Visual function in human ocular toxoplasmosis

AIM: To assess functional impairment in terms of visual acuity reduction and visual field defects in inactive ocular toxoplasmosis. METHODS: 61 patients with known ocular toxoplasmosis in a quiescent state were included in this prospective, cross-sectional study. A complete ophthalmic examination, retinal photodocumentation and standard automated perimetry (Octopus perimeter, program G2) were performed. Visual acuity was classified on the basis of the World Health Organization definition of visual impairment and blindness: normal (> or =20/25), mild (20/25 to 20/60), moderate (20/60 to 20/400) and severe (<20/400). Visual field damage was correspondingly graded as mild (mean defect <4 dB), moderate (mean defect 4-12 dB) or severe (mean defect >12 dB). RESULTS: 8 (13%) patients presented with bilateral ocular toxoplasmosis. Thus, a total of 69 eyes was evaluated. Visual field damage was encountered in 65 (94%) eyes, whereas only 28 (41%) eyes had reduced visual acuity, showing perimetric findings to be more sensitive in detecting chorioretinal damage (p<0.001). Correlation with the clinical localisation of chorioretinal scars was better for visual field (in 70% of the instances) than for visual acuity (33%). Moderate to severe functional impairment was registered in 65.2% for visual field, and in 27.5% for visual acuity. CONCLUSION: In its quiescent stage, ocular toxoplasmosis was associated with permanent visual field defects in >94% of the eyes studied. Hence, standard automated perimetry may better reflect the functional damage encountered by ocular toxoplasmosis than visual acuity.

Distance doubling visual acuity test: a reliable test for nonorganic visual loss

BACKGROUND: To determine the value of the distance doubling visual acuity test in the diagnosis of nonorganic visual loss in a comparative observational case series. METHODS: Twenty-one consecutive patients with nonorganic visual acuity loss and 21 subjects with organic visual loss as controls were included. Best corrected visual acuity was tested at the normal distance of 5 meters using Landolt Cs. The patient was then repositioned and best corrected visual acuity was tested with the previous optotypes at double the distance via a mirror. RESULTS: Nonorganic visual acuity loss was identified in 21 of 21 patients. Sensitivity and specificity of distance-doubling visual acuity test in functional visual loss were found to be 100% (CI; 83%-100%) and 100% (CI; 82%-100%), respectively. CONCLUSION: Distance doubling visual acuity test is widely used to detect nonorganic visual loss. Our results show that this test has a high specificity and sensitivity to detect nonorganic visual impairment.

About the role of visual field defects in pure alexia

Pure alexia is an acquired reading disorder characterized by a disproportionate prolongation of reading time as a function of word length. Although the vast majority of cases reported in the literature show a right-sided visual defect, little is known about the contribution of this low-level visual impairment to their reading difficulties. The present study was aimed at investigating this issue by comparing eye movement patterns during text reading in six patients with pure alexia with those of six patients with hemianopic dyslexia showing similar right-sided visual field defects. We found that the role of the field defect in the reading difficulties of pure alexics was highly deficit-specific. While the amplitude of rightward saccades during text reading seems largely determined by the restricted visual field, other visuo-motor impairments-particularly the pronounced increases in fixation frequency and viewing time as a function of word length-may have little to do with their visual field defect. In addition, subtracting the lesions of the hemianopic dyslexics from those found in pure alexics revealed the largest group differences in posterior parts of the left fusiform gyrus, occipito-temporal sulcus and inferior temporal gyrus. These regions included the coordinate assigned to the centre of the visual word form area in healthy adults, which provides further evidence for a relation between pure alexia and a damaged visual word form area. Finally, we propose a list of three criteria that may improve the differential diagnosis of pure alexia and allow appropriate therapy recommendations.

Dementia presenting with visual complaints

A 78-year-old female developed memory problems after a 2-year history of persistent visual complaints. Ocular pathology did not explain the extent of her perceived visual impairment. Cognitive screening tests found prominent visuo-constructive deficits and a comprehensive dementia assessment revealed the diagnosis of Alzheimer's disease. This case describes visual complaints as the initial symptom of dementia, pre-dating memory impairment by several years. We discuss clinical signs of cerebral visual impairment and suggest a simple screening measure.

Servicios bibliotecarios accesibles para personas con discapacidad visual en la Universidad Nacional de La Plata, Argentina

El trabajo, de tipo descriptivo exploratorio, pretende conocer cuál es el estado en que se encuentran algunas de las bibliotecas universitarias de la UNLP para ofrecer un servicio accesible a personas con discapacidad visual. Se analiza qué servicios de este tipo poseen actualmente, con qué barreras se enfrentan los usuarios y qué soluciones se han implementado. A tal fin se indagará, por un lado, cómo están diseñados los sitios web de las bibliotecas elegidas, y por otro, cómo integran estas bibliotecas en sus servicios y productos documentales a estas personas, esto es, si cuentan con material bibliográfico y servicios accesibles. Por último, se esbozan algunas propuestas para superar la situación actual en estas bibliotecas universitarias

La orientación vocacional - ocupacional en sujetos con necesidades educativas especiales derivadas de la discapacidad visual en la etapa de transición escuela secundaria - Educación superior

Este trabajo está dirigido a indagar los factores asociados a las elecciones que realizan los sujetos con Necesidades Educativas Especiales derivadas de la Discapacidad Visual en la etapa de transición entre la escolaridad secundaria y las posibilidades de proseguir estudios superiores. Para este fin, se ha tomado en consideración que la Orientación Vocacional Ocupacional y la transición hacia la vida adulta adquieren características específicas en el caso de jóvenes que presentan Discapacidad Visual, particularmente en relación con la preparación para la continuación de estudios superiores. El interés de este trabajo reside en poder esclarecer la existencia de factores que facilitan u obstaculizan ese tránsito, a partir de la observación de sujetos disminuidos visuales y ciegos que finalizan sus estudios secundarios. Se trata de un tema que ha ocasionado interés y preocupación acerca de las estrategias a seguir para garantizar un ingreso y permanencia exitosos en los estudios superiores elegidos. Sin embargo, si se desconocen o más bien se carece de evidencia acerca de los factores a los que obedece el fenómeno descripto, es difícil poder diseñar estrategias de intervención que resulten adecuadas. Con el fin de tomar conocimiento sobre las problemáticas específicas de los jóvenes que finalizan sus estudios secundarios y que presentan Discapacidad Visual, se eligió una escuela especial de referencia en la mencionada discapacidad y se seleccionaron en ella los alumnos que participaron de este proyecto

Servicios bibliotecarios accesibles para personas con discapacidad visual en la Universidad Nacional de La Plata, Argentina

El trabajo, de tipo descriptivo exploratorio, pretende conocer cuál es el estado en que se encuentran algunas de las bibliotecas universitarias de la UNLP para ofrecer un servicio accesible a personas con discapacidad visual. Se analiza qué servicios de este tipo poseen actualmente, con qué barreras se enfrentan los usuarios y qué soluciones se han implementado. A tal fin se indagará, por un lado, cómo están diseñados los sitios web de las bibliotecas elegidas, y por otro, cómo integran estas bibliotecas en sus servicios y productos documentales a estas personas, esto es, si cuentan con material bibliográfico y servicios accesibles. Por último, se esbozan algunas propuestas para superar la situación actual en estas bibliotecas universitarias

La orientación vocacional - ocupacional en sujetos con necesidades educativas especiales derivadas de la discapacidad visual en la etapa de transición escuela secundaria - Educación superior

Este trabajo está dirigido a indagar los factores asociados a las elecciones que realizan los sujetos con Necesidades Educativas Especiales derivadas de la Discapacidad Visual en la etapa de transición entre la escolaridad secundaria y las posibilidades de proseguir estudios superiores. Para este fin, se ha tomado en consideración que la Orientación Vocacional Ocupacional y la transición hacia la vida adulta adquieren características específicas en el caso de jóvenes que presentan Discapacidad Visual, particularmente en relación con la preparación para la continuación de estudios superiores. El interés de este trabajo reside en poder esclarecer la existencia de factores que facilitan u obstaculizan ese tránsito, a partir de la observación de sujetos disminuidos visuales y ciegos que finalizan sus estudios secundarios. Se trata de un tema que ha ocasionado interés y preocupación acerca de las estrategias a seguir para garantizar un ingreso y permanencia exitosos en los estudios superiores elegidos. Sin embargo, si se desconocen o más bien se carece de evidencia acerca de los factores a los que obedece el fenómeno descripto, es difícil poder diseñar estrategias de intervención que resulten adecuadas. Con el fin de tomar conocimiento sobre las problemáticas específicas de los jóvenes que finalizan sus estudios secundarios y que presentan Discapacidad Visual, se eligió una escuela especial de referencia en la mencionada discapacidad y se seleccionaron en ella los alumnos que participaron de este proyecto

La orientación vocacional - ocupacional en sujetos con necesidades educativas especiales derivadas de la discapacidad visual en la etapa de transición escuela secundaria - Educación superior

Este trabajo está dirigido a indagar los factores asociados a las elecciones que realizan los sujetos con Necesidades Educativas Especiales derivadas de la Discapacidad Visual en la etapa de transición entre la escolaridad secundaria y las posibilidades de proseguir estudios superiores. Para este fin, se ha tomado en consideración que la Orientación Vocacional Ocupacional y la transición hacia la vida adulta adquieren características específicas en el caso de jóvenes que presentan Discapacidad Visual, particularmente en relación con la preparación para la continuación de estudios superiores. El interés de este trabajo reside en poder esclarecer la existencia de factores que facilitan u obstaculizan ese tránsito, a partir de la observación de sujetos disminuidos visuales y ciegos que finalizan sus estudios secundarios. Se trata de un tema que ha ocasionado interés y preocupación acerca de las estrategias a seguir para garantizar un ingreso y permanencia exitosos en los estudios superiores elegidos. Sin embargo, si se desconocen o más bien se carece de evidencia acerca de los factores a los que obedece el fenómeno descripto, es difícil poder diseñar estrategias de intervención que resulten adecuadas. Con el fin de tomar conocimiento sobre las problemáticas específicas de los jóvenes que finalizan sus estudios secundarios y que presentan Discapacidad Visual, se eligió una escuela especial de referencia en la mencionada discapacidad y se seleccionaron en ella los alumnos que participaron de este proyecto

Reducing visual deficits caused by refractive errors in school and preschool children: results of a pilot school program in the Andean region of Apurimac, Peru

Background: Refractive error is defined as the inability of the eye to bring parallel rays of light into focus on the retina, resulting in nearsightedness (myopia), farsightedness (Hyperopia) or astigmatism. Uncorrected refractive error in children is associated with increased morbidity and reduced educational opportunities. Vision screening (VS) is a method for identifying children with visual impairment or eye conditions likely to lead to visual impairment. Objective: To analyze the utility of vision screening conducted by teachers and to contribute to a better estimation of the prevalence of childhood refractive errors in Apurimac, Peru. Design: A pilot vision screening program in preschool (Group I) and elementary school children (Group II) was conducted with the participation of 26 trained teachers. Children whose visual acuity was<6/9 [20/30] (Group I) and≤6/9 (Group II) in one or both eyes, measured with the Snellen Tumbling E chart at 6 m, were referred for a comprehensive eye exam. Specificity and positive predictive value to detect refractive error were calculated against clinical examination. Program assessment with participants was conducted to evaluate outcomes and procedures. Results: A total sample of 364 children aged 3–11 were screened; 45 children were examined at Centro Oftalmológico Monseñor Enrique Pelach (COMEP) Eye Hospital. Prevalence of refractive error was 6.2% (Group I) and 6.9% (Group II); specificity of teacher vision screening was 95.8% and 93.0%, while positive predictive value was 59.1% and 47.8% for each group, respectively. Aspects highlighted to improve the program included extending training, increasing parental involvement, and helping referred children to attend the hospital. Conclusion: Prevalence of refractive error in children is significant in the region. Vision screening performed by trained teachers is a valid intervention for early detection of refractive error, including screening of preschool children. Program sustainability and improvements in education and quality of life resulting from childhood vision screening require further research.

Servicios bibliotecarios accesibles para personas con discapacidad visual en la Universidad Nacional de La Plata, Argentina

El trabajo, de tipo descriptivo exploratorio, pretende conocer cuál es el estado en que se encuentran algunas de las bibliotecas universitarias de la UNLP para ofrecer un servicio accesible a personas con discapacidad visual. Se analiza qué servicios de este tipo poseen actualmente, con qué barreras se enfrentan los usuarios y qué soluciones se han implementado. A tal fin se indagará, por un lado, cómo están diseñados los sitios web de las bibliotecas elegidas, y por otro, cómo integran estas bibliotecas en sus servicios y productos documentales a estas personas, esto es, si cuentan con material bibliográfico y servicios accesibles. Por último, se esbozan algunas propuestas para superar la situación actual en estas bibliotecas universitarias

A INCLUSÃO SOCIAL E AS MEDIAÇÕES NA RECEPÇÃO DA COMUNICAÇÃO MERCADOLÓGICA TELEVISIVA POR PESSOAS COM DEFICIÊNCIA VISUAL

Este trabalho é estimulado pela reflexão sobre a recepção da comunicação mercadológica televisiva por pessoas com deficiência visual, assim como sobre a percepção quanto às iniciativas do governo e das empresas em prol da inclusão. O estudo busca, com base na Teoria das Mediações, que é estudada por teóricos dos Estudos de Recepção, entender de que forma as pessoas com deficiência visual interagem com as diferentes categorias de comerciais de televisão, a partir de seus valores, percepções de mundo e condições em que se encontram. Deste modo, observa-se ainda o nível de sentimento de pertencimento das pessoas com deficiência visual quanto à preocupação do governo e das empresas em causas sociais. Os procedimentos que dirigem a investigação caracterizam-se por uma reflexão a partir de dados decorrentes de pesquisa bibliográfica, articulada a uma pesquisa de campo de natureza qualitativa. O trabalho conclui que a percepção das pessoas com deficiência visual se distancia do que está sendo proposto, feito e aparentemente sendo bem divulgado em prol da inclusão; bem como, observa a necessidade de aprimoramento da conscientização da sociedade, e consequentemente dos comunicadores, sobre a importância da aproximação entre as pessoas com deficiência visual e a comunicação mercadológica televisiva. Nesta percepção, o trabalho apresenta sugestões no âmbito comunicacional que poderiam tornar as causas sociais realmente expressivas na vida das pessoas com deficiência visual.

Objective and psychophysical studies of infant visual development

Distortion or deprivation of vision during an early `critical' period of visual development can result in permanent visual impairment which indicates the need to identify and treat visually at-risk individuals early. A significant difficulty in this respect is that conventional, subjective methods of visual acuity determination are ineffective before approximately three years of age. In laboratory studies, infant visual function has been quantified precisely, using objective methods based on visual evoked potentials (VEP), preferential looking (PL) and optokinetic nystagmus (OKN) but clinical assessment of infant vision has presented a particular difficulty. An initial aim of this study was to evaluate the relative clinical merits of the three techniques. Clinical derivatives were devised, the OKN method proved unsuitable but the PL and VEP methods were evaluated in a pilot study. Most infants participating in the study had known ocular and/or neurological abnormalities but a few normals were included for comparison. The study suggested that the PL method was more clinically appropriate for the objective assessment of infant acuity. A study of normal visual development from birth to one year was subsequently conducted. Observations included cycloplegic refraction, ophthalmoscopy and preferential looking visual acuity assessment using horizontally and vertically oriented square wave gratings. The aims of the work were to investigate the efficiency and sensitivity of the technique and to study possible correlates of visual development. The success rate of the PL method varied with age; 87% of newborns and 98% of infants attending follow-up successfully completed at least one acuity test. Below two months monocular acuities were difficult to secure; infants were most testable around six months. The results produced were similar to published data using the acuity card procedure and slightly lower than, but comparable with acuity data derived using extended PL methods. Acuity development was not impaired in infants found to have retinal haemorrhages as newborns. A significant relationship was found between newborn binocular acuity and anisometropia but not with other refractive findings. No strong or consistent correlations between grating acuity and refraction were found for three, six or twelve months olds. Improvements in acuity and decreases in levels of hyperopia over the first week of life were suggestive of recovery from minor birth trauma. The refractive data was analysed separately to investigate the natural history of refraction in normal infants. Most newborns (80%) were hyperopic, significant astigmatism was found in 86% and significant anisometropia in 22%. No significant alteration in spherical equivalent refraction was noted between birth and three months, a significant reduction in hyperopia was evident by six months and this trend continued until one year. Observations on the astigmatic component of the refractive error revealed a rather erratic series of changes which would be worthy of further investigation since a repeat refraction study suggested difficulties in obtaining stable measurements in newborns. Astigmatism tended to decrease between birth and three months, increased significantly from three to six months and decreased significantly from six to twelve months. A constant decrease in the degree of anisometropia was evident throughout the first year. These findings have implications for the correction of infantile refractive error.

Oculo-visual changes and clinical considerations affecting older patients with dementia

Purpose: Dementia is associated with various alterations of the eye and visual function. Over 60% of cases are attributable to Alzheimer's disease, a significant proportion of the remainder to vascular dementia or dementia with Lewy bodies, while frontotemporal dementia, and Parkinson's disease dementia are less common. This review describes the oculo-visual problems of these five dementias and the pathological changes which may explain these symptoms. It further discusses clinical considerations to help the clinician care for older patients affected by dementia. Recent findings: Visual problems in dementia include loss of visual acuity, defects in colour vision and visual masking tests, changes in pupillary response to mydriatics, defects in fixation and smooth and saccadic eye movements, changes in contrast sensitivity function and visual evoked potentials, and disturbance of complex visual functions such as in reading ability, visuospatial function, and the naming and identification of objects. Pathological changes have also been reported affecting the crystalline lens, retina, optic nerve, and visual cortex. Clinically, issues such as cataract surgery, correcting the refractive error, quality of life, falls, visual impairment and eye care for dementia have been addressed. Summary: Many visual changes occur across dementias, are controversial, often based on limited patient numbers, and no single feature can be regarded as diagnostic of any specific dementia. Nevertheless, visual hallucinations may be more characteristic of dementia with Lewy bodies and Parkinson's disease dementia than Alzheimer's disease or frontotemporal dementia. Differences in saccadic eye movement dysfunction may also help to distinguish Alzheimer's disease from frontotemporal dementia and Parkinson's disease dementia from dementia with Lewy bodies. Eye care professionals need to keep informed of the growing literature in vision/dementia, be attentive to signs and symptoms suggestive of cognitive impairment, and be able to adapt their practice and clinical interventions to best serve patients with dementia.

Desenho de deficiência visual: uma experiência no ensino de artes visuais na perspectiva da educação inclusiva

Over the past 30 years, Art Education in interface with disabilities has been a subject of increasing interest in research in academia, especially with regard to Special Education, but still has some shortages in terms of socialization studies to discuss this type of teaching from the perspective of inclusive education. In this scenario, this paper presents an analysis from the field of teaching Visual Arts in the context of school inclusion, with emphasis on teaching drawing to the visually impaired. The conducted literature indicates a number of authors who discuss teaching drawing to people with visual disabilities, who are dedicated primarily to the Special Education context. In this sense, the shortage of research that discuss this teaching from the perspective of inclusive education, this research aimed at the inclusive approach to teaching drawing in the school context. Thus, the aim of this study was to develop a proposal for a pedagogical intervention in Visual Arts, with reference to drawing and its construction process, with the participation of seeing and unseeing students. Therefore, the methodological approach, which was qualitative, was the intervention research, in the light of the Bakhtinian principles of dialogism and otherness, with exploratory study characteristics. The locus of the research was the State School Admiral Newton Braga Faria, which is located in Alecrim, on the East Zone of Natal / RN and is near the Institute for Education and Rehabilitation of the Blind - IERC / RN. The class chosen for intervention was the 7th grade “C” afternoon shift, which had children aged 12 to 16, with 27 students enrolled, three students with disabilities: 02 blind girls and 01 deafblind boy with light hearing and visual loss. As interlocutors of the research, we could also count on the Art teacher who served as a collaborator, as well as teacher in the school’s Multifunction Resource Room. The instruments and research procedures were observation, semi-structured interview, field diary and the photo / video recording. In the development of research, we conducted 10 workshops with multisensory teaching sequences, articulating the physical, tactile and graphical expressions as intrinsic to the reading and production of drawing for both seeing and unseeing students. The process and data built on research allowed for a reflection on cultural experiences with drawing in the school context and on the interactions between seeing and unseeing students in the production and analysis of tactile-visual drawings. They also point out the construction of a teaching approach to drawing, in the context of the common class, from educational workshops that enable artistic and aesthetic interactions from the perspective of school inclusiveness. Thus, we argued that the mobilization of the tactile, physical and graphical expressions can be adopted in a multisensory approach that enables a pedagogical focus that involves all students and is not restricted to the presence of students with visual impairment.