö/socioekonomiska skäl. Slutsats: Det är viktigt att fortsätta forska på de faktorer som påverkar patienters följsamhet vid ögondroppsbehandling för att sjuksköterskan ska kunna vägleda till en ökad följsamhet.

Plane Detection Using Affine Homography

AIRES, Kelson R. T.; ARAÚJO, Hélder J.; MEDEIROS, Adelardo A. D. Plane Detection Using Affine Homography. In: CONGRESSO BRASILEIRO DE AUTOMÁTICA, 2008, Juiz de Fora, MG: Anais... do CBA 2008.

Impact de la cécité sur le système nociceptif

La vision joue un rôle très important dans la prévention du danger. La douleur a aussi pour fonction de prévenir les lésions corporelles. Nous avons donc testé l’hypothèse qu’une hypersensibilité à la douleur découlerait de la cécité en guise de compensation sensorielle. En effet, une littérature exhaustive indique qu’une plasticité intermodale s’opère chez les non-voyants, ce qui module à la hausse la sensibilité de leurs sens résiduels. De plus, plusieurs études montrent que la douleur peut être modulée par la vision et par une privation visuelle temporaire. Dans une première étude, nous avons mesuré les seuils de détection thermique et les seuils de douleur chez des aveugles de naissance et des voyants à l’aide d’une thermode qui permet de chauffer ou de refroidir la peau. Les participants ont aussi eu à quantifier la douleur perçue en réponse à des stimuli laser CO2 et à répondre à des questionnaires mesurant leur attitude face à des situations douloureuses de la vie quotidienne. Les résultats obtenus montrent que les aveugles congénitaux ont des seuils de douleur plus bas et des rapports de douleur plus élevés que leurs congénères voyants. De plus, les résultats psychométriques indiquent que les non-voyants sont plus attentifs à la douleur. Dans une deuxième étude, nous avons mesuré l’impact de l'expérience visuelle sur la perception de la douleur en répliquant la première étude dans un échantillon d’aveugles tardifs. Les résultats montrent que ces derniers sont en tous points similaires aux voyants quant à leur sensibilité à la douleur. Dans une troisième étude, nous avons testé les capacités de discrimination de température des aveugles congénitaux, car la détection de changements rapides de température est cruciale pour éviter les brûlures. Il s’est avéré que les aveugles de naissance ont une discrimination de température plus fine et qu’ils sont plus sensibles à la sommation spatiale de la chaleur. Dans une quatrième étude, nous avons examiné la contribution des fibres A∂ et C au traitement nociceptif des non-voyants, car ces récepteurs signalent la première et la deuxième douleur, respectivement. Nous avons observé que les aveugles congénitaux détectent plus facilement et répondent plus rapidement aux sensations générées par l’activation des fibres C. Dans une cinquième et dernière étude, nous avons sondé les changements potentiels qu’entrainerait la perte de vision dans la modulation descendante des intrants nociceptifs en mesurant les effets de l’appréhension d’un stimulus nocif sur la perception de la douleur. Les résultats montrent que, contrairement aux voyants, les aveugles congénitaux voient leur douleur exacerbée par l’incertitude face au danger, suggérant ainsi que la modulation centrale de la douleur est facilitée chez ces derniers. En gros, ces travaux indiquent que l’absence d’expérience visuelle, plutôt que la cécité, entraine une hausse de la sensibilité nociceptive, ce qui apporte une autre dimension au modèle d’intégration multi-sensorielle de la vision et de la douleur.

Identification des gènes modifiant l’âge d’apparition du glaucome primaire à angle-ouvert dans une famille canadienne-française fondatrice.

Le glaucome est un groupe hétérogène de maladies qui sont caractérisées par l’apoptose des cellules ganglionnaires de la rétine et la dégénérescence progressive du nerf optique. Il s’agit de la première cause de cécité irréversible, qui touche environ 60 millions de personnes dans le monde. Sa forme la plus commune est le glaucome à angle ouvert (GAO), un trouble polygénique causé principalement par une prédisposition génétique, en interaction avec d’autres facteurs de risque tels que l’âge et la pression intraoculaire élevée (PIO). Le GAO est une maladie génétique complexe, bien que certaines formes sévères sont autosomiques dominantes. Dix-sept loci ont été liés à la maladie et acceptés par la « Human Genome Organisation » (HUGO) et cinq gènes ont été identifiés à ces loci (MYOC, OPTN, WDR36, NTF4, ASB10). Récemment, des études d’association sur l’ensemble du génome ont identifié plus de 20 facteurs de risque fréquents, avec des effets relativement faibles. Depuis plus de 50 ans, notre équipe étudie 749 membres de la grande famille canadienne-française CA où la mutation MYOCK423E cause une forme autosomale dominante de GAO dont l’âge de début est fortement variable. Premièrement, il a été montré que cette variabilité de l’âge de début de l’hypertension intraoculaire possède une importante composante génétique causée par au moins un gène modificateur. Ce modificateur interagit avec la mutation primaire et altère la sévérité du glaucome chez les porteurs de MYOCK423E. Un gène modificateur candidat WDR36 a été génotypé dans 2 grandes familles CA et BV. Les porteurs de variations non-synonymes de WDR36 ainsi que de MYOCK423E de la famille CA ont montré une tendance à développer la maladie plus jeune. Un outil de forage de données a été développé pour représenter des informations connues relatives à la maladie et faciliter la priorisation des gènes candidats. Cet outil a été appliqué avec succès à la dépression bipolaire et au glaucome. La suite du projet consiste à finaliser un balayage de génome sur la famille CA et à séquencer les loci afin d’identifier les variations modificatrices du glaucome. Éventuellement, ces variations permettront d’identifier les individus dont le glaucome risque d’être plus agressif.

Quantitative evaluation of visual function 12 months after bilateral implantation of a diffractive trifocal IOL

PURPOSE: To quantitatively evaluate visual function 12 months after bilateral implantation of the Physiol FineVision® trifocal intraocular lens (IOL) and to compare these results with those obtained in the first postoperative month. METHODS: In this prospective case series, 20 eyes of 10 consecutive patients were included. Monocular and binocular, uncorrected and corrected visual acuities (distance, near, and intermediate) were measured. Metrovision® was used to test contrast sensitivity under static and dynamic conditions, both in photopic and low-mesopic settings. The same software was used for pupillometry and glare evaluation. Motion, achromatic, and chromatic contrast discrimination were tested using 2 innovative psychophysical tests. A complete ophthalmologic examination was performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Psychophysical tests were performed 1 month after surgery and repeated 12 months postoperatively. RESULTS: Final distance uncorrected visual acuity (VA) was 0.00 ± 0.08 and distance corrected VA was 0.00 ± 0.05 logMAR. Distance corrected near VA was 0.00 ± 0.09 and distance corrected intermediate VA was 0.00 ± 0.06 logMAR. Glare testing, pupillometry, contrast sensitivity, motion, and chromatic and achromatic contrast discrimination did not differ significantly between the first and last visit (p>0.05) or when compared to an age-matched control group (p>0.05). CONCLUSIONS: The Physiol FineVision® trifocal IOL provided satisfactory full range of vision and quality of vision parameters 12 months after surgery. Visual acuity and psychophysical tests did not vary significantly between the first and last visit.

Assessing Potential Laser Strike Protection Engineering Control for United States Coast Guard Aircraft

Thesis (Master's)--University of Washington, 2016-06

Perceptual load affects eyewitness accuracy and susceptibility to leading questions

Load Theory (Lavie, 1995, 2005) states that the level of perceptual load in a task (i.e.,the amount of information involved in processing task-relevant stimuli) determines the efficiency of selective attention. There is evidence that perceptual load affects distractor processing, with increased inattentional blindness under high load. Given that high load can result in individuals failing to report seeing obvious objects, it is conceivable that load may also impair memory for the scene. The current study is the first to assess the effect of perceptual load on eyewitness memory. Across three experiments (two video-based and one in a driving simulator), the effect of perceptual load on eyewitness memory was assessed. The results showed that eyewitnesses were less accurate under high load, in particular for peripheral details. For example, memory for the central character in the video was not affected by load but memory for a witness who passed by the window at the edge of the scene was significantly worse under high load. High load memories were also more open to suggestion, showing increased susceptibility to leading questions. High visual perceptual load also affected recall for auditory information, illustrating a possible cross-modal perceptual load effect on memory accuracy. These results have implications for eyewitness memory researchers and forensic professionals.

The synthetic progestin norgestrel modulates Nrf2 signaling and acts as an antioxidant in a model of retinal degeneration

Retinitis pigmentosa (RP) is one of the most common retinal degenerative conditions affecting people worldwide, and is currently incurable. It is characterized by the progressive loss of photoreceptors, in which the death of rod cells leads to the secondary death of cone cells; the cause of eventual blindness. As rod cells die, retinal-oxygen metabolism becomes perturbed, leading to increased levels of reactive oxygen species (ROS) and thus oxidative stress; a key factor in the secondary death of cones. In this study, norgestrel, an FDA-approved synthetic analog of progesterone, was found to be a powerful neuroprotective antioxidant, preventing light-induced ROS in photoreceptor cells, and subsequent cell death. Norgestrel also prevented light-induced photoreceptor morphological changes that were associated with ROS production, and that are characteristic of RP. Further investigation showed that norgestrel acts via post-translational modulation of the major antioxidant transcription factor Nrf2; bringing about its phosphorylation, subsequent nuclear translocation, and increased levels of its effector protein superoxide dismutase 2 (SOD2). In summary, these results demonstrate significant protection of photoreceptor cells from oxidative stress, and underscore the potential of norgestrel as a therapeutic option for RP.

Visual results with the use of prismatic lenses in the treatment of congenital nystagmus: a clinical case

Purpose: It is important to establish a differential diagnosis between the different types of nystagmus, in order to give the appropriate clinical approach to every situation and to improve visual acuity. The nystagmus is normally blocked when the eyes are positioned in a particular way. This makes the child adopt a posture of ocular torticollis that reduces the nistagmiformes movements, improving the vision in this position. A way to promote the blocking of the nystagmic movements is by using prismatic lenses with opposite bases, to block or minimize the oscillatory movements. This results in a vision improvement and it reduces the anomalous head position. There is limited research on the visual results in children with nystagmus after using prisms with opposing bases. Our aim is to describe the impact on the visual acuity (VA ) of theprescription prism lenses in a nystagmus patient starting at 3 months of age. Methods: Case report on thirty month old caucasian male infant, with normal growth and development for their age, with an early onset of horizontal nystagmus at 3 months of age. Ophthalmic examination included slit lamp examination, fundus, refractive study, electrophysiological and magnetic resonance tests, measurement of VA over time with the Teller Acuity Cards (TAC ) in the distance agreed for the age. At age ten months, the mother noted a persistent turn to the right of the child’s head, which became increasingly more severe along the months. There’s no oscillopcia. At 24 months, an atropine refraction showed the following refractive error: 0D.: -1,50, OS: -0,50 and prismatic lens adapting OD 8 Δ nasal base and OE 8 Δ temporal base. Results: Thirty month old child, with adequate development for their age, with onset of idiopatic horizontal nystagmus, at 3 months of age. Normal ocular fundus and magnetic ressoance without alterations, sub-normal results in electrophysiological tests and VA with values below normal for age. At 6 months OD 20/300; OE 20/400; OU 20/300. At 9 months OD 20/250; OE 20/300; OU 20/150 (TAC a 38 cm). At 18 months OD 20/200; OE 20/100; OU 20/80 (TAC at 38 cm), when the head is turned to the right and the eyes in levoversão, the nystagmus decreases in a “neutral” area. At 24 month, with the prismatic glasses, OD 20/200 OE 20/100, OU20/80 (TAC at 54 cm, reference value is 20/30 – 20/100 para OU e 20/40 – 20/100 monocular), there was an increase in the visual acuity. The child did visual stimulation with multimedia devices and using glasses. After adaptation of prisms: at 30 months VA (with Cambridge cards) OD e OE = 6/18. The child improved the VA and reduced the anomalous head position. There is also improvement in mobility and fine motricity. Conclusion: Prisms with opposing bases., were used in the treatment of idiopathic nystagmus. Said prisms were adapted to reduce the skewed position of the head, and to improve VA and binocular function. Monitoring of visual acuity and visual stimulation was done using electronic devices. Following the use of prismatic, the patient improved significantly VA and the anomalous head position was reduced.