Joseph Pizzimenti

An exploratory investigation of handheld computer interaction for older adults with visual impairments

This study explores factors affecting handheld computer interaction for older adults with Age-related Macular Degeneration (AMD). This is largely uncharted territory, as empirical investigations of human-computer interaction (HCI) concerning users with visual dysfunction and/or older adults have focused primarily on desktop computers. For this study, participants with AMD and visually-healthy controls used a handheld computer to search, select and manipulate familiar playing card icons under varied icon set sizes, inter-icon spacing and auditory feedback conditions. While all participants demonstrated a high rate of task completion, linear regression revealed several relationships between task efficiency and the interface, user characteristics and ocular factors. Two ocular measures, severity of AMD and contrast sensitivity, were found to be highly predictive of efficiency. The outcomes of this work reveal that users with visual impairments can effectively interact with GUIs on small displays in the presence of low-cost, easily implemented design interventions. This study presents a rich data set and is intended to inspire future work exploring the interactions of individuals with visual impairments with non-traditional information technology platforms, such as handheld computers.

Central serous chorioretinopathy after epidural steroid injection

Central serous chorioretinopathy (CSC) is a condition characterized by serous detachment of the neurosensory retina in the posterior pole. Corticosteroids administered by various routes is reported as a possible cause of CSC. We report the cases of two patients who developed CSC after receiving a corticosteroid injection in the epidural space for the treatment of back pain. In both patients, the accumulation of subretinal fluid spontaneously resolved within several weeks. Patients who develop CSC after epidural analgesia with corticosteroids should be alerted to the possible relationship between CSC and this treatment. Clinicians should advise all patients with CSC to avoid systemic corticosteroids administered by any route, unless they have a compelling medical indication. Pharmacists should advise patients to seek evaluation if visual changes occur during or after corticosteroid therapy.

Eye on Diabetes: A Multidisciplinary Patient Education Intervention

PURPOSE The purpose of this study is to compare the efficacy of usual care to an intervention emphasizing patient education targeted at a multicultural adult patient population with diabetes seeking eye care in an academic health center. METHODS Ninety patients were randomized to usual care or to the intervention. All patients received a comprehensive eye health and vision examination and completed a demographic survey, a patient satisfaction survey, and a diabetes eye health pretest and posttest administered by a masked examiner at 1 week and 3 months. A multidisciplinary (optometry, pharmacy, endocrinology) patient education curriculum was developed for patients randomized to the intervention. Because the dependent variable was measured at 3 points on a nominal scale, a binary generalized estimating equation was employed. RESULTS The assessment of patient knowledge at baseline revealed misconceptions about diabetic eye disease. While most patients recognized that people with diabetes should have regularly scheduled eye examinations through dilated pupils (90.0%), most patients incorrectly reported that diabetic eye disease usually has early warning signs (75.6%). While controlling for age, gender, race, education, and HbA1c level, subjects who participated in the intervention were 2 times more likely to score higher on the posttest (chi(2) = 45.51, P > .00). No differences between pretest and posttest scores were found for patients who did not participate in the intervention (chi(2) = 11.67, P > .11). CONCLUSIONS Patients who participated in the educational intervention demonstrated an increase in knowledge across time. Patients may benefit from education emphasizing the importance of dilated eye examinations in the absence of ocular symptoms.

In vivo diagnostic imaging of ocular toxocariasis.

Toxocariasis was first reported in the early 1950s. Distribution is worldwide but the incidence is highest in the southeastern United States, Puerto Rico and the West Indies. Serological surveys have indicated that from four to 30 per cent of people in the United States are infected with the parasite. Two clinical diseases are described: visceral larva migrans (VLM) affecting multiple systemic organs and ocular larva migrans (OLM) affecting the eye. Ocular involvement appears clinically as a granuloma of the posterior pole or peripheral retina, or as an endophthalmitis. Ocular toxocariasis carries a poor visual prognosis secondary to its widespread tissue involvement. Accurate diagnosis of the active condition, timely intervention (when needed) and awareness of important sequelae are crucial. Posterior segment imaging technologies such as optical coherence tomography (OCT) and B-scan ultrasonography may aid in diagnosis and management, as well as increase our understanding of the pathophysiology of this condition.

Strategic design for users with diabetic retinopathy: factors influencing performance in a menu-selection task

This paper examines factors that affect performance of a basic menu selection task by users who are visually healthy and users with Diabetic Retinopathy (DR) in order to inform better interface design. Interface characteristics such as multimodal feedback, Windows® accessibility settings, and menu item location were investigated. Analyses of Variance (ANOVA) were employed to examine the effects of interface features on task performance. Linear regression was used to further examine and model various contextual factors that influenced task performance. Results indicated that Windows® accessibility settings significantly improved performance of participants with more progressed DR. Additionally, other factors, including age, computer experience, visual acuity, and menu location were significant predictors of the time required for subjects to complete the task.

An investigation of handheld device use by older adults with age-related macular degeneration

This study investigates factors affecting handheld human – computer interaction (HCI) for older adults with Age-related Macular Degeneration (AMD). This is largely an uncharted territory, as empirical investigations of HCI concerning users with visual dysfunction and/or older adults have focused primarily on desktop computers. For this study, participants with AMD and visually healthy controls used a handheld computer to search, select and manipulate familiar playing card icons under varied icon set sizes, inter-icon spacing and auditory feedback conditions. While all participants demonstrated a high rate of task completion, linear regression revealed several relationships between task efficiency and the interface, user characteristics and ocular factors. Two ocular measures, severity of AMD and contrast sensitivity, were found to be highly predictive of efficiency. The outcomes of this work reveal that users with visual impairments can effectively interact with graphical user interfaces on small displays in the presence of low-cost, easily implemented design interventions. Furthermore, results demonstrate that the detrimental influence of AMD and contrast sensitivity on handheld technology interaction can be offset by such interventions. This study presents a rich data set and is intended to inspire future work characterizing and modeling the interactions of individuals with visual impairments with non-traditional information technology platforms and contexts.

Serpiginous choroiditis in a herpes-positive patient.

Background. Viruses are one of the most common causes of infections involving the posterior segment of the eye. Viral infections can be congenital or acquired and can affect the retina, choroid, or optic nerve. Herpes simplex virus has been implicated in a number of posterior segment conditions, including serpiginous choroiditis (SC), which has generally been described as idiopathic. Case Report. A 57-year-old black female presented with decreased and distorted vision in both eyes, of 10 months duration. Funduscopy revealed radial, deep grayish lesions emanating off of the optic disc in a peripapillary fashion. The clinical appearance was suggestive of SC, which was confirmed by fluorescein angiography. Serologic testing was positive for herpes simplex virus and thus may suggest a causative link between the virus and the choroiditis. Conclusions. SC has been historically cited as an idiopathic process. There have been only rare reports linking this process with a viral etiology. Laboratory testing and clinical work-up needs to be obtained in any patient suspected of having SC, to detect a viral etiology. Treatment of an underlying condition may lead to optimum resolution in these patients.

Cystoid Macular Edema as a Result of Immune-recovery Uveitis

Background. Potent antiretroviral therapy can lead to improved immunity in patients with acquired immune deficiency syndrome. However, ocular inflammation can occur in predisposed individuals. This inflammation is referred to as immune-recovery uveitis. Cystoid macular edema (CME) is a complication that can result from this inflammation and is emerging as a major cause of visual loss in human immunodeficiency virus (HIV)-infected patients. Case Report. A 52-year-old man presented with complaints of intermittent decreased vision that had coincided with the initiation of antiviral treatment. He also reported metamorphopsia and floaters in both eyes of several years duration. He had a history of HIV for 20 years and was only recently started on Highly Active Antiretroviral Therapy (HAART). He reported a vague history of ocular problems involving his retina. Retinal examination revealed bilateral areas of peripheral scarring from presumed past ocular inflammation and thickening and irregularity at each macula. Ancillary testing was performed, and CME was diagnosed. Conclusions. Immune-recovery uveitis is a leading cause of visual disturbance in HIV-infected patients with a history of cytomegalovirus (CMV) retinitis on HAART. Although the immune recovery associated with the advent of HAART has decreased the need for potent CMV medications, the heightened immune response can be associated with sight-threatening inflammation.

Electrooculography and optical coherence tomography reveal late-onset Best disease.

Purpose Best vitelliform macular dystrophy, also known as Best disease, is a macular dystrophy characterized by bilateral yellowish egg yolk–like lesion(s) present within the maculae. It is a slowly progressive disease that usually presents at childhood. Best vitelliform macular dystrophy frequently proceeds through stages, beginning with a classic presentation described as vitelliform. A similar condition, known as adult-onset foveomacular vitelliform dystrophy, has been described among adult patients. Although the two maculopathies may look similar, they are considered two separate entities, because of the age of onset and overall clinical presentation. Case Report A 54-year-old man presented with gradual-onset blurred near vision in each eye. Previous records showed a history of unremarkable dilated fundus examinations for the past 8 years. Best-corrected distance acuities measured 20/20 OD and 20/20 OS. Amsler grid testing revealed a mild metamorphopsia OD and OS. Dilated fundoscopy revealed macular pseudohypopyon in each eye. In vivo imaging of the maculae was obtained with spectral-domain optical coherence tomography findings. Electrooculography findings were consistent with Best vitelliform macular dystrophy of atypical, late onset. Conclusions Best vitelliform macular dystrophy may vary in its presentation. Electrooculography and spectral-domain optical coherence tomography can aid in establishing the definitive diagnosis.

Use of multifocal ERG and OCT for diagnosing Stargardt's disease

Stargardt’s disease (Stargardt’s macular dystrophy, juvenile macular degeneration) was originally described by Stargardt in the early 1900s and is known as the most common congenital macular dystrophy, with an incidence of one in every 10,000. Stargardt’s disease (STGD) is characterised as a widespread lipofusin storage disease of the retinal pigment epithelium (RPE). Typically, it presents between the first to third decades of life and is associated with a progressive, bilateral decrease in visual acuity leading to legal blindness and central visual acuity of 6/60 to 6/120. Though it is typically associated with an autosomal recessive (AR) inheritance pattern, autosomal dominant (AD) cases have been reported with later onset and less severe acuity loss. Classic findings include bilateral macular changes that begin as granular mottling with progression toward a ‘beaten bronze’ maculopathy. The late stage of the disease is associated with macular atrophic degeneration. Yellow-white flecks in the posterior pole may be noted; they are described as tri-radiating ‘fish tail’ (pisciform) flecks. Traditionally, Stargardt’s disease has been diagnosed through clinical evaluation and fluorescein angiography (IVFA), which demonstrates a dark or ‘silent’ choroid due to the blockage of the fluorescein by the lipofusin deposition in the RPE. Though fluorescein angiography has been considered the ‘gold standard’ in verifying the presence of the disease, the characteristic dark choroid pattern is seen in only 85 per cent of patients with Stargardt’s disease. There have been reports of patients with autosomal dominant inheritance pattern who fail to demonstrate this classic fluorescein angiography finding. Newer and minimally invasive procedures, such as the multifocal electroretinogram (mfERG) and optical coherence tomography (OCT), may aid in diagnosing and managing patients with the disease. These ancillary tests may be used in the event that fluorescein angiography cannot be performed or used in conjunction with traditional fluorescein angiography as a complementary procedure. Multifocal electroretinography (mfERG) is a minimally invasive procedure that has been shown to be helpful in the diagnosis of Stargardt’s disease. Unlike traditional flash electroretinography (fERG), this technology has proved extremely reliable in diagnosing and monitoring various forms of macular dystrophy. In the case of Stargardt’s disease, the patient presents with significant variation in presentation; from normal to reduced acuity, minimal to significant fundus findings and normal to slightly reduced full field flash electrophysiological findings. Regardless of the presentation, Stargardt’s patients typically have a significant reduction of the foveal response and central approximately 10 degrees in both eyes on mfERG, even early in the disease process with relatively good visual acuity and minimal fundus findings. In addition to electrophysiology, retinal imaging technology such as OCT has proved effective in correlating structural damage with functional visual loss. The OCT findings of patients with Stargardt’s disease include decreased thickness of the retina, most notably in the foveola. The OCT also reveals photoreceptor loss and external nuclear layer changes, as well as abnormalities in the retinal pigment epithelium.