Visual impairment, postural stability and falls among older adults with glaucoma

Purpose: To investigate the impact of glaucomatous visual impairment on postural sway and falls among older adults.Methods: The sample comprised 72 community-dwelling older adults with open-angle glaucoma, aged 74.0 5.8 years (range 62 to 90 years). Measures of visual function included binocular visual acuity (high-contrast), binocular contrast sensitivity (Pelli- Robson) and binocular visual fields (merged monocular HFA 24-2 SITA-Std). Postural stability was assessed under four conditions: eyes open and closed, on a firm and on a foam surface. Falls were monitored for six months with prospective falls diaries. Regression models, adjusting for age and gender, examined the association between vision measures and postural stability (linear regression) and the number of falls (negative binomial regression). Results: Greater visual field loss was significantly associated with poorer postural stability with eyes open, both on firm (r = 0.34, p < 0.01) and foam (r = 0.45, p < 0.001) surfaces. Eighteen (25 per cent) participants experienced at least one fall: 12 (17 per cent) participants fell only once and six (eight per cent) participants fell two or more times (up to five falls). Visual field loss was significantly associated with falling; the rate of falls doubled for every 10 dB reduction in field sensitivity (rate ratio = 1.08, 95% CI = 1.02–1.13). Importantly, in a model comprising upper and lower field sensitivity, only lower field loss was significantly associated with the number of falls (rate ratio = 1.17, 95% CI = 1.04–1.33). Conclusions: Binocular visual field loss was significantly associated with postural instability and falls among older adults with glaucoma. These findings provide valuable directions for developing falls risk assessment and falls prevention strategies for this population.

Empirical measurement of the Enright phenomenon, a distortion of perceived driving speed

Purpose: In 1970, Enright observed a distortion of perceived driving speed, induced by monocular application of a neutral density (ND) filter. If a driver looks out of the right side of a vehicle with a filter over the right eye, the driver perceives a reduction of the vehicle’s apparent velocity, while applying a ND filter over the left eye increases the vehicle’s apparent velocity. The purpose of the current study was to provide the first empirical measurements of the Enright phenomenon. Methods: Ten experienced drivers were tested and drove an automatic sedan on a closed road circuit. Filters (0.9 ND) were placed over the left, right or both eyes during a driving run, in addition to a control condition with no filters in place. Subjects were asked to look out of the right side of the car and adjust their driving speed to either 40 km/h or 60 km/h. Results: Without a filter or with both eyes filtered subjects showed good estimation of speed when asked to travel at 60 km/h but travelled a mean of 12 to 14 km/h faster than the requested 40 km/h. Subjects travelled faster than these baselines by a mean of 7 to 9 km/h (p < 0.001) with the filter over their right eye, and 3 to 5 km/h slower with the filter over their left eye (p < 0.05). Conclusions: The Enright phenomenon causes significant and measurable distortions of perceived driving speed under realworld driving conditions.

Influence of presbyopic corrections on driving-related eye and head movements

Purpose: To investigate whether wearing different presbyopic refractive corrections alters the pattern of eye and head movements when searching for dynamic targets in driving-related traffic scenes. Methods: Eye and head movements of 20 presbyopes (mean age = 56.2 ± 5.7 years), who had no experience of wearing presbyopic corrections or were unadapted wearers were recorded using the faceLABTM eye and head tracker, while wearing five different corrections: single vision lenses (SV), progressive addition lenses (PALs), bifocal spectacles (BIF), monovision and multifocal contact lenses (MTF CLs) in random order (within-subjects comparison). Recorded traffic scenes of suburban roads and expressways with edited targets were viewed as dynamic stimuli. Results: The magnitude of eye and head movements was significantly greater for SV, BIF and PALs than monovision and MTF CLs (p < 0.001). In addition, BIF wear led to more eye movements than PAL wear (p = 0.017), while PAL wear resulted in greater head movements than SV wear (p = 0.018). The ratio of eye to head movement was smaller for PALs than all other groups (p < 0.001). The number of saccades made to fixate a target was significantly higher for BIF and PALs than monovision or MTF CLs (p < 0.05). Conclusions: Different presbyopic corrections can alter eye and head movement patterns. Wearing spectacles such as BIF and PALs produced relatively greater eye and head movements and saccades when viewing dynamic targets. The impact of these changes in eye and head movement patterns may have implications for driving performance under real world driving conditions.

Driving performance in persons with hemianopia and quadrantanopia assessed under in-traffic conditions

Purpose: To evaluate the on-road driving performance of persons with homonymous hemianopia or quadrantanopia in comparison to age-matched controls with normal visual fields. Methods: Participants were 22 hemianopes and eight quadrantanopes (mean age 53 years) and 30 persons with normal visual fields (mean age 52 years) and were either current drivers or aiming to resume driving. All participants completed a battery of tests of vision (ETDRS visual acuity, Pelli-Robson letter contrast sensitivity, Humphrey visual fields), cognitive tests (trials A and B, Mini Mental State Examination, Digit Symbol Substitution) and an on-road driving assessment. Driving performance was assessed in a dual-brake vehicle with safety monitored by a certified driving rehabilitation specialist. Backseat evaluators masked to the clinical characteristics of participants independently rated driving performance along a 22.7 kilometre route involving urban and interstate driving. Results: Seventy-three per cent of the hemianopes, 88 per cent of quadrantanopes and all of the drivers with normal fields received safe driving ratings. Those hemianopic and quadrantanopic drivers rated as unsafe tended to have problems with maintaining appropriate lane position, steering steadiness and gap judgment compared to controls. Unsafe driving was associated with slower visual processing speed and impairments in contrast sensitivity, visual field sensitivity and executive function. Conclusions: Our findings suggest that some drivers with hemianopia or quadrantanopia are capable of safe driving performance, when compared to those of the same age with normal visual fields. This finding has important implications for the assessment of fitness to drive in this population.

Head and eye movements and lane keeping in drivers with hemianopia and quadrantanopia compared to controls

Purpose: To compare the eye and head movements and lane-keeping of drivers with hemianopia and quadrantanopia with that of age-matched controls when driving under real world conditions. Methods: Participants included 22 hemianopes and 8 quadrantanopes (M age 53 yrs) and 30 persons with normal visual fields (M age 52 yrs) who were ≥ 6 months from the brain injury date and either a current driver or aiming to resume driving. All participants drove an instrumented dual-brake vehicle along a 14-mile route in traffic that included non-interstate city driving and interstate driving. Driving performance was scored using a standardised assessment system by two “backseat” raters and the Vigil Vanguard system which provides objective measures of speed, braking and acceleration, cornering, and video-based footage from which eye and head movements and lane-keeping can be derived. Results: As compared to drivers with normal visual fields, drivers with hemianopia or quadrantanopia on average were significantly more likely to drive slower, to exhibit less excessive cornering forces or acceleration, and to execute more shoulder movements off the seat. Those hemianopic and quadrantanopic drivers rated as safe to drive by the backseat evaluator made significantly more excursive eye movements, exhibited more stable lane positioning, less sudden braking events and drove at higher speeds than those rated as unsafe, while there was no difference between safe and unsafe drivers in head movements. Conclusions: Persons with hemianopic and quadrantanopic field defects rated as safe to drive have different driving characteristics compared to those rated as unsafe when assessed using objective measures of driving performance.

Simulated cataracts and their effect on speech intelligibility

Purpose: The classic study of Sumby and Pollack (1954, JASA, 26(2), 212-215) demonstrated that visual information aided speech intelligibility under noisy auditory conditions. Their work showed that visual information is especially useful under low signal-to-noise conditions where the auditory signal leaves greater margins for improvement. We investigated whether simulated cataracts interfered with the ability of participants to use visual cues to help disambiguate the auditory signal in the presence of auditory noise. Methods: Participants in the study were screened to ensure normal visual acuity (mean of 20/20) and normal hearing (auditory threshold ≤ 20 dB HL). Speech intelligibility was tested under an auditory only condition and two visual conditions: normal vision and simulated cataracts. The light scattering effects of cataracts were imitated using cataract-simulating filters. Participants wore blacked-out glasses in the auditory only condition and lens-free frames in the normal auditory-visual condition. Individual sentences were spoken by a live speaker in the presence of prerecorded four-person background babble set to a speech-to-noise ratio (SNR) of -16 dB. The SNR was determined in a preliminary experiment to support 50% correct identification of sentence under the auditory only conditions. The speaker was trained to match the rate, intensity and inflections of a prerecorded audio track of everyday speech sentences. The speaker was blind to the visual conditions of the participant to control for bias.Participants’ speech intelligibility was measured by comparing the accuracy of their written account of what they believed the speaker to have said to the actual spoken sentence. Results: Relative to the normal vision condition, speech intelligibility was significantly poorer when participants wore simulated catarcts. Conclusions: The results suggest that cataracts may interfere with the acquisition of visual cues to speech perception.

Driving-related eye and head movements are changed by the type of presbyopic correction

Purpose: To investigate whether wearing different presbyopic vision corrections alters the pattern of eye and head movements when viewing dynamic driving-related traffic scenes. Methods: Participants included 20 presbyopes (mean age: 56±5.7 years) who had no experience of wearing presbyopic vision corrections (i.e. all were single vision wearers). Eye and head movements were recorded while wearing five different vision corrections: single vision lenses (SV), progressive addition spectacle lenses (PALs), bifocal spectacle lenses (BIF), monovision (MV) and multifocal contact lenses (MTF CL) in random order. Videotape recordings of traffic scenes of suburban roads and expressways (with edited targets) were presented as dynamic driving-related stimuli and digital numeric display panels included as near visual stimuli (simulating speedometer and radio). Eye and head movements were recorded using the faceLAB™ system and the accuracy of target identification was also recorded. Results: The magnitude of eye movements while viewing the driving-related traffic scenes was greater when wearing BIF and PALs than MV and MTF CL (p≤0.013). The magnitude of head movements was greater when wearing SV, BIF and PALs than MV and MTF CL (p<0.0001) and the number of saccades was significantly higher for BIF and PALs than MV (p≤0.043). Target recognition accuracy was poorer for all vision corrections when the near stimulus was located at eccentricities inferiorly and to the left, rather than directly below the primary position of gaze (p=0.008), and PALs gave better performance than MTF CL (p=0.043). Conclusions: Different presbyopic vision corrections alter eye and head movement patterns. In particular, the larger magnitude of eye and head movements and greater number of saccades associated with the spectacle presbyopic corrections, may impact on driving performance.

The effect of monocular and binocular cataract blur on postural stability among older adults

Purpose: First-eye cataract surgery can reduce the rate of falls among older adults, yet the effect of second-eye surgery on the rate of falling remains unclear. The present study investigated the effect of monocular and binocular simulated cataract blur on postural stability among older adults. Methods: Postural stability was assessed on 34 healthy older adults (mean 68.2 years, SD 3.5) with normal vision, using a portable force platform (BT4, HUR Labs, Finland) which collected data on centre of pressure (COP) displacement. Stability was assessed on firm and foam surfaces under four binocular viewing conditions using Vistech filters to simulate cataract blur: [1] best-corrected vision both eyes; [2] blur over non-dominant eye, [3] blur over dominant eye and [4] blur over both eyes. Binocular logMAR visual acuity, Pelli-Robson contrast sensitivity and stereoacuity were also measured under these viewing conditions and ocular dominance measured using the hole-in-card test. Generalized estimating equations with an exchangeable correlation structure examined the effect of the surface and vision conditions on postural stability. Results: Visual acuity and contrast sensitivity were significantly reduced under monocular and binocular cataract blur compared to normal viewing. All blur conditions resulted in loss of stereoacuity. Binocular cataract blur significantly reduced postural stability compared to normal vision on the firm (COP path length; p=0.013) and foam surface (anterior-posterior COP RMS, COP path length and COP area; p<0.01). However, no significant differences in postural stability were found between the monocular blur conditions compared to normal vision, or between the dominant and non-dominant monocular blur conditions on either the firm or foam surfaces. Conclusions: Findings indicate that binocular blur significantly impairs postural stability, and suggests that improvements in postural stability may justify first-eye cataract surgery, particularly during somatosensory disruption. Postural stability was not significantly impaired in the monocular cataract blur conditions compared to the normal vision condition, nor was there any effect of ocular dominance on postural stability in the presence of monocular cataract blur.

An investigation of the effects of lateral wind loading on pole frame housing

This project set out to investigate the behaviour of a pole frame house subjected to a lateral wind load. The behaviour of poles embedded in the ground was examined. The existing theoretical methods for determining lateral load capacity of an embedded pole were reviewed, and three common methods of pole embedment were tested at different depths to gauge the response of poles and types of pole embedment to a lateral load. The most suitable embedment method was used in the foundation for a full-scale model pole house, which was constructed and tested at various stages during the construction to examine the response of a pole house to lateral wind load. The full scale testing was also used to monitor the effect of the various structural components on the overall stiffuess of the house. The results from the full scale tests were used to calibrate a computer model of a pole house which could then be used to predict the behaviour of different configurations of pole house construction without the need for further expensive full scale tests.

Cyclist visibility at night : perceptions of visibility do not necessarily match reality

Visibility limitations make cycling at night particularly dangerous. We previously reported cyclists’ perceptions of their own visibility at night and identified clothing configurations that made them feel visible. In this study we sought to determine whether these self-perceptions reflect actual visibility when wearing these clothing configurations. In a closed-road driving environment, cyclists wore black clothing, a fluorescent vest, a reflective vest, or a reflective vest plus ankle and knee reflectors. Drivers recognised more cyclists wearing the reflective vest plus reflectors (90%) than the reflective vest alone (50%), fluorescent vest (15%) or black clothing (2%). Older drivers recognised the cyclists less often than younger drivers (51% vs 27%). The findings suggest that reflective ankle and knee markings are particularly valuable at night, while fluorescent clothing is not. Cyclists wearing fluorescent clothing may be at particular risk if they incorrectly believe themselves to be conspicuous to drivers at night.