Female blind baseball players against gender discrimination: the "red diamonds" experience

Background

Sport has the well-known power of improving body awareness, self-esteem, and social interaction, thus promoting quality of life and psychophysical wellbeing. Specifically referring to adapted disciplines, habitual practice often becomes an effective integration and self-efficacy booster. Among disabilities, visual impairment deeply alters body image perception, autonomy, and environmental/social interaction heavily reducing sport or leisure involvement opportunities. In particular, visually impaired women represent one of the most vulnerable categories to gender and disability discrimination. Moreover, even when congenitally sightless, they perceive social pressure of mainstream beauty ideals, mostly spread by media, comparable to their sighted peers. On these premises and the previously demonstrated psychophysical benefits of Italian blind baseball practice on this target population, the present study aimed to deepen the social and educative potentialities of such adapted sport applying a more sociological research approach.

Methods

The "red diamonds" event, namely, the first ever female blind baseball match, was the setting for the administration of our structured online survey. In detail, our survey comprised different evaluation tools such as the 18-item Psychological Well-Being Scale, the 12-item Short Form questionnaire, the Dresden Body Image questionnaire, the Rosenberg Self-Esteem Scale, and sociological model designed questions. Quality of life, psychological wellbeing, self-esteem, body image, and perceived female sport psychological violence were investigated in the whole women sample (n = 33) voluntarily adhering to the game.

Results

Survey results revealed no statistically significant differences between visually impaired players (n = 13; mean age: 32.84 ± 12.05 years) and sighted on-field subjects (i.e., coaches, assistants, and referees; n = 20; mean age: 47.15 ± 12.31 years) in almost all the inquired variables, thus remarking the social and functional benefits of adapted sport through the "dual embodiment" and empowerment phenomenon.

Conclusions

Given that the event was inspired by and performed on the World Day against women violence, our study deepened not only the topic of disability discrimination but also the currently alarming gender-related one. In such a context, the present research might provide interesting cues for further investigations on disability and gender disparities in sports, hence spreading interest in this under-investigated field. In perspective, the "red diamonds" experience could also contribute to inspiring and progressively developing educative tools against any kind of discrimination by promoting integration and social growth through regular sports practice.

Reliability of Binocular Esterman Visual Field Test in Patients with Glaucoma and Other Ocular Conditions

The binocular Esterman visual field test (EVFT) of 120 points was the first method to quantify the defects in the binocular visual field. It is used in many parts of the world as a standard test to determine whether an individual has the visual capabilities to drive safely. In Japan, it is required for the grading and issuance of visual disability certificates. The purpose of this study was to determine the reliability of the EVFT results. We studied 104 patients who had undergone the binocular EVFT at Mie University Hospital. Their mean age was 68.0 ± 11.4 years, and the best-corrected visual acuity of the better eye was 0.18 ± 0.38 logMAR units. The EVFT was performed twice on the same day, and the results of the first and second tests were compared. The mean Esterman scores for the first and second test were 89.3 ± 30.5 and 89.1 ± 30.2, respectively, and the test times were 338.9 ± 86.8 and 336.7 ± 76.4 s, respectively. The differences were not significant (p = 0.69 and p = 0.33). In the Bland-Altman analyses (second-first test) of the Esterman scores, the mean difference was 0.38 without significant fixed errors (p = 0.20) or proportional errors (p = 0.27). The limits of agreement within the 1.96 standard deviation were -8.96 to +9.45 points. The agreement rate for the most peripheral 24 test points was significantly lower than the agreement rate for the other 96 test points (p < 0.01). The agreement rate of the upper visual field was significantly lower than that of the lower field (p < 0.01). The overall reliability rate of the EVFT is acceptable, but the peripheral and upper test points have relatively low reliability rates. These findings are important for interpretations of the EVFT results.

Universal design of instruction to enhance learning for university students with visual disabilities

Background

There has been a steady increase in the number of students with disabilities (SWD) in Higher Education Institutions (HEIs) in South Africa, with a significant number of students having visual disabilities. Equal access remains a key challenge in the classroom setting, thus emphasising a significant gap.

Objectives

This paper capitalised on the significance of this gap and examined the potential of Universal Design of Instruction (UDI) to promote equal access for students with visual disabilities (SWVDs) in the classroom within a university setting in order to maximise learning outcomes.

Method

The study was conducted at the University of KwaZulu-Natal (UKZN), which had approximately 204 SWVDs. This paper draws primarily on the quantitative component of the study. Data collection entailed distributing a questionnaire to all SWVDs. Analysis was conducted using SPSS 21, which produced descriptive and inferential statistics. The theoretical framework of Sen's Capability Approach in line with the Social Model of Disability was applied.

Results

Findings indicated a lack of UDI in the classroom with very little compliance to all principles, resulting in increased challenges in teaching and learning for SWVDs. The incorporation of UDI in the classroom does have a positive correlation with learning outcomes.

Conclusion

The incorporation of UDI principles can offer a potential design for easier access to teaching and learning to enhance and maximise learning outcomes; alleviate access challenges in the classroom; and address the negative experiences thereof for SWVDs.

Contribution

The study adds value to the scarce body of knowledge on UDI in the classroom for university SWVDs from a learning enhancement perspective.

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.

Assessing the implementation of user-centred design standards on assistive technology for persons with visual impairments: a systematic review

Despite scientific and technological advances in the field of assistive technology (AT) for people with visual impairment (VI), technological designs are frequently based on a poor understanding of the physical and social context of use, resulting in devices that are less than optimal for their intended beneficiaries. To resolve this situation, user-centred approaches in the development process of AT have been widely adopted in recent years. However, there is a lack of systematization on the application of this approach. This systematic review registered in PROSPERO (CRD42022307466), assesses the application of the ISO 9241-210 human-centred design principles in allegedly "user-centred designed" AT developments for persons with VI (see Supplementary PROSPERO Protocol). The results point to a wide variation of the depth of understanding of user needs, a poor characterization of the application of the User Centred Design (UCD) approach in the initial design phases or in the early prototyping, and a vague description of user feedback and device iteration. Among the principles set out in ISO 9241-210, the application of 5.6: "the design team includes multidisciplinary skills and perspectives" is the one for which the least evidence is found. The results show there is not enough evidence to fully assess the impact of UCD in (1) promoting innovation regarding AT products and practices, and (2) Judging if AT produced following such standards is leading to better user access, wellbeing outcomes and satisfaction. To address this gap it is necessary to, first, generate better implementation of UCD in AT development and second, to strengthen evidence regarding the implementation and outcomes of using UCD for AT. To better engage with the realities of persons with VI, we propose capacity building across development teams regarding UCD, its principles and components; better planning for UCD implementation; and cross-fertilization across engineering disciplines and social and clinical science.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=307466 PROSPERO (CRD42022307466).

Increased risk of Parkinson's disease amongst patients with age-related macular degeneration and visual disability: A nationwide cohort study

BACKGROUND AND PURPOSE

The association between Parkinson's disease (PD) and age-related macular degeneration (AMD) has been shown in previous reports. However, the association between the severity of AMD and PD development is unknown. The aim was to evaluate the association of AMD with/without visual disability (VD) with the risk of PD occurrence using the National Health Insurance data in South Korea.

METHODS

A total of 4,205,520 individuals, 50 years or older and without a previous diagnosis of PD, participated in the Korean National Health Screening Program in 2009. AMD was verified using diagnostic codes, and participants with VD were defined as those with loss of vision or visual field defect as certified by the Korean Government. The participants were followed up until 31 December 2019, and incident cases of PD were identified using registered diagnostic codes. The hazard ratio was calculated for groups (control and AMD with/without VD) using multivariable adjusted Cox regression analysis.

RESULTS

In total, 37,507 participants (0.89%) were diagnosed with PD. Amongst individuals with AMD, the risk of PD development was higher in individuals with VD (adjusted hazard ratio [aHR] 1.35, 95% confidence interval [CI] 1.09-1.67) than in those without (aHR 1.22, 95% CI 1.15-1.30) compared with controls. Additionally, an increased risk of PD was observed in individuals with AMD compared with controls, regardless of the presence of VD (aHR 1.23, 95% CI 1.16-1.31).

CONCLUSIONS

Visual disability in AMD was associated with the development of PD. This suggests that neurodegeneration in PD and AMD may have common pathways.

Reactive Agility and Pitching Performance Improvement in Visually Impaired Competitive Italian Baseball Players: An Innovative Training and Evaluation Proposal

Visual input significantly affects kinesthesis skills and, hence, visually impaired individuals show less developed sensorimotor control, especially in an unfamiliar outdoor environment. Regular blind baseball practice can counteract such a deficit but, given the complex kinetic chain model required, a targeted workout proposal is needed to improve the main athletic gesture performance. On these premises, we investigated, for the first time, the running and pitching performance of a competitive Italian blind baseball team through quantitative tools and parameters such as Libra Easytech sensorized proprioceptive board, goniometric active range of motion, chronometric speed, and pitching linear length. Moreover, the perceived physical exertion was assessed by the Borg CR10 scale. Consequently, an adapted athletic training protocol was designed and tested on the field during the competitive season, with the aim to strengthen sport specific-gesture coordination and efficacy as well as to prevent injuries. Quantitative assessments showed an improvement in ankle stability index, bilateral upper limb and hip mobility, reactive agility, running braking phase control during second base approaching, and auditory target-related pitching accuracy along with a decrease in perceived physical exertion. This protocol might therefore represent an effective and easily reproducible training and evaluation approach to tailor management of visually impaired baseball players, and safely improve their athletic performance under the supervision of an adapted exercise specialist.

Age-Related Macular Degeneration With Visual Disability Is Associated With Cardiovascular Disease Risk in the Korean Nationwide Cohort

Background Age-related macular degeneration (AMD) is the leading cause of visual disability. AMD shares some risk factors with the pathogenesis of cardiovascular disease (CVD). However, previous studies examining the association between AMD and the risk of CVD provide conflicting results. Hence, we investigated the association between AMD, visual disability, and the risk of CVD. Methods and Results This is a nationwide cohort study using data from the Korean National Health Insurance System database (2009-2019) on subjects who underwent a national health screening program in 2009. A total of 3 789 963 subjects were categorized by the presence of AMD and visual disability. Visual disability was defined as a best-corrected visual acuity of ≤20/100 by validated documentation from a specialist physician. Cox regression hazard model was used to examine the hazard ratios (HRs) of CVD, including myocardial infarction and ischemic stroke, after adjusting for potential confounders. During a mean 9.77 years of follow-up, AMD was associated with a 5% higher risk of myocardial infarction (adjusted HR [aHR], 1.05 [95% CI, 1.01-1.10]) but not associated with increased risk of overall CVD (aHR, 1.02 [95% CI, 1.00-1.05]) or ischemic stroke (aHR, 1.02 [95% CI, 0.98-1.06]). However, when AMD was accompanied by visual disability, there was increased risk of CVD (aHR, 1.17 [95% CI, 1.06-1.29]), myocardial infarction (aHR, 1.18 [95% CI, 1.01-1.37]), and ischemic stroke (aHR, 1.20 [95% CI, 1.06-1.35]). These trends were more evident in women and subjects with cardiometabolic comorbidities. Conclusions AMD with visual disability, but not all AMD, was associated with an increased risk of CVD. Patients with AMD who have visual disability should be targeted for CVD prevention.

Breaking Down Barriers: Findings from a Literature Review on Housing for People with Disabilities in Latin America

Accessibility to housing is crucial for people with disabilities as it provides them with equal opportunities and allows them to live independently. A systematic literature review has been conducted to understand the current research on accessibility in housing for people with disabilities in Latin America. The study analysed 56 papers and used co-word analysis to identify common themes and topics within the documents. The results of the analysis showed that Brazil (61%) is the country with the most research on the subject, physical disability, at 36%, is the impairment most analysed, and interventions or analysis for the older people (45%) in their homes is the most researched type of population. The co-word analysis revealed that topics such as policy, regulations, the use of technologies, ergonomics interventions, and architectural criteria or barriers to the daily life of disabled people were frequently discussed in the papers. Although this work shows a substantial and growing increase in research on housing for people with disabilities in Latin America, it also demonstrates the importance of increasing research on other types of impairment, such as visual and cognitive-intellectual disabilities, and including children, caregivers, or even young adults.

Vision related quality-of-life among patients with traumatic or non-traumatic ocular disease and its association with the Rights of Persons with Disabilities Act: Unveiling-the-hidden

Purpose

To assess vision-related quality of life (VrQoL) in cases with visual loss after ocular trauma (OT) or non-traumatic ocular disease (NTOD) using the National Eye Institute's 25-Item Visual Function Questionnaire 25 (VFQ-25) and its association with visual disability % (VD%) based on the Rights of Persons with Disabilities (RPwD) Act, 2016.

Methods

This was a prospective observational study conducted among cases with ocular morbidity in either or both eyes with a visual acuity of ≤6/24. VFQ-25 questionnaire was administered to measure QoL scores. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 23. P < 0.05 was taken as significant.

Results

Eighty-eight respondents completed the questionnaire. Mean age of participants was 40.272 ± 9.35 years (range: 23-55 years). Forty-three (48.9%) and 45 (51.1%) participants had OT and NTOD, respectively. The most common cause was traumatic optic neuropathy (21.6%) followed by corneal causes (19.4%). Low visual QoL scores were reported in all the cases (57.52 ± 16.08). Between OT and NTOD, a significant difference in terms of age (P = 0.001) and general vision (P = 0.03) was seen. Lowest scores were for driving. Based on VD%, 77 cases had ≤40 and the rest had >40% VD with a significant difference in overall mean scores (P = 0.03), specifically in domains of general vision (P = 0.00), near activities (P = 0.00), and driving (P = 0.007). QoL was decreased in each subscale of ≤40%VD group, who faced the same predicament everywhere as by the cases with more disability.

Conclusion

Ocular morbidity is associated with low QoL, predominantly in domains like general vision, near activities and driving. The RPwD Act leaves out a huge population with VD without any government benefits. One might need to consider other vision-related factors also to provide them with social, psychological, and employment benefits.

How Face Masks Affect the Use of Echolocation by Individuals With Visual Impairments During COVID-19: International Cross-sectional Online Survey

Background

Although a critical safety measure, preliminary studies have suggested that the use of a face mask may pose a problem for some users with disabilities. To date, little is known about how the wearing of a traditional face mask may pose a barrier to individuals with visual impairments who draw on auditory cues and echolocation techniques during independent travel.

Objective

The goal of this study was to document the difficulties, if any, encountered during orientation and mobility due to the use of a face mask during the COVID-19 pandemic and the strategies used to address these barriers.

Methods

In total, 135 individuals aged 18 years and older who self-identified as being blind, being deafblind, or having low vision and who could communicate in either English or French completed an anonymous cross-sectional online survey between March 29 and August 23, 2021.

Results

In total, 135 respondents (n=52, 38.5%, men; n=83, 61.5%, women) between the ages of 18 and 79 (mean 48.22, SD 14.48) years participated. Overall, 78 (57.7%) self-identified as blind and 57 (42.3%) as having low vision. In addition, 13 (9.6%) identified as having a combined vision and hearing loss and 3 (2.2%) as deafblind. The most common face coverings used were cloth (n=119, 88.1%) and surgical masks (n=74, 54.8%). Among the barriers raised, participants highlighted that face masks made it more difficult to locate people (n=86, 63.7%), communicate with others (n=101, 74.8%), and locate landmarks (n=82, 60.7%). Although the percentage of those who used a white cane before the pandemic did not substantially change, 6 (14.6%) of the 41 participants who were guide dog users prior to the pandemic reported no longer working with a guide dog at the time of the survey. Moreover, although guide dog users reported the highest level of confidence with independent travel before the pandemic, they indicated the lowest level of confidence a year after the pandemic began.

Conclusions

These results suggest that participants were less able to draw on nonvisual cues during independent travel and social interactions due to the use of a facemask, contributing to a reduction in perceived self-confidence and independence. Findings inform the development of evidence-based recommendations to address identified barriers.

Survey on Psychological Well-Being and Quality of Life in Visually Impaired Individuals: Dancesport vs. Other Sound Input-Based Sports

Sport practice has the widely demonstrated potential of promoting well-being and physical/mental health, especially in disabled individuals. Nowadays, visually impaired people can participate in several sports commonly adapted and played substituting visual input with auditory or tactile ones. By integrating movement and music, dance can simultaneously promote physical and emotional involvement and enhances vicarious sense recruitment. On these premises, we performed a survey to assess the psychological well-being (PWB) and quality of life (QoL) in visually impaired athletes, comparing dancesport vs other sound input-based sports. Twenty-one visually impaired dancers and twenty-seven visually impaired athletes practicing adapted baseball, showdown, blind futsal, or blind tennis completed a structured self-report survey including the Italian version of PWB-18 scale and the Short Form-12 (SF-12) questionnaire. Dancers reported significantly higher scores in PWB-18 autonomy, environmental mastery, and self-acceptance along with a higher PWB total score than the other athlete group. Similarly, the SF-12 questionnaire results demonstrated significantly higher scores in both physical and mental QoL of visually impaired dancers compared with other athletes. In conclusion, our findings suggest that, given its peculiarities, the practice of dancesport may have a stronger positive impact on PWB and QoL of visually impaired individuals than other sound input-based sports.

Validation of an eBAT as a mobility aid for blind people

One of the challenges faced by blind persons to achieve optimal mobility is the detection and avoidance of obstacles located in their travel path. Besides the widely used white cane, alternative or complementary devices have been developed, such as electronic aids that provide feedback about the environment. However, the devices available have been unable to provide an optimal solution with widespread acceptance, motivating the present work. The eBAT (electronic Buzzer for Autonomous Travel) is designed to offer optimal protection and employs the user's own mobile phone for easier use and reduced manufacturing costs. For this work, a group of 25 blind individuals was used to validate the eBAT based on the single-subject with reversal method (ABA study). The results show a significant decrease in the number of involuntary contacts in an unknown travel path between the first phase of the study, which did not involve the eBAT, and the second, where it was used. When the device was again removed in the third phase, the number of contacts rose. We may therefore conclude that the eBAT fills an important gap in mobility aids for blind people, yielding a clear benefit by reducing the participants' feeling of insecurity.

Influence of Physical Activity and Sport on the Inclusion of People with Visual Impairment: A Systematic Review

People with visual impairment have greater difficulty in accessing physical activity and sport, and a lack of social interaction is also associated with a risk of exclusion. Work is currently being done to include people with visual impairment through physical activity and sport. However, there is a lack of studies examining the status and overall effectiveness of interventions in the pre- and post-COVID stage. This study aimed to provide solid evidence on the characteristics and effectiveness of interventions for the inclusion of people with visual impairment through physical activity and sport in order to address the need for dissemination on this topic. The bibliographic search was carried out with the words "Physical activity", "Physical exercise", "Sport", "Physical training", "visual disability", "visual impairment" and "inclusion" in the databases PubMed, Scopus, Web of Science and Google Scholar from 2018 to 2021.The article selection process was according to the PRISMA protocol with a final selection of nine articles. The main results highlighted that the programmes improve the perception of people with disabilities, increase social skills and health and increase the social importance of people with disabilities in the social environment. Among the most generalised conclusions were the need for specialised training, the need for social inclusion and participation of people with visual impairment in their environments and increased physical activity.

The Impact of COVID-19 on Individuals with Hearing and Visual Disabilities during the First Pandemic Wave in Italy

BACKGROUND

The COVID-19 pandemic has imposed radical behavioral and social changes in the general population, significantly impacting the lives of individuals affected by disabilities. The aim of this study was to investigate the impact of COVID-19 on non-institutionalized subjects with sensorineural disabilities during the first COVID-19 wave in Italy.

METHODS

A 39-item online national survey was disseminated from 1 April 2020 to 31 June 2020 via social media throughout Italy to communities of individuals with proven severe sensorineural disabilities, affiliated to five national patient associations. The survey collected extensive information on the socio-demographic profile, health, everyday activities, and lifestyle of individuals with hearing and visual disabilities.

RESULTS

One hundred and sixty-three respondents with hearing (66.9%) and visual (33.1%) disabilities returned a usable questionnaire. The mean age of interviewees was 38.4 ± 20.2 years and 56.3% of them were females. Despite the vast majority of respondents (77.9%) perceiving their health status as unchanged (68.8% of interviewees with hearing deficits vs. 96.3% of those with visual impairments), about half the interviewees reported sleep disorders during lock-down, more likely those with visual deficits. Remote services were seemingly more effective for business than school activities. Furthermore, although just 18.8% of respondents rated remote rehabilitation care unsatisfactory, only 12.8% of interviewees felt supported by health and social services during the COVID-19 emergency. The vast majority of respondents were concerned about the future and the risk of SARS-CoV-2 contagion, particularly individuals with hearing impairments. Among the various risk mitigation measures, facemasks caused the greatest discomfort due to communication barriers, particularly among interviewees affected by hearing disabilities (92.2% vs. 45.7%). The most common request (46.5%) of respondents to reduce the inconveniences of the COVID-19 emergency country lock-down was improving the access to and delivery of health and social services for individuals with sensorineural disabilities (19.3%), followed by the use of transparent masks (17.5%).

CONCLUSIONS

Although health protection measures such as face masks and social distancing play a key role in preventing and controlling the spread of SARS-CoV-2, the unmet needs of disabled individuals should be carefully considered, especially those affected by sensory disabilities. Tailored access to health and social services for individuals affected by sensorineural disabilities should be implemented. Additional actions should include the use of to face masks to reduce communication barriers linked to hearing-impairment, as well as the improvement of remote services, especially distance learning at school.

Causes of Visual Impairment Among the Registered Visually Disabled: A Retrospective Study

Purpose

To study the causes of visual impairment among Bahraini patients registered as visually disabled.

Materials and methods

A retrospective descriptive study of all patients referred to the Ministry of Social Development for visual disability from January 2014 to December 2019 was performed. Information recorded were age, gender, the cause of the visual impairment, and visual acuity in the better eye. If a patient had multiple ophthalmic diseases, the untreatable disease causing visual impairment was recorded. Patients were considered to have visual impairment according to World Health Organization criteria.

Results

A total of 484 Bahraini patients were included in the study. The mean age was 57.3 years of age ranging from 3 to 100 years; 63% of the total cases were males. The most common cause of visual impairment was diabetic retinopathy (DR) 201 (41.53%), followed by glaucoma 161 (33.26%). This is followed by hereditary and congenital disorders 34 (7.02%), glaucoma combined with DR 21 (4.34%), other retinal diseases 17 (3.51), retinitis pigmentosa 14 (2.89), optic atrophy 9 (1.86), corneal disorders 8 (1.65%), age-related macular degeneration 8 (1.65%), and others 11 (0.83%).

Conclusion

DR and glaucoma are the major causes of visual impairment among adults. Complications leading to visual impairment of both disorders are avoidable. Prevention measures to be taken control these diseases and prevent their morbidity. Congenital and hereditary disorders are the most common causes of visual impairment among children.

Developing a disability inclusive model for low vision service

The current practice for low vision management in India exclusively focuses on clinical aspects without much of the rehabilitation components. While making all efforts to improve independent living skills, daily living activities, and quality of life as a whole for people living visual disabilities, vision rehabilitation is an indispensable component. There is no single appropriate low vision and rehabilitation model implementable at health care institutions in the country to cover these fundamental aspects of a visually impaired individual. We did a literature review to know the existing practices of low vision and various disability models. The purpose of the review is to discern any pitfalls and shortcomings in managing visually disabled in India and to underpin the credibility and feasibility as well as suitability of the developed model. The review was done using search key terms low vision, current practices, visual disability, disability models, vision rehabilitation, and service delivery. Therefore, the article discusses the development of an inclusive low vision management model name as “Clinico-Social Model”, which we consider the most appropriate for the best management of people with vision loss. The primary aim of this model is to provide both clinical and vision rehabilitation components of management for people with visual disabilities. Such an approach is likely to have the potential to improve the quality of life of people with vision loss and can provide practical guide to eye care managers across India. Given the specific context in the current practices of low vision in India, it is desirable to design a similar model to care for the visually disabled.

Sounds That People with Visual Impairment Want to Experience

This article presents the expectations of visually impaired people with regard to the content of a set of sound exercises planned for implementation, which will mainly enable these people to become familiar with the sounds associated with specific life situations. Consultations were carried out with 20 people with visual impairment, which allowed for the recognition of the needs of these people regarding the sounds with which they wish to become acquainted. The 35 initially proposed sounds were assessed using a five-grade scale. These sounds included those that would be heard in a number of situations in which a person with a visual impairment could potentially be found, both at home and, for example, while in the street or at an office. During the consultations, people with visual impairment usually rated the sounds proposed for inclusion in the set of sound exercises as highly relevant or relevant. In most cases, the assessment was analogous regardless of whether the person had a visual impairment since birth or developed it relatively recently. There were also more than 100 sounds that were proposed for inclusion in the set. The results of the consultation demonstrate how important the information contained in sound is for people with visual impairment.

Using Public Datasets to Identify Priority Areas for Ocular Telehealth

Purpose: Telemedicine can expand access to ocular services, but barriers include restrictive policies and poor reimbursement. A tool to identify priority regions for interventions is needed. Methods: Eye care provider (ECP) density, self-reported visual disability, and demographics were calculated using census data and professional registries. The relationship between visual disability and ECP density was explored in fractional regression models. These data were compared with state telemedicine policy favorability. Results: For each additional ECP per 100,000 population, there was 0.0111% less disability in the county (95% confidence interval -0.0150% to -0.00719%) in an adjusted model. Of 3,142 counties, 1,078 (34%) were in the worst population-weighted quartile for ECP density and visual disability. Conclusions: Low ECP density is associated with higher visual disability, suggesting an opportunity for ocular telehealth. Counties with favorable policy climates should be prioritized for telemedicine implementation. Public datasets can be used to survey wide geographic areas to identify areas worthy of detailed needs assessments.

Early age of onset predicts severity of visual impairment in patients with neuromyelitis optica spectrum disorder

BACKGROUND

Severe residual visual loss (SRVL) is frequent in neuromyelitis optica spectrum disorders (NMOSD). Identifying higher-risk patients at onset is important to prevent disability accumulation.

OBJECTIVE

To determine predictors of SRVL in a large NMOSD cohort.

METHODS

Patient characteristics at last visual acuity (VA) evaluation were retrospectively collected. VA was scored 0: better than 20/40, 1: 20/40-20/99, 2: 20/100-20/200, and 3: worse than 20/200. SRVL was defined as a combined score (VA worst + best eye) ⩾ 4. Descriptive statistics were used to compare groups and logistic regression to evaluate predictors of VA.

RESULTS

106 patients (mean age at disease onset (AO): 35.8 ± 16.5 years) were included. Patients with SRVL had earlier AO (mean: 26.7 vs 38.0 years) compared to non-SRVL group (p = 0.005). Patients with AO < 21 years were more likely to have SRVL, be blind, present with binocular optic neuritis, have recurrent optic neuritis, and receive oral therapy first-line than those with AO ⩾ 21. After adjusting for race, sex, and disease duration, the odds of SRVL were 4.68 times higher in patients < 21 at disease onset (95% CI: 1.53-14.34, p = 0.007).

CONCLUSION

Early AO predicts SRVL in NMOSD, independent of disease duration. High-efficacy therapies should be considered for first-line treatment in this group.

Analysis of visual disability in Buenos Aires, Argentina. Pathologic myopia is the leading cause in working age

This study assessed the causes of visual impairment over a decade in Buenos Aires City. This is a retrospective case series where we reviewed the database of visual disability certificates issued by the Buenos Aires City Ministry of Health between 2009 and 2017. In Argentina, visual disability is defined as a visual acuity = 20/200 in the better eye, or a corresponding visual field of less than 20 degrees in the less impaired eye. The database included the following variables: year of issue, age, gender, and cause of visual disability. Between 2009 and 2017 a total of 7656 subjects were certified as legally blind. The mean age of the sample was 57 ± 21 years and 52.1% were females. The emission was near 700 certificates per year. The age distribution showed that 62.8% of certificates were from patients older than 50 years and that only 6.6% were given to subjects under 20. The leading causes of visual disability in Buenos Aires City were age-related macular degeneration (ARMD) with a rate of 15.5%, degenerative myopia (14.4%), primary open-angle glaucoma (11.3%) and diabetic retinopathy (6.6%). In subjects younger than 50, degenerative myopia was the first cause of visual disability. Interestingly in Argentina, where the prevalence of myopia is low, degenerative myopia is found to be the major cause of visual disability in middle-aged adult subjects. Population and clinical methods to avoid this preventable disease should need to be implemented as a matter of urgency.

Intervention effects on professionals' attitudes towards the participation of adults with visual and severe or profound intellectual disabilities

Background

We investigated the effects of the “Care for Participation+” (CFP+) intervention on direct support professionals’ (DSPs’) attitudes regarding the participation of adults with visual and severe or profound intellectual disabilities (VSPID).

Methods

We implemented a pilot non‐randomized controlled trial with two control groups to compare DSPs’ attitudes towards CFP+ using the Attitudes towards Participation Questionnaire (APQ) and DSPs’ written profiles of adults with VSPID.

Results

CPP+ and the Participation Mind Map control group showed a positive trend for the “leisure/recreation,” “social relations,” and “ability to act” APQ domains compared to the usual care control group. The CFP+ group described significantly fewer disabilities at 6 months, reflecting a more positive attitude than controls.

Conclusion

CFP+ had positive effects on DSPs’ attitudes towards the participation of adults with VSPID. The small sample size, ceiling effects, measurement instruments used, and implementation difficulties may have hampered understanding the full potential of CFP+.

A New System for Assessing Visual Disability Using a Digital Visor

Background: Considering the lack of universally accepted visual requirements for driving and for defining various grades of visual disability, the aim of this study is to propose a new method that provides a numerical score resulting from a combined assessment of the visual field and visual acuity loss obtained using a digital technology visor. Methods: This study presents a new system for calculating the percentage of visual disability by combining binocular visual acuity and binocular visual field assessments. A new Global Vision Evaluation System digital technology visor uses standardized, reproducible criteria to produce well-defined, numerically expressed test results. Through a specific algorithm, the device produces a numerical value expressing the percentage of visual disability. Results: Eighty-six subjects with various types of visual impairment underwent visual acuity and visual field test examinations carried out employing both traditional methods and the new digital visor. The two methods provided homogeneously similar results regarding the positioning of the subjects on the visual disability scale. Conclusions: The new digital visor seems to be a valid method to ensure that visual disability assessments are more homogeneous and reliable, and that, consequently, the resources available for this purpose are more fairly distributed.

A Clinical Audit on the Predictors for Visual Morbidity in Patients with Behçet's Disease Attending Cairo University Hospitals

OBJECTIVES

To study the visual disability predictors in Behçet's disease (BD).

METHODS

A cross-sectional observational study including 54 patients. Sociodemographic and cumulative clinical characteristics were obtained. Ophthalmic examination focused on disease activity and degree of visual loss.

RESULTS

Presenting features included oral ulcers, orogenital ulcers, uveitis, and vascular involvement. Ocular involvement was also present in a majority of the cases 74.1%. The age at onset had no significant effect on diagnostic time lag (P = .9), unlike rural residency (P = .02). Laterality, ocular activity, and interventions significantly affected final visual acuity (P˂0.001). A diagnostic time lag ≥ 9 months significantly affected final visual acuity (P = .039).

CONCLUSION

BD is associated with considerable vision loss at a young age. Panuveitis, bilaterality, ocular activity, and interventions are significant predictors. A diagnostic time lag ≥ 9 months is associated with poor visual outcomes and is significantly associated with rural residency.

Towards the Recognition of the Emotions of People with Visual Disabilities through Brain-Computer Interfaces

A brain–computer interface is an alternative for communication between people and computers, through the acquisition and analysis of brain signals. Research related to this field has focused on serving people with different types of motor, visual or auditory disabilities. On the other hand, affective computing studies and extracts information about the emotional state of a person in certain situations, an important aspect for the interaction between people and the computer. In particular, this manuscript considers people with visual disabilities and their need for personalized systems that prioritize their disability and the degree that affects them. In this article, a review of the state of the techniques is presented, where the importance of the study of the emotions of people with visual disabilities, and the possibility of representing those emotions through a brain–computer interface and affective computing, are discussed. Finally, the authors propose a framework to study and evaluate the possibility of representing and interpreting the emotions of people with visual disabilities for improving their experience with the use of technology and their integration into today’s society.

Progressive resistance training for persons with intellectual disabilities and visual impairment

BACKGROUND

Knowledge concerning the feasibility and effects of progressive resistance training (PRT) for persons with intellectual disabilities and visual impairment who are categorized in Gross Motor Function Classification System (GMFCS) Level 1 is limited. The aim of our study was to evaluate feasibility and effect of PRT on participants' Quadriceps strength and personal goals.

METHODS

Eight Participants followed a PRT program for 10 weeks. Feasibility was determined by percentage of attendance and compliance. The effect of PRT was analyzed with a linear mixed model (p < 0.05) and by normalized bootstrap (95% CI).

RESULTS

Participants attended 87.8% of the sessions and trained according to the PRT program, indicating sufficient compliance. Quadriceps strength increased significantly by 69%, and participants' personal goals were achieved.

CONCLUSION

PRT is a feasible and potentially effective method for increasing Quadriceps strength as well as achieving personal goals in persons with intellectual disabilities and visual impairment with GMFCS Level 1.

Assistive technology for students with visual disability in schools for the blind in Delhi

Background: To understand the awareness and utilization of assistive technology in students at schools for the blind in Delhi.Methods: A cross sectional study was conducted among 250 students selected randomly from 10 blind schools in Delhi. Binocular distance presenting and pinhole vision acuity were assessed using Snellen "E" chart and a multiple pinhole occluder. Students were also interviewed using a questionnaire about 42 assistive devices to understand their awareness and use.Results: Male participants were 72.8%. Of the total, 27.6% students had best corrected visual acuity <6/18 to 1/60, and the rest had <1/60 vision. The awareness about tactile and sound-based technology was good among students: Braille books (98%), Braille slate and stylus (99.2%), handheld audio recorders (77.6%) and screen readers (77.2%). Good awareness was reported for abacus (88.8%), walking long canes (94.4%) and smart cane (89.6%), audible balls (96%), Braille chess (82.8%) and talking watch (98%). Among the students with <6/18 to 1/60 vision, the awareness of visual based technology ranged from 0.8% (typoscope) to 43.6% (video magnifiers). Braille technology was used for reading by 96.4% (books) and for writing by 96.8% (Braille slate and stylus) irrespective of visual status. Other devices were poorly used ranging from nil (typoscope) to 55% (screen readers). The use of math and science learning devices was poor (<20%). Walking canes were used by 59% of students whereas 87.2% students used audible ball for games.Conclusion: The results showed that majority of students used tactile based technology irrespective of visual status.Implications for rehabilitationStudents with visual disability need assistive technology for a wide range of activities including academic learning.Students in schools for the blind who have binocular best corrected vision acuity of 1/60 or better should be encouraged to use visual based assistive technology instead of tactile based.Students with binocular best corrected vision acuity less than1/60 should be encouraged to use other available tactile and sound-based assistive technologies as well as Braille books and Braille slate and stylus for their academic activities including maths and sciences.Teachers should be trained in the use of various assistive technologies for reading, writing, maths, sciences, sports, mobility and activities of daily living.

An educational intervention on foot self-care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers

AIMS AND OBJECTIVES

To assess the effectiveness of a 12-week educational intervention on foot self-care behaviour among diabetic retinopathy patients with visual disability and their primary caregivers in China.

BACKGROUND

Diabetes with the coexistence of diabetic retinopathy and foot problems complicating diabetes not only represents a personal disaster, but also becomes a serious burden to public health in China. A foot self-care educational intervention is both cost-effective and feasible even in a health resource-limited setting, which should be developed and evaluated.

DESIGN

Quasi-experimental.

METHODS

From July-September 2017, we enrolled 80 eligible hospitalised diabetic retinopathy patients and their primary caregivers by convenient sampling method in a first-class comprehensive hospital in Nantong, in China. Before and after the educational intervention that is in accordance with the TREND statement (for details, see the "Supplementary File 1"), researchers and subjects filled out the self-designed questionnaire on foot problems complicating diabetes and the Diabetic Foot Self-care Behavior Scale, respectively.

RESULTS

Scores of foot self-care behaviour among the subjects significantly improved from 54.19 ± 8.01-75.85 ± 5.04. The number of patients with fasting blood glucoses <7.0 mmol/L improved from 43 (53.75%)-80 (100%). The results of incidence of foot problems complicating diabetes were not statistically significant. The complete execution of each item in Diabetic Foot Self-care Behavior Scale of subjects was apparently higher.

CONCLUSIONS

This educational intervention can facilitate positive foot self-care behaviours among the diabetic retinopathy patients with visual disability and their primary caregivers in China.

RELEVANCE TO CLINICAL PRACTICE

This study adds to the evidence of the effectiveness of an educational intervention to foster positive foot self-care behaviours. This educational intervention appears to be prospective in promoting diabetic home-based self-management in China, and the delivery method of the intervention may be applied to other chronic diseases.

The association between socioeconomic status and visual disability among older adults in China

AIM

To investigate the association between socioeconomic status (SES) and visual disability (VD) among older Chinese adults.

METHODS

We obtained data from the Second National Sample Survey on Disability, conducted in China in 2006. A total number of 192 375 older adults (aged≥65y) were screened for suspected VD via interviews with trained examiners. Those who screened positively for VD were referred to ophthalmologists to obtain a final diagnosis.

RESULTS

VD was prevalent among 7.29% of Chinese adults aged 65 and older, and was higher in rural areas (8.71%) than in urban areas (4.82%). After adjusting for SES indicators and covariates, we found that less-educated older adults were more likely to suffer from VD, with an odds ratio (OR) of 2.50 (95%CI: 2.26-2.82) for illiterates, compared with those who graduated from senior high school or above. Older adults who were in the lowest income quintile were more at risk of VD, with an OR of 1.81 (95%CI: 1.68-2.95), compared with adults in the highest income quintile. In urban areas, when compared with adults who graduated from senior high school or above, those who did not continue their education after junior high school, primary school, or those who were illiterate, were more likely to suffer from VD, with an OR of 1.35 (95%CI: 1.51-1.59), 1.84 (95%CI: 1.60-2.12), and 2.63 (95%CI: 2.27-3.04), respectively. Lower levels of income were statistically significant when associated with VD. In rural areas, adults who were illiterate had an OR of 2.21 (95%CI: 1.75-2.79) when compared to adults with senior high school or above education level. Per capita, household income remained significantly associated with VD. Older adults who were ≥85, female, single, and residing in rural areas were associated with higher risks of VD.

CONCLUSION

Individual-level SES among the elderly, in the form of education and income, is associated with VD among elderly Chinese adults in both urban and rural areas; however, the association is stronger in rural areas. Further studies are still required to explore the mechanism behind the relationships.

A comparison between patients with epiphora and cataract of the activity limitations they experience in daily life due to their visual disability

PURPOSE

The objective of this study was to compare patients with epiphora and cataract in terms of the activity limitations they experience in daily life due to their visual disability and to validate the use of the Catquest-9SF questionnaire for epiphora patients.

METHODS

Seventy-two consecutively encountered adult patients with confirmed lacrimal obstruction and listed for dacryocystorhinostomy (DCR) or lacrimal intubation at the St. Erik Eye Hospital, Stockholm, Sweden, completed the Catquest-9SF questionnaire, which measures activity limitations in daily life due to visual disability. The psychometric qualities of the Catquest-9SF results obtained from this group of patients were evaluated by Rasch analysis. Rasch analysis was further employed to convert the ordinal raw data to a Rasch score for comparison with the preoperative scores of patients registered in the Swedish National Cataract Register (NCR) during March 2013.

RESULTS

The Catquest-9SF exhibited good psychometric qualities when investigating epiphora patients, with the exception of a misfit for Item 4, the item regarding facial recognition. On the Rasch scale (-5.43 = no activity limitations to +5.01 = severe activity limitations), the mean score for epiphora patients was -0.82 while for patients listed for 1st eye and 2nd eye cataract surgery it was -0.17 and -0.76, respectively. An equivalence test confirmed that the reported visual disability of epiphora patients was not significantly different from visual disability reported by patients waiting for 2nd eye cataract surgery.

CONCLUSION

The Catquest-9SF is a valid measure of visual disability in patients with epiphora. Epiphora patients experience visual disability to the same degree as patients awaiting 2nd eye cataract surgery.

Profile and management outcomes of glaucoma cases at Qassim University Hospital

OBJECTIVE

In view of the paucity of community-based data about glaucoma in Saudi Arabia, better planning to address visual disabilities due to glaucoma is a challenge. Providing hospital-based data from semi-urban places will complement the picture based on information of tertiary eye hospitals of capital.

METHODS

This is one-armed cohort study. All patients attending glaucoma subspecialty unit at our university hospital during 2014-2015 were evaluated for their demographic details, ocular status at presentation, management modalities, and follow-up status of treated eyes. The qualified and absolute success rates (intraocular pressure <22 mmHg with/without medication) were estimated. The determinants of success were analyzed.

RESULTS

We assessed 219 eyes of 122 patients of glaucoma patients. Bilateral glaucoma was in 97 (79.7%) patients. Primary chronic angle closure glaucoma in 102 (46.6%) eyes and primary open angle glaucoma (POAG) in 56 (25.6%) were the main types of glaucoma. More than half of the eyes with glaucoma had a normal functional vision, while 9.2% had vision <20/400. At presentation, 133 (60.7%) had undergone surgical procedure including laser iridotomy. At last follow-up, 135 (62%) of glaucomatous eyes were not using glaucoma medications. The decline in a number of glaucoma medications at last follow-up compared to 1^st visit was statistically significant (P < 0.001).

CONCLUSIONS

At tertiary eye center of semi-urban area of Saudi Arabia had primary chronic angle-closure glaucoma (PCACG) as the main type of adult glaucoma. Vision does not seem to understand the severity of glaucoma at presentation. POAG cases were medically managed while PCACG cases were managed both with laser and surgeries.

Tactile Radar: experimenting a computer game with visually disabled

BACKGROUND

Visually disabled people increasingly use computers in everyday life, thanks to novel assistive technologies better tailored to their cognitive functioning. Like sighted people, many are interested in computer games - videogames and audio-games. Tactile-games are beginning to emerge. The Tactile Radar is a device through which a visually disabled person is able to detect distal obstacles. In this study, it is connected to a computer running a tactile-game. The game consists in finding and collecting randomly arranged coins in a virtual room.

METHODS

The study was conducted with nine congenital blind people including both sexes, aged 20-64 years old. Complementary methods of first and third person were used: the debriefing interview and the quasi-experimental design.

RESULTS

The results indicate that the Tactile Radar is suitable for the creation of computer games specifically tailored for visually disabled people.

CONCLUSIONS

Furthermore, the device seems capable of eliciting a powerful immersive experience. Methodologically speaking, this research contributes to the consolidation and development of first and third person complementary methods, particularly useful in disabled people research field, including the evaluation by users of the Tactile Radar effectiveness in a virtual reality context. Implications for rehabilitation Despite the growing interest in virtual games for visually disabled people, they still find barriers to access such games. Through the development of assistive technologies such as the Tactile Radar, applied in virtual games, we can create new opportunities for leisure, socialization and education for visually disabled people. The results of our study indicate that the Tactile Radar is adapted to the creation of video games for visually disabled people, providing a playful interaction with the players.

How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review

OBJECTIVES

To review systematically the evidence of age-related macular degeneration (AMD) affecting real-world visual ability and quality of life (QoL). To explore trends in specific topics within this body of the literature.

DESIGN

Systematic review.

METHODS

A systematic literature search was carried out using MEDLINE, EMBASE, CINAHL, PsycINFO, PsychARTICLES and Health and Psychosocial Instruments for articles published up to January 2015 for studies including people diagnosed with AMD, assessing real-world visual ability or QoL as an outcome. Two researchers screened studies for eligibility. Details of eligible studies including study design, characteristics of study population and outcomes measured were recorded in a data extraction table. All included studies underwent quality appraisal using the Mixed Methods Appraisal Tool 2011 Version (MMAT).

RESULTS

From 5284 studies, 123 were eligible for inclusion. A range of approaches were identified, including performance-based methods, quantitative and qualitative patient-reported outcome measures (PROMs). AMD negatively affects tasks including mobility, face recognition, perception of scenes, computer use, meal preparation, shopping, cleaning, watching TV, reading, driving and, in some cases, self-care. There is evidence for higher rates of depression among people with AMD than among community dwelling elderly. A number of adaptation strategies have been associated with AMD of varying duration. Much of the research fails to report the type of AMD studied (59% of included studies) or the duration of disease in participants (74%). Of those that do report type studied, the breakdown is as follows: wet AMD 20%, dry AMD 4% and both types 17%.

CONCLUSIONS

There are many publications highlighting the negative effects of AMD in various domains of life. Future research should focus on delivering some of this research knowledge into patient management and clinical trials and differentiating between the types of AMD.

Depressive symptoms in older adults awaiting cataract surgery

BACKGROUND

To assess the prevalence and predictors of depressive symptoms in a cohort of older adults awaiting cataract surgery and establish threshold vision at which depressive symptoms may emerge.

DESIGN

Analysis of cross-sectional baseline data from a longitudinal cohort study of patients aged ≥65 years on Australian public hospital cataract surgery waiting lists.

PARTICIPANTS

We included 329 participants enrolled October 2013-August 2015.

METHODS

Participants completed assessment of depressive symptoms, visual disability, quality of life, social participation and exercise frequency at least one month prior to cataract surgery. High and low contrast habitual vision was examined and systemic comorbidities noted.

MAIN OUTCOME MEASURE

Depressive symptoms prior to first eye cataract surgery.

RESULTS

The prevalence of depressive symptoms was 28.6% (94/329). Univariate analysis identified that participants with poorer high contrast vision, reduced quality of life, greater patient-reported visual disability, higher comorbidity score and who were taking more medications were more likely to exhibit signs of depression. Greater patient-reported visual disability (P = 0.02), reduced quality of life (P = 0.003) and a higher comorbidity score (P = 0.02) remained significantly associated with depressive symptoms in the multivariable model. Depressive symptoms emerged at a visual acuity of 6/12.

CONCLUSIONS

These findings demonstrate a high prevalence of depressive symptoms in older persons with cataract, emerging at modest levels of vision loss. Efficient referral processes, timely surgical management, and improved screening and coordinated treatment of depressive symptoms during the surgical wait may minimize the negative psychological effects of cataract in this already vulnerable population.

Prevalence and causes of avoidable blindness and severe visual impairment in a tribal district of Maharashtra, India

BACKGROUND

We present the outcomes of a survey conducted in Nandurbar, a tribal district of Maharashtra, India. It was based on "Rapid Assessment for Avoidable Blindness" methodology and conducted in 2009 in Nandurbar, a tribal district of Maharashtra, India.

MATERIALS AND METHODS

We examined persons of 50 years and older ages. Ophthalmic assistants noted the distant vision [best corrected vision (BCV) and as presented]. Ophthalmologist examined eyes of persons with vision less than 6/18. The principal cause of impairment in each eye and the most "preventable" or "treatable" cause were assigned. We calculated the prevalence rates of bilateral blindness, severe visual impairment (SVI), and moderate visual impairment (MVI).

RESULT

We examined 2,005/2,300 persons (response rate 87.2%). The prevalence of blindness, SVI, and MVI for the BCV was 1.63% (95% CI 1.11-2.15), 5.93% (95% CI 4.96-6.90), and 14.6% (95% CI 13.2-16.1), respectively. The prevalence of blindness, SVI, and MVI for the presented vision was 1.87% (1.32-2.42), 6.72% (95% CI 5.70-7.74), and 19% (95% CI 17.4-20.6), respectively. Unoperated cataract was responsible for 77% of different visual disabilities. The coverage of existing cataract surgery service was 9.4%. Lack of knowledge about cataract surgery was the main cause of unoperated cataract among 41% of interviewed participants with cataract and SVI.

CONCLUSION

Unoperated cataract was the main curable cause of visual disabilities in tribal population of India. Increasing awareness and offering cataract surgeries at affordable cost in the district would reduce visual disabilities.

Diabetic retinopathy in Oman: a hospital based study

The magnitude of diabetic retinopathy, its determinants, and coverage of laser treatment for diabetic retinopathy among registered people with diabetes in Oman are presented. 2249 randomly selected subjects representing 5564 registered diabetics were examined. WHO recommended definitions of diabetes, retinopathy, and other related conditions were used. Physicians reported the profile of the diabetes while ophthalmologists reported ocular profile and the eye care provided to them. The prevalence of diabetic retinopathy was 14.39% (95% CI 13.46 to 15.31). Men had significantly higher rate of retinopathy than women. The retinopathy rate was higher in age groups 50-59 years and 60-69 years. The rates of background retinopathy, proliferative retinopathy, and diabetic maculopathy were 8.65%, 2.66%, and 5.12%, respectively. The rate was higher among subjects with longer duration of diabetes than those with a shorter duration. Those with an HbA(1c) level more than 9% had significantly higher rates of diabetic retinopathy than those with an HbA(1c) level less than 9%. The retinopathy rate was higher in cases with hypertension, nephropathy, and neuropathy. Of those with diabetic retinopathy who were advised to have treatment at the time of registration, only 20% were treated with laser therapy.