The impact of visual impairments in self-esteem and locus of control

The role of self-esteem on motivational aspects of Greek blind athletes competing in individual and team sports

Physical activity and sports can be considered important sources of motivation for people with visual impairments; however limited attention has been given to blind peoples' involvement in sports and to the intra-personal variables such as self-esteem and motivation that affect their sport participation. The purpose of the present study was a) to explore the relationship between self-esteem and intrinsic motivation in blind athletes, and b) to assess the levels of self-esteem and intrinsic motivation and identify differences in intrinsic motivation and self-esteem as a function of gender and sport type (individual-team sports). Participants were 78 (27 females) Greek blind athletes (30.29 ± 1.18 years of age) competing in team (N = 44) and individual (N = 34) sports. Participants completed the Intrinsic Motivation Inventory questionnaire (IMI) and Rosenberg Self-Esteem Scale (RSES) questionnaire. The findings revealed that high values on self-esteem could predict blind athletes' perceived competence (p = .001) and strengthen their intrinsic motivation while enabling them to regulate pressure and tension (p < .05). However, female athletes appeared to be more pressured than males (p < .05), and interestingly, team sport athletes scored higher in intrinsic motivation than individual sports athletes (p < .05). The findings provide useful insights regarding the role of self-esteem in blind athletes' motivational profiles and draw attention to the role of perceived competence in blind athletes' sporting experiences, emphasizing that team sport context may serve as a fertile ground for enhancing intrinsic motivation.

Long-term visual outcomes and ocular complications in children with Marner's hereditary cataracts operated in the period 1940-2021

PURPOSE

To investigate visual development and long-term complications after cataract surgery in childhood.

METHODS

This cross-sectional study included patients from a family with Marner's hereditary cataracts who had cataract surgery before 18 years of age. The study was conducted from 1 January 2022 until 31 December 2022. The patients contributed to their medical files and participated in an updated ophthalmologic examination.

RESULTS

We included 52 patients (101 eyes, 34 females). The median age at cataract surgery was 7 years (IQR: 5-10) and the age at examination was 40 years (IQR: 21-54). Primary and secondary intraocular lens implantation had been performed in 47.5% (25 patients, 48 eyes) and 16.8% (10 patients, 17 eyes). Visual acuity was ≤0.3 logMAR in 77% (78 eyes), and <0.5 logMAR in 8% (8 eyes). Glaucoma was present in 17% (9 patients, 12 eyes), ocular hypertension in 6% (3 patients, 4 eyes), and 10% (5 patients, 5 eyes) had prior retinal detachment. Mild visual field loss (2 < mean defect (MD) ≤ 6 dB) was found in 62% (63 eyes) and moderate to advanced visual field loss (MD > 6 dB) in 24% (24 eyes). Thirty-five patients (67%) held a driver's licence, and three were not allowed to drive due to low visual function. All patients were employed.

CONCLUSION

After cataract surgery in childhood, many patients achieve normal visual acuity, but mild visual field loss is common. Long-term follow-up is important due to the high risk of glaucoma.

Neuroprotective Effect of Tauroursodeoxycholic Acid (TUDCA) on In Vitro and In Vivo Models of Retinal Disorders: A Systematic Review

BACKGROUND

Tauroursodeoxycholic acid (TUDCA) is a naturally produced hydrophilic bile acid that has been used for centuries in Chinese medicine. Numerous recent in vitro and in vivo studies have shown that TUDCA has neuroprotective action in various models of retinal disorders.

OBJECTIVE

To systematically review the scientific literature and provide a comprehensive summary on the neuroprotective action and the mechanisms involved in the cytoprotective effects of TUDCA.

METHODS

A systematic review was conducted in accordance with the PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Systematic literature search of United States National Library of Medicine (PubMed), Web of Science, Embase, Scopus and Cochrane Library was performed, which covered all original articles published up to July 2022. The terms, "TUDCA" in combination with "retina", "retinal protection", "neuroprotection" were searched. Possible biases were identified with the adopted SYRCLE's tool.

RESULTS

Of the 423 initially gathered studies, 24 articles met inclusion/exclusion criteria for full-text review. Six of them were in vitro experiments, 17 studies reported in vivo data and one study described both in vitro and in vivo data. The results revealed the effect of TUDCA on different retinal diseases, such as retinitis pigmentosa (RP), diabetic retinopathy (DR), retinal degeneration (RD), retinal ganglion cell (RGC) injury, Leber's hereditary optic neuropathy (LHON), choroidal neovascularization (CNV), and retinal detachment (RDT). The quality scores of the in vivo studies were ranged from 5 to 7 points (total 10 points), according to SYRCLE's risk of bias tool. Both in vitro and in vivo data suggested that TUDCA could effectively delay degeneration and apoptosis of retinal neurons, preserve retinal structure and function, and its mechanism of actions might be related with inhibiting apoptosis, decreasing inflammation, attenuating oxidative stress, suppressing endoplasmic reticulum (ER) stress, and reducing angiogenesis.

CONCLUSION

This systematic review demonstrated that TUDCA has neuroprotective effect on in vivo and in vitro models of retinal disorders, reinforcing the currently available evidence that TUDCA could be a promising therapeutic agent in retinal diseases treatment. However, well designed clinical trials are necessary to appraise the efficacy of TUDCA in clinical setting.

Physical activity and sport practice to improve balance control of visually impaired individuals: a narrative review with future perspectives

Visual disability negatively impacts balance, everyday self-efficacy, and mobility and often leads affected subjects to perceive physical exercise as a burdensome challenge thus discouraging them from practicing. Despite the well-proven benefits of regular physical activity in visually impaired people, especially addressing postural control, there are no specific guidelines and most of the available literature seems to be flawed by critical issues. Given the wide heterogeneity and the multidimensional needs of this population, a more realistic and target-specific perspective is needed in order to properly investigate and promote exercise practice and adherence for balance improvement. On this basis, through a critical overview of the recent literature, the present article aimed to enrich the current knowledge about this topic by providing innovative suggestions, both practical and methodological, and specifically deepening the disability-related deficits and peculiarities of different age ranges. Moreover, since a multidisciplinary approach is advisable when designing and leading exercise protocols tailored to visually impaired individuals, such innovative hints also highlighted the central role of the adapted physical activity specialist, hence contributing to foster its official professional recognition and involvement in this field.

A cross-lagged study of psychosocial adaptation among students with visual impairments: Coping, self-esteem, and social integration

BACKGROUND

As three key indicators of psychosocial adaptation, coping, self-esteem, and social integration are vital for students with visual impairments.

AIMS

This study aimed to examine the reciprocal relationships among visually impaired students' coping, self-esteem, and social integration.

METHODS

Students with visual impairments (N_Time1 = 311, N_Time2 = 170) from four special schools in mainland China responded to three inventories at two timepoints over one year. Cross-lagged panel modelling was performed to analyse the data.

RESULTS

After controlling for gender, self-esteem positively predicted self-directed coping and negatively predicted relinquished-control coping. An inverse path was found in the prediction of relinquished-control coping to self-esteem. Social integration positively predicted self-esteem. Furthermore, gender did not moderate the relationships in the cross-lagged model.

CONCLUSIONS AND IMPLICATIONS

Evidence is provided for a negative loop between self-esteem and relinquished-control coping. Social integration could be a precursor of self-esteem, and self-esteem could be a precursor of self-directed coping. Moreover, the study has practical implications for special schools, teachers, parents, and students on enhancing visually impaired students' psychosocial adaptation.

Towards Career Satisfaction by Career Adaptation Model Among Individuals With Visual Impairment

The present study aimed to examine the fit of the career adaptation model for individuals with visual impairment. This study was conducted on 319 individuals with visual impairment. The results demonstrated the relationship between adaptivity and adaption was fully mediated by adaptability and adapting. In addition, career adaptability partially mediated the relationship between adaptivity and adapting. However, the results did not confirm the mediating role of adapting in the relationship between adaptability and adaptation. Finally, the results indicated the full mediator role of adaptability in the association between adaptivity and adaptation. The findings highlighted the important role of adaptability in the career adaptation model to explain career satisfaction. Therefore, intervention programs based on career adaptability can empower individuals with visual impairment and promote career satisfaction.

Barriers and facilitators to recognize and discuss depression and anxiety experienced by adults with vision impairment or blindness: a qualitative study

BACKGROUND

Depression and anxiety are highly prevalent, but often unrecognized in adults with vision impairment (VI) or blindness. The purpose of this study was to explore visually impaired and blind adults' views on facilitators and barriers in recognizing and discussing mental health problems.

METHODS

Semi-structured interviews, based on the Integrated Model for Change, were conducted with 16 visually impaired or blind adults receiving support from three Dutch low vision service organizations. Interview data was analyzed using the framework approach.

RESULTS

Participants perceived their focus on practical support with regard to their VI, lack of mental health literacy, and misattribution of symptoms of depression or anxiety as barriers for recognizing mental health problems. With regard to discussing mental health problems, they perceived difficulties in acknowledging their VI and mental health problems due to feelings of vulnerability and inequality. Participants mentioned that their social support system and healthcare providers (could) facilitate them in recognizing and discussing mental health problems. However, participants thought that healthcare providers currently often lacked the knowledge, skills and attitude to recognize and discuss this topic with their clients.

CONCLUSION

Our findings suggest that visually impaired and blind adults may experience several barriers to recognize, acknowledge and discuss mental health. Healthcare providers and social support systems seem essential for them in reducing these barriers. However, there might be a mismatch between the needs of visually impaired and blind adults and healthcare providers' knowledge, skills and attitude. Training healthcare providers may improve detection of depression and anxiety in adults with VI or blindness, and enhance clinician-patient communication on mental health.

The Meaning of Musicing in the Post-traumatic Growth of Individuals With Adventitious Visual Impairment: Applying the Life History Method by Mandelbaum

This study investigated individuals with adventitious visual impairment (AVI) acquired during adulthood through a traumatic event, for an in-depth and contextual understanding of the factors and processes that led to positive changes in their post-traumatic growth. The life history method was applied on 15 individuals with AVI (seven males and eight females) through in-depth interviews about their life. The study’s analytical framework involved three domains: dimensions, turnings, and adaptations of life, as proposed by Mandelbaum. The results revealed the following key factors: of the dimensions of life—family, rehabilitation center, and music groups; of turnings of life—positive change through awareness and tolerance of impairments, new challenge posed by rehabilitation training, and finding inner resources through music; and of adaptations of life—accepting one’s life in a harsh social environment, actively establishing relationships with others as an individual with visual impairment, and re-finding meaning of life through musicing. This study contributes by revealing the role of each of the above-mentioned factors and identifying their correlations. The results suggest that musicing may help individuals with AVI develop empathy and engage in social communication through active self-disclosure.

The Michigan Vision-Related Anxiety Questionnaire: A Psychosocial Outcomes Measure for Inherited Retinal Degenerations

OBJECTIVE

We sought to construct and validate a patient-reported outcome measure for screening and monitoring vision-related anxiety in patients with inherited retinal degenerations.

DESIGN

Item-response theory and graded response modeling to quantitatively validate questionnaire items generated from qualitative interviews and patient feedback.

METHODS

Patients at the Kellogg Eye Center (University of Michigan, Ann Arbor, Michigan, USA) with a clinical diagnosis of an inherited retinal degeneration (n = 128) participated in an interviewer-administered questionnaire. The questionnaire consisted of 166 items, 26 of which pertained to concepts of "worry" and "anxiety." The subset of vision-related anxiety questions was analyzed by a graded response model using the Cai Metropolis-Hastings Robbins-Monro algorithm in the R software mirt package. Item reduction was performed based on item fit, item information, and item discriminability. To assess test-retest variability, 25 participants completed the questionnaire a second time 4 to 16 days later.

RESULTS

The final questionnaire consisted of 14 items divided into 2 unidimensional domains: rod function anxiety and cone function anxiety. The questionnaire exhibited convergent validity with the Patient Health Questionnaire for symptoms of depression and anxiety. This vision-related anxiety questionnaire has high marginal reliability (0.81 for rod-function anxiety, 0.83 for cone-function anxiety) and exhibits minimal test-retest variability (ρ = 0.81 [0.64-0.91] for rod-function anxiety and ρ = 0.83 [0.68-0.92] for cone-function anxiety).

CONCLUSIONS

The Michigan Vision-Related Anxiety Questionnaire is a psychometrically validated 14-item patient-reported outcome measure to be used as a psychosocial screening and monitoring tool for patients with inherited retinal degenerations. It can be used in therapeutic clinical trials for measuring the benefit of an investigational therapy on a patient's vision-related anxiety.

Association of vision problems with psychosocial factors among middle-aged and older individuals: findings from a nationally representative study

Objectives: Little is known about the specific association of vision loss and psychosocial outcome measures in contrast to other health limitations. The aim of this study was to identify whether vision problems are associated with psychosocial outcomes among middle-aged and older adults and to compare it with the association between other chronic health conditions and psychosocial factors.Method: Cross-sectional data came from wave 5 (2014) of the German Ageing Survey which is a representative sample of non-institutionalized individuals ≥ 40 years in Germany. Psychosocial outcomes (life satisfaction, positive affect, negative affect, depressive symptoms, optimism, general self-esteem, and social isolation) were assessed using well-established and widely used scales. Self-rated trouble reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used as independent variables of interest.Results: Regressions showed that both 'vision problems: reading the newspaper' and 'vision problems: difficulties recognizing people' are consistently associated with worse psychosocial outcomes (decreased life satisfaction, decreased positive affect, increased negative affect, increased depressive symptoms, decreased optimism, decreased self-esteem and increased social isolation). In contrast, none of the physical illnesses was consistently associated with all psychosocial outcome measures.Conclusion: Adjusting for various potential confounders and in contrast to various chronic diseases, our findings emphasize an association between vision problems and worse psychosocial outcomes in middle-aged and older adults. Future longitudinal studies are needed to validate our findings.

The Impact of an Ocular Prosthesis on the Quality of Life, Perceived Stress, and Clinical Adaptation of Anophthalmic Patients: A Clinical and Longitudinal Trial

PURPOSE

This prospective study evaluated and correlated the impact of ocular prostheses on quality of life and stress with socioeconomic level and clinical characteristics. The clinical difficulties and perceptions of patients after ocular rehabilitation were evaluated.

MATERIALS AND METHODS

Anophthalmic patients (at least 18 years of age) who were not users of ocular prostheses were recruited. The Medical Outcomes Short-Form Health Survey (SF-36) and Perceived Stress Scale (PSS-10) questionnaires were administered before and after 3 and 6 months of prosthesis installation. Clinical characteristics, difficulties, and perceptions were evaluated by quantitative and descriptive analysis (7 days, 3 months, 6 months). Data were analyzed by the Friedman test and Pearson Correlation test (α = 0.05).

RESULTS

The final sample consisted of 26 patients. Quality of life showed improvement in the "Bodily Pain" and "General Health" domains. Wearing the prosthesis did not influence perceived stress. The clinical evaluation showed clinical discharge over 6 months and presence of pain only at 7 days. A weak correlation occurred between sociodemographic characteristics and the categories "Role-Physical" (r = 0.423) and "General Health" (r = 0.494); cause of anophthalmia and "Role-Physical" (r = -0.471); and type of surgery and "General Health" (r = -0.432).

CONCLUSIONS

According to the results of this study, the provision of ocular prostheses showed positive influence in 2 domains of quality of life and weak correlations with socioeconomic level, type of surgery, and cause of loss. Ocular rehabilitation did not influence stress. The use and care of the prostheses did not affect tissue inflammation, but the discharge was continuous.

Locus of Control in College Students with and Without Visual Impairments, and the Visual Characteristics that Affect It

Introduction:

According to previous research, locus of control (LOC) has a crucial role in an individual’s psychological well-being. The purpose of this study was 3-fold: (1) comparing LOC of college students with and without visual impairments while controlling for gender, educational level, and age; (2) investigating the relationship between LOC and visual characteristics in college students with visual impairments; and (3) predicting LOC of these students using their visual characteristics.

Methods:

The design of this study was causal-comparative. The statistical population included a sample of college students with and without visual impairments who were enrolled at the University of Isfahan, Iran. Fifteen of the 20 college students with visual impairments were selected through convenience sampling and amongst sighted students, 15 individuals were selected in a way that they were matched with college students with visual impairment regarding gender, educational level, and age. The Rotter Locus of Control Scale was used to measure LOC. Also, visual impairment characteristics and demographic data were collected. The results were analyzed by t-test and stepwise regression analysis.

Results:

Results indicated no significant difference between LOC of college students with and without visual impairments ( p > .05), and both groups tended to have internal LOC on average. The results indicated that adjustment to visual impairment and the recent status of visual impairment might predict the LOC of a college student who is visually impaired and explained 59.2% of its variance with this sample ( p < .005).

Discussion:

LOC of college students with visual impairments was similar to their sighted counterparts. The better adjusted the person was to his or her visual impairment and the less worsening the status of visual impairment was, the higher internal LOC he or she had.

Implications for practitioners:

Families and society can help individuals with visual impairments build their internal LOC, by teaching them how to adjust to their disability and providing them the conditions to increase their independence. At the same time, preparing them for entering university may also help them develop their sense of internal LOC.

Mastery and self-esteem mediate the association between visual acuity and mental health: a population-based longitudinal cohort study

BACKGROUND

With deteriorating eyesight, people often become dependent on others for many aspects of their daily lives. As a result, they feel less 'in control' and experience lower self-esteem. Lower sense of mastery and self-esteem are known to predict depression, but their roles in people with visual impairment have only marginally been investigated. Therefore, this study aimed to determine the influence of mastery and self-esteem on the relationship between visual acuity and mental health.

METHODS

A longitudinal cohort study was performed using data from the Longitudinal Aging Study Amsterdam (LASA), collected between 2001 and 2012. A community-based population of 2599 older adults were included, who were randomly selected from population registers. Outcomes of interest were the Pearlin Mastery Scale, Rosenberg Self-Esteem Scale, Center for Epidemiologic Studies - Depression scale and the Hospital Anxiety Depression Scale - Anxiety subscale. Linear mixed models were used to establish the association between visual acuity and mental health over time.

RESULTS

Mean age was 72 years, 56% was female and 1.2% qualified as having low vision. Visual impairment was associated with a lower sense of mastery (β = - 0.477, p < 0.001), lower self-esteem (β = - 0.166, p = 0.008) and more depression (β = 0.235, p < 0.001). No significant association between visual acuity and anxiety was found. The relationship between visual acuity and depression was mediated by self-esteem (25%) and sense of mastery (79%).

CONCLUSIONS

Vision loss was associated with depression. This association was mediated by self-esteem and sense of mastery. This provides us with new possibilities to identify, support and treat those at risk for developing depression by aiming to increase their self-esteem and sense of mastery.

"Cannot see? Use your strengths!" A randomized controlled trial of strengths intervention for improving self-esteem among visually impaired individuals

OBJECTIVE

To evaluate the association between strengths use and self-esteem among visually impaired individuals in Study 1 and reveal the causal effect of a strengths intervention in Study 2.

DESIGN

A prospective cross-sectional design in Study 1 and a randomized controlled, open-label, parallel-group comparative design in Study 2.

SETTING

Several welfare institutions for visually impaired individuals in the Kanto area of Japan.

SUBJECTS

In Study 1, 59 participants with visual impairments (mean age = 49.34 ± 4.89 years, range = 22-82 years) were recruited. In Study 2, participants (mean age = 41.36 ± 12.09 years, range = 22-61 years) were recruited and randomly assigned to an intervention (n = 11) or wait-list control group (n = 11).

INTERVENTION

A strengths intervention was performed in Study 2.

MAIN MEASURES

In Study 1, we examined the association between Strengths Use Scale and Rosenberg Self-Esteem Scale scores. In Study 2, the primary outcome was the difference in change in Rosenberg Self-Esteem Scale scores from baseline to one-month follow-up between the groups.

RESULTS

In Study 1, simple and multiple regression analyses revealed that the Rosenberg Self-Esteem Scale score was significantly associated with the Strengths Use Scale score (β = 0.60, P < 0.001; β = 0.55, P < 0.001, respectively). In Study 2, we found a significant between-groups difference in the improvement in Rosenberg Self-Esteem Scale scores from baseline to one-month follow-up (F(1, 19) = 18.61, P < 0.001).

CONCLUSION

Utilizing psychological strengths might improve self-esteem among visually impaired individuals.

Neuroprotective strategies for retinal disease

Diseases that affect the eye, including photoreceptor degeneration, diabetic retinopathy, and glaucoma, affect 11.8 million people in the US, resulting in vision loss and blindness. Loss of sight affects patient quality of life and puts an economic burden both on individuals and the greater healthcare system. Despite the urgent need for treatments, few effective options currently exist in the clinic. Here, we review research on promising neuroprotective strategies that promote neuronal survival with the potential to protect against vision loss and retinal cell death. Due to the large number of neuroprotective strategies, we restricted our review to approaches that we had direct experience with in the laboratory. We focus on drugs that target survival pathways, including bile acids like UDCA and TUDCA, steroid hormones like progesterone, therapies that target retinal dopamine, and neurotrophic factors. In addition, we review rehabilitative methods that increase endogenous repair mechanisms, including exercise and electrical stimulation therapies. For each approach, we provide background on the neuroprotective strategy, including history of use in other diseases; describe potential mechanisms of action; review the body of research performed in the retina thus far, both in animals and in humans; and discuss considerations when translating each treatment to the clinic and to the retina, including which therapies show the most promise for each retinal disease. Despite the high incidence of retinal diseases and the complexity of mechanisms involved, several promising neuroprotective treatments provide hope to prevent blindness. We discuss attractive candidates here with the goal of furthering retinal research in critical areas to rapidly translate neuroprotective strategies into the clinic.

Strengths use as a secret of happiness: Another dimension of visually impaired individuals' psychological state

It is well recognized that visual impairments (VI) worsen individuals’ mental condition. However, little is known about the positive aspects including subjective happiness, positive emotions, and strengths. Therefore, the purpose of this study was to investigate the positive aspects of persons with VI including their subjective happiness, positive emotions, and strengths use. Positive aspects of persons with VI were measured using the Subjective Happiness Scale (SHS), the Scale of Positive and Negative Experience-Balance (SPANE-B), and the Strengths Use Scale (SUS). A cross-sectional analysis was utilized to examine personal information in a Tokyo sample (N = 44). We used a simple regression analysis and found significant relationships between the SHS or SPANE-B and SUS; on the contrary, VI-related variables were not correlated with them. A multiple regression analysis confirmed that SUS was a significant factor associated with both the SHS and SPANE-B. Strengths use might be a possible protective factor from the negative effects of VI.

Assisting the visually impaired to deal with telephone interview jobs using information and commutation technology

This study proposed a new information and commutation technology assisted blind telephone interview (ICT-ABTI) system to help visually impaired people to do telephone interview jobs as normal sighted people and create more diverse employment opportunities for them. The study also used an ABAB design to assess the system with seven visually impaired people. As the results, they can accomplish 3070 effective telephone interviews per month independently. The results also show that working performance of the visually impaired can be improved effectively with appropriate design of operation working flow and accessible software. The visually impaired become productive, lucrative, and self-sufficient by using ICT-ABTI system to do telephone interview jobs. The results were also shared through the APEC Digital Opportunity Center platform to help visually impaired in Philippines, Malaysia and China.

The impact of individual characteristics in self-esteem and locus of control of young adults with visual impairments

In this study the impact of personal/individual characteristics (gender, vision status, age, age at loss of sight, recency of vision loss, education level, employment status, and ability of independent movement) in locus of control (LOC) and self-esteem were examined. Eighty-four young adults with visual impairments (42 with blindness and 42 with low vision) took part in this study. The significant predictors of self-esteem were vision status, age at loss of sight, recency of vision loss and educational level. Moreover, significant predictors of LOC were vision status and independent movement.