Kevin J. Warrian

A New Method of Assessing Ability to Perform Activities of Daily Living: Design, Methods and Baseline Data

Purpose: To describe study protocol and baseline characteristics of initial subjects. Methods: Prospective study of 194 glaucoma patients. After informed consent, patients were evaluated using a third-generation, performance-based measure, Assessment of Disability Related to Vision (ADREV), nine tasks to simulate daily living activities; including: reading in reduced illumination, recognizing facial expression, detecting motion, recognizing street signs, locating objects, ambulating, placing pegs into different sized holes, telephoning, and matching socks. All patients completed clinical tests including visual acuity (Early Treatment Diabetric Retinopathy Study [ETDRS]), monocular and binocular visual fields, contrast sensitivity, stereopsis, and National Eye Institutes Visual Functioning Questionnaire (NEI VFQ-25). Main outcome measures are scores on subtests, total scores of ADREV and NEI VFQ-25. Results: Mean age was 67.1 years; 51% were female, 55% were of European extraction. Seventy-two percent had open-angle glaucoma. Visual acuity (logMAR) ranged from -0.18 to 2.20, visual field mean defect ranged from −32.68 to 2.62, Binocular field score ranged from 5 to 100 and contrast sensitivity score ranged from 0 to 1.8. While ADREV score ranges from 0 (total disability) to 63 (no disability), total ADREV score ranged from 3.0 to 61.7. Total NEI VFQ-25 score ranged from 17.8 (low score indicates incapable) to 100 (high score indicates not hindered).Conclusions: Methodology of this study should provide information about disability caused by visual loss, specifically glaucoma, how difficulties in performing activities relate to standard clinical tests, and how they correlate to quality of life from patients point of view. Subsequent papers will delineate findings and discuss their application.

Performance-based measures of visual function.

Review of the substantial literature reveals that the importance of performance-based measures of visual function is becoming increasingly recognized. Alone, or in combination with other assessment modalities, they have been shown to provide a reliable and valid means of evaluating visual ability. Further, they have been demonstrated to predict outcomes better than self-report or clinical measures alone.

The effect of personality on measures of quality of life related to vision in Glaucoma patients

Aim: To determine the effect of personality on vision-specific health-related quality of life (HRQoL). Methods: Based on power calculations, 148 individuals diagnosed as having glaucoma or ocular hypertension, without ocular comorbidity, were selected using criteria that included age over 30, no recent or upcoming surgery, the absence of a diagnosis of clinical depression or any other psychiatric illness. Qualifying participants completed the 25-Item National Eye Institute’s Visual Function Questionnaire (VFQ), the Neuroticism, Extraversion and Openness Personality Inventory Revised (NEO PI-R) and the 15-Item Geriatric Depression Scale (GDS-15), and provided information regarding their demographic characteristics and past medical history. Each patient also underwent an ocular examination. Data analysis was conducted to determine the relationship between NEO PI-R personality profiles and VFQ scoring, while controlling for the effects of a range of demographic, psychiatric, past medical and clinical ophthalmic variables. Results: Multivariate analysis indicated that after controlling for a range of covariates, three out of five NEO PI-R personality domains shared statistically significant associations with a variety of VFQ total and subscale score measurements. Conclusion: Normal variations in personality characteristics influence how patients report their vision-specific HRQoL.

Assessing age-related macular degeneration with the ADREV performance-based measure.

Purpose: To validate a new third-generation performance-based measure titled the “assessment of disability related to vision” (ADREV) in a study population of individuals with age-related macular degeneration. Methods: Patients with either exudative or nonexudative age-related macular degeneration, but without ocular comorbidity, completed the ADREV, the 25-item National Eye Institute’s visual functioning questionnaire, and a range of clinical assessments. Correlations were calculated between the data provided by the ADREV, visual functioning questionnaire, and clinical ophthalmic measures. Regression and bootstrap analysis were preformed to determine the relative relationship between specific clinical measures and ADREV performance, while controlling for a range of potentially confounding factors. Results: One hundred twelve patients completed the study and correlative analysis showed that ADREV total and subscale scores were more related to nearly all measures of clinical ophthalmic status in comparison with the data provided by the visual functioning questionnaire. Significant correlative relationships between ADREV and visual functioning questionnaire scores showed moderate to high correlation. Central visual acuity and contrast sensitivity shared the strongest association with performance of activities. Conclusions: The ADREV is a valid instrument for the assessment of visual disability in patients with age-related macular degeneration. Furthermore, the data provided by this performance measure had stronger relationships with clinical indicators of visual impairment in comparison with self-report.

A Novel Combination Point-of-View (POV) Action Camera Recording to Capture the Surgical Field and Instrument Ergonomics in Oculoplastic Surgery.

Purpose:To evaluate a novel combination head-mounted/chest-mounted point-of-view recording system for oculoplastic surgical procedures. Methods:The point-of-view head camera captures the surgical field, while the point-of-view chest camera captures a wide field of view to record instrument ergonomics. Various methods of recording were trialed. Results:The head camera with a narrow field of view was better for recording fine details of the surgical field. The chest camera recording a wide field of view was optimal for recording hand positions. Stereoscopic recording of the instrument ergonomics was helpful in relaying the relative positions of the surgeon’s hands and instruments. Conclusions:Point-of-view cameras are cost–effective means of recording oculoplastics procedures. The authors feel simultaneously recording the surgeon’s ergonomics and the corresponding instrument movements within the surgical field, from the “surgeons view”, will augment surgical education.

A comparison of methods used to evaluate mobility performance in the visually impaired

Purpose To compare three different approaches to measuring mobility performance when evaluating the visually impaired. Methods 488 participants, including 192 glaucoma, 112 age-related macular degeneration, 91 diabetic retinopathy and 93 healthy volunteers, completed the Assessment of Disability Related to Vision (ADREV) mobility course. The performance of participants on the mobility course was evaluated by noting errors made and time required for completion. Errors noted and time taken were compared using multivariate logistic regression to determine which measurement better differentiated patients with visual disease from healthy volunteers. Multivariate logistic regression was also used to evaluate the combined metric of ADREV errors divided by time to determine its ability to discriminate participants with visual disease from healthy volunteers. Results Errors noted and time taken while ambulating through the standardised mobility course shared a weak but statistically significant association (Pearsons r=0.36, p<0.05). After controlling for demographic and medical comorbidities, logistic regression analysis revealed that errors noted were better at discriminating individuals with visual disease from healthy volunteers (OR 2.8–4.9, 95% CI 1.5 to 10.3) compared with the time taken for mobility course completion (OR 1.1, 95% CI 1.0 to 1.2). These findings were consistent across all comparisons between healthy volunteers and participants with each type of visual impairment. Finally, the combined metric of ADREV errors divided by time was far more predictive of visual disease compared with either time taken or errors noted during mobility testing (OR 11.0–17.7, 95% CI 3.6 to 77.1). Conclusions A validated scoring system based on errors is more effective when assessing visual disability during mobility testing than recording the time taken for course completion. The combined metric of ADREV errors noted divided by time taken was most predictive of all the methods used to evaluate visual disability during mobility testing.

Surgeonsʼ Point-of-View Video Recording Technique for Scleral Buckling

Surgeons’ Point-of-View Video Recording Technique for Scleral Buckling Recording scleral buckling surgery has traditionally been limited by several factors. Commonly used overhead recording systems are costly and require constant repositioning during surgery to ensure that they capture the images of interest. A common alternative to overhead recording devices is to use an assisting photographer to capture images over the shoulders of the surgeons in an obtrusive and labor-intensive process. These approaches are limited in that the surgery is recorded from a perspective that is different from that of the surgeon. Point-of-view (POV) cameras record high-definition video and are used extensively in adventure sports. Point-ofview cameras have a low profile, compact design, and are easy to use. Previously, Bizzotto et al used a previous generation head-mounted version of these POV cameras to record surgery. They concluded that the technology was helpful in many respects for surgery involving larger subject matter such as orthopedic surgery but inadequate to film microsurgical techniques. In a similar vein of research, Gooi et al mounted a POV camera to a microscope to successfully record hand positions during ophthalmic surgery. In this report, we present the findings of our evaluation of a current head-mounted POV camera system to record scleral buckling surgery.