Surprising New Research from the National Eye Institute on Surgical Options for Congenital CataractsPosted on 3/11/2014 at 1:54 PM
by Maureen Duffy
For adults who undergo cataract surgery, implantation of an artificial lens, also called an intraocular [i.e., within the eye] lens, or IOL, has been the standard of care for many years.
However, an ongoing clinical trial, sponsored in part by the National Eye Institute, suggests that for many infants, surgery followed by the use of contact lenses for several years – and an eventual lens implant – may be a better solution.
The research, entitled Comparison of Contact Lens and Intraocular Lens Correction of Monocular Aphakia During Infancy, was published "online first" in the March 6, 2014 issue of JAMA Ophthalmology (formerly Archives of Ophthalmology). JAMA Ophthalmology is an international peer-reviewed journal published monthly by the American Medical Association.
The study is authored by the Infant Aphakia [i.e., an eye without a lens] Treatment Study Group, with lead investigator Scott R. Lambert, MD, from Emory University, as the corresponding author. The purpose of the Infant Aphakia Treatment Study Group is to determine whether infants with a unilateral [i.e., in one eye] congenital cataract are more likely to develop better vision following cataract surgery if they undergo either (a) implantation of an intraocular lens or (b) treatment with a contact lens. The study also compares the occurrence of postoperative complications and the degree of parental stress between the two treatments.
About the Research
From Contacts better than permanent lenses for infants after cataract surgery from the National Institutes of Health:
Some prior research suggested that using an IOL to treat cataract during infancy can improve long-term visual outcomes … IOLs can also spare babies – and their parents – the discomfort of daily contact lens changes and reduce the risk of introducing germs into the eye.
On the other hand, the use of IOLs during infancy also has some drawbacks. Surgeons have difficulty judging the right focusing power of the artificial lens for an infant, because it's a time of rapid eye growth. Also, while IOL implants are typically safe and complication-free for adults, they are more likely to cause postoperative problems for infants.
The Infant Aphakia Treatment Study ultimately enrolled 114 infants who were between 1 to 6 months old at the time of surgery. By random assignment, about half of the infants received an IOL and the other half received contact lenses. The lenses were soft silicon or hard gas-permeable plastic, and designed to fit small eyes.
There were no significant differences in visual acuity between the two groups at age 1, or at age 4 1/2. However, there were more post-surgical complications in the IOL group, which in turn led to more corrective surgeries. The most frequent complication was lens reproliferation – when lens cells left behind after cataract surgery migrate into the pupil and interfere with vision.
By age 5, lens reproliferation was 10 times more common with IOLs, occurring in 23 (40 percent) of infants in that group, compared to two infants (4 percent) in the contact lens group. This complication and others led to the need for one or more additional eye surgeries among 41 (72 percent) of the infants in the IOL group, and 12 (21 percent) in the contact lens group.
By age 5, nine children in the contact lens group developed minor eye infections that cleared up with antibiotic drops, and in one child, a contact lens broke during wear. None of these issues had permanent effects on vision. Three infants in the contact lens group had IOLs implanted before age 5, because their families had difficulty with day-to-day contact lens changing and maintenance.
"We think that for most infants with unilateral cataract, contact lenses are a better option than an IOL," Dr. Lambert said. "However, in some cases, the parents and their physician may decide that contact lens wear proves to be too challenging, and ultimately not in the child's best interests."
Congenital cataract is sometimes hereditary, which means that some parents may have vision problems of their own that would make it difficult to change their kids' contacts. Affordability could also be a challenge for some families. Although health insurance plans generally pay for an IOL, most plans do not pay for contact lenses.
About Intraocular Lenses
Once the natural lens in the eye has been removed, the eye loses its ability to focus light and images clearly on to the retina, the light-sensitive tissue that lines the inside surface of the eye. Before the development of artificial lenses, hard contact lenses or very thick eyeglasses were the only options for correcting vision after cataract surgery.
Artificial intraocular lenses were developed in the early part of the 20th century, and ophthalmologist Harold Ridley, M.D. implanted the first artificial lens in 1949 in London. In 1952, the first artificial lens was implanted in the United States at Wills Eye Hospital in Philadelphia. Since that time, cataract surgery and artificial lenses have continued to evolve and develop.
In most cases, the natural lens is removed and the artificial lens is implanted during the same surgery. The artificial lens is usually placed within the lens capsule, which is the small "sac" or membrane that once enclosed the natural lens and held it in place.
You can read more about the different types of intraocular lenses at What is an Artificial Lens? at VisionAware.org.
More about the Study from JAMA Ophthalmology
From the article abstract:
Design, Setting, and Participants: The Infant Aphakia Treatment Study is a randomized clinical trial with 5 years of follow-up that involved 114 infants with unilateral congenital cataracts at 12 sites. A traveling examiner assessed visual acuity at age 4.5 years.
Results: Significantly more patients in the IOL group had at least 1 adverse event after cataract surgery (contact lens, 56%; IOL, 81%). Glaucoma/glaucoma suspect occurred in 35% of treated eyes in the contact lens group vs. 28% of eyes in the IOL group. Since the initial cataract surgery, significantly more patients in the IOL group have had at least 1 additional intraocular surgery (contact lens, 21%; IOL, 72%).
Conclusions and Relevance: When operating on an infant younger than 7 months of age with a unilateral cataract, we recommend leaving the eye aphakic and focusing the eye with a contact lens. IOL implantation should be reserved for those infants for whom the cost and handling of a contact lens would be so burdensome as to result in significant periods of uncorrected aphakia.
You can learn more about adult cataracts at An Introduction to Cataracts and Cataract Surgery at VisionAware.
by Maureen Duffy
Editor's note: One of the many benefits associated with an online information center and website, such as VisionAware, is the ability to track readers' search terms [i.e., information readers are seeking as they search the Internet]. The following questions about home repair and workshop safety with low vision or blindness consistently appear in VisionAware's information queries:
- Do I have to give up woodworking now that I'm blind?
- I have low vision. How can I make simple repairs around the house?
An Answer from Blind Woodworker Gil Johnson
This week, during Workplace Eye Health and Safety Awareness Month, our answer comes from Gil Johnson. Gil is the author of Gil's Guide to Home Repairs and Gil's Guide to Woodworking on the VisionAware website.
First, Some Woodworking Safety Tips
If you're experienced in this area, you know that safety is the most important consideration when using any type of tool or power tool. Even if you've had many years of experience with power tools and home repairs, I recommend you use a safety checklist that includes the following:
- Regardless of your visual status (blind, visually impaired, or low vision), always wear impact-resistant safety glasses that completely enclose your eye area and are shielded along the sides and top edge of the lenses. They can be worn like glasses, or can fit over your own eyeglasses. Many types of safety glasses can also be obtained with prescription lenses.
- When using power tools, you will also need ear protection, such as foam ear plugs or headphone-style ear muffs.
- If you have low vision, make sure that the lighting in your work area provides sufficient illumination. You can read more about lighting at the VisionAware Home Repairs Safety and Preparation Checklist. A lamp with an adjustable flex-arm or gooseneck is usually a good choice because you can adjust the direction of the light as needed. A flexible-arm floor lamp on wheels allows you to move the light with you as you move around your work area.
- To help with locating and using your tools and controls, you can mark the tool handles and the most commonly-used settings with any of the methods and materials in Organizing Your Workshop Area.
- Clamps can help secure pieces that you are gluing, cutting, or drilling.
- Keep track of the location of your power cord before and during the time you are cutting or drilling. One solution is to use your power tool with an extension cord, keeping the cord over your shoulder and behind you. Also, the thickness of an extension cord should be equal to, or greater than, the cord on the power tool. Otherwise, the extension cord can overheat and cause a fire or severe burns.
- Become familiar with the controls and make sure you are able to turn your power tool "on" and "off" immediately, prior to plugging it in and using it.
Measuring Tips and Techniques
One of the challenges facing people with reduced vision is taking accurate measurements. For people with some vision or no vision at all, this can seem like a real barrier. However, there are several ways to take good measurements if you have difficulty seeing the markings on a ruler or tape measure.
Estimating Measurements without Using a Ruler
- One inch is approximately the distance from the first knuckle to the fingertip.
- Four inches is approximately the width of the hand along the base of the fingers.
- Eighteen inches is approximately the distance from the elbow to the fingertips, with the arm outstretched.
One- and Three-Foot Rulers and Retractable Tape Measures
- Most hardware stores or home supply centers have one-foot rulers or three-foot yardsticks. Sometimes they are free or are quite inexpensive. These may have large enough markings so that you may be able to read them if you have low vision.
- If you can't read the numbers, ask a friend or family member to make a notch along one edge at one-inch increments and on the other edge in half-inch increments. This can enable you to use your fingernail to count the notches and get a reasonably accurate measurement.
- You can use a piece of string to measure available space. Tie a knot in the string at the length you want to measure and lay the string along a ruler or tape measure to determine the length.
- Make a dark pencil mark or use a push pin on a one-foot ruler or yardstick to indicate the available space.
- If you have some remaining vision, you may be able to read the markings in better lighting, or you can ask a family member or friend to read the measurement for you.
- Most retractable tape measures have a built-in lock. You can lock the tape at the measurement you want and read it in better lighting or ask a family member or friend to read the measurement to you.
Specialized Measuring Tools
Several types of measuring devices have been adapted or designed for use by persons with low vision or no vision. Most are easy to use and allow for fairly accurate measurements.
Rulers and Yardsticks
- One-foot rulers and three-foot yardsticks with pre-made tactile markings at 1/4, 1/2, and 1 inch
- One-foot rulers with large print and/or braille markings
A one-foot ruler with tactile and braille markings
Talking Tape Measure
- The Talking Tape Measure is a 16-foot retractable tape measure that has been modified to give a measurement reading in synthetic speech.
- Speech is available in the following languages: English, French, Italian, Norwegian, Spanish, and Swedish.
- The Talking Tape Measure is available from Cobalt Systems Limited.
You can find resources for adapted measuring tools in the Assistive Products category in the VisionAware Directory of Services.
Additional Woodworking and Home Repair Information
Part 2: Ten Braille Tips for iDevices by Scott Davert, AppleVis Editorial Team and Accessibility SpecialistPosted on 3/4/2014 at 9:18 AM
by Maureen Duffy
Guest blogger Scott Davert, M.A., VRT, (at left) is an AppleVis Editorial Team Member and a Senior Instructor in the Adaptive Technology Department and Communications Learning Center at the Helen Keller National Center for Deaf-Blind Youths and Adults. Previously, Scott has reviewed new accessibility features in iOS 7, RoboBraille, and the Humanware Communicator app.
In his latest review, Scott has compiled 10 useful tips for braille users of the iPod, iPhone, and iPad, based upon his personal experience and his work with individuals who are deaf-blind and use braille with their iDevices.
In Part 1 of his review, Scott discussed Bluetooth pairing and connectivity; Unified English Braille and translation tables; turning off VoiceOver sounds; reviewing messages and information in braille; and conserving and extending battery life. In this week's Part 2, Scott discusses five additional tips, including activating VoiceOver help and turning off automatic contracted braille.
6. Hey, What's This Button Do?
While most modern-day braille displays have a Perkins-style keyboard and cursor router buttons, they also have some buttons that make them unique and are configured to help make your life easier in various ways. For example, some buttons may scroll in a certain direction and be located so that you can operate them while keeping your hands on the display.
While the manual or the various commands listed on Apple.com are great, it's not always convenient to pull up such a list. Fortunately, iOS has you covered.
From anywhere in iOS, press space with K to activate VoiceOver help. This will allow you to press buttons and keyboard combinations to find out what they do and let you practice gestures and keyboard commands for a Bluetooth keyboard.
This information will flash briefly in braille and then disappear. You can press space with N (as I wrote in Part 1) to read it again at your own pace if you didn't catch it the first time. To exit keyboard help, press space with B to activate the back button. You will be returned to where you were before entering this mode.
(Please note: When there is no message flashing, the braille display will still show the last text that was on it before you entered keyboard help. This is a known bug that has been reported.)
7. Hurry Up, Why Don't You?
In iOS 7, there have been many changes to the user interface. While most of these do not impact braille users directly, there is one that can affect the performance of your device. This is called Reduced Motion.
Go in to Settings > General > Accessibility, and under the Vision heading, turn on "reduced motion." This will cause less battery drain and should also speed up your device a bit more, as there is less demand on the processor when this feature is turned on. For additional ways to conserve battery power, read Tips For Improving Battery Life in iOS 7 by David Goodwin.
8. But Can Do? I Don't Think So!
Some readers may be shrugging their shoulders at the title of this tip, but anyone who knows contracted braille will understand. Some braille users enjoy using contracted braille, but their typing speed may be slower than the iDevice likes. If you wait too long between letters when typing out the word "float," for example, you may end up with the non-word "fromlikeoathat."
Why does this happen? After a few seconds, the Apple braille driver assumes that when you enter a single letter, you want that to be the contracted braille one-word equivalent. In iOS 7, there is a feature that allows you to turn off this Automatic Braille Translation.
Go into Settings > General > Accessibility > VoiceOver > Braille to turn this feature off, which will ensure that nothing is translated until you press either space or backspace. The drawback is that you cannot see words as you type them; in addition, editing becomes rather cumbersome, since you must hit space with dots 4 and 5 in order to translate without hitting the space bar.
While this may be a good feature for users who can keep track of what they're writing, it's a feature I'd use only when writing a document. You can always re-enable Automatic Braille Translation during the editing process. Alternatively, pressing space with G from anywhere within the operating system will toggle between contracted and uncontracted braille.
While it may take slightly longer to type out uncontracted braille, you may find it actually saves time in the long run, since you will not have to go back and correct all of those mistranslations. Turning contracted braille on and off is a feature with all versions of iOS that have braille support.
(Please note: If you choose to type in uncontracted braille, you will need to use the computer braille symbols for punctuation marks and numbers, such as the period (dots 4 and 6) and the question mark (dots 1-4-5-6).
9. The Braille Master is at the Controls
Also new in iOS 7 is the Control Center, which gives you easy access to what Apple feels are essential controls that require convenient access, such as WiFi, Bluetooth, and Do Not Disturb, for example.
While touch screen users must tap the Status Bar and then swipe up with three fingers to reach the Control Center, a braille user can simply press space with dots 2 and 5 from anywhere in iOS. Press space with B to exit the Control Center.
10. Get Notified
Similarly, touch screen-only users can tap the Status Bar and then swipe down with three fingers to pull up the Notifications Center. As a braille user, you can pull up your Notifications Center instantly by pressing space with dots 4 and 6. Press space with B to exit the Notifications Center.
For more information, you can contact Scott at firstname.lastname@example.org.
Part 1: Ten Braille Tips for iDevices by Scott Davert, AppleVis Editorial Team and Accessibility SpecialistPosted on 2/27/2014 at 8:24 AM
by Maureen Duffy
Guest blogger Scott Davert, M.A., VRT, (at left) is an AppleVis Editorial Team Member and a Senior Instructor in the Adaptive Technology Department and Communications Learning Center at the Helen Keller National Center for Deaf-Blind Youths and Adults. Previously, Scott has reviewed new accessibility features in iOS 7, RoboBraille, and the Humanware Communicator app
In his latest review, Scott has compiled 10 useful tips for braille users of the iPod, iPhone, and iPad, based upon his personal experience and his work with individuals who are deaf-blind and use braille with their iDevices.
1. Improving the Connection Process
If Bluetooth is enabled, each time you press the Home key on your iDevice, it will search for other Bluetooth devices to connect to. This includes braille displays that have already been paired. Thus, to have a greater chance of getting your iDevice and braille display to start communicating immediately, it is a good idea to have your braille display on and in "Discoverable" mode (meaning that your Bluetooth-enabled device has the ability to search for and locate other devices within range) or "Terminal for Screen Reader" mode before unlocking your iDevice.
As long as the two have been paired previously, and "braille display" is chosen in VoiceOver, the pairing process should commence very quickly. It is true that you can sometimes get the braille display to connect while turning it on with your iDevice already unlocked, but this will not always be successful.
2. What's with the Funky Symbols in iOS 7?
If you are a braille user living in the United States, Canada, the United Kingdom, or any other country that has not yet officially adopted Unified English Braille (UEB), you may be wondering what the deal is with some of the braille translation. The issue is that iOS 7 automatically uses the UEB table, no matter how your regional and language settings are configured, including any previously configured English translation tables prior to an iOS 7 upgrade.
If you want to switch back to US or UK braille, go to Settings > General > Accessibility > VoiceOver > Braille and then select Translation Table. Select one of the three choices offered, and your braille will switch to that translation table.
3. Noisy VoiceOver, Quiet Display
In iOS 7, you can turn off VoiceOver sounds without affecting system sounds. This is useful if you want to receive sound alerts about notifications but find the clicks and beeps of VoiceOver to be annoying. There are two ways of doing this: You can either add it to your Rotor settings with VoiceOver or go to Settings > General > Accessibility > VoiceOver and turn the "sounds" off.
4. What Was That Again?
Sometimes, VoiceOver will give you a result or display information that flashes in braille and then disappears. One example of this is the LookTel Money Reader app, another is TapTapSee, and a third, in certain instances, is Dice World.
Fortunately, beginning with iOS 6, you can read it again at your own pace if you didn't catch it the first time. To do so, press space with N, which reviews a history of the last few items VoiceOver sent to the braille display. To go to the previous item, press space with dot 1; to advance through the history, press space with dot 4. When you've finished reviewing these messages, press space with N again to return to wherever you were in iOS.
Please note: While you are reviewing these messages, pressing space with dot 1 or dot 4 will still move the VoiceOver cursor; therefore, when you press space with N for the second time, you may be returned to a different point on the screen.
5. Dude, Where's My Battery Life?
Anyone who uses external hardware that connects through Bluetooth can attest to the fact that it is quite the battery hog, whether it's an external GPS receiver, headset, keyboard, or braille display. While logic may dictate that using the Screen Curtain will help save battery, since it makes the screen go dark, this is not true.
The Screen Curtain is, quite literally, a curtain that goes over your screen and is a VoiceOver specific function. You can verify this by turning your screen brightness up to 100 percent while the Screen Curtain is enabled and watching your battery do a downward spiral. You can also feel heat around the edges of the screen after using your device with the brightness set this high after several minutes.
Instead, set your screen brightness to 0 percent. Just remember to increase the screen brightness when you want a sighted user to see your screen clearly. You can do this by going in to the Control Center in iOS 7. With earlier versions of iOS, you can also adjust the screen brightness by going to Settings > Brightness > Wallpaper and then making the adjustment. For even more practical ways to conserve battery power, read Tips For Improving Battery Life in iOS 7 by David Goodwin.
Ten Useful Tips: Part Two
In Part 2 of his "Top Ten" review, Scott discusses five additional tips, including ways to activate VoiceOver help and turn off automatic contracted braille. For more information, you can contact Scott at email@example.com.
by Maureen Duffy
It's time for some VisionAware blogroll love once again. As I explained in my introductory "blogroll love" post,
... the VisionAware "blind bloggers" collective is a marvelous way to position my favorite bloggers front-and-center. You'll discover outstanding writing – and not only about blindness issues. My favorite bloggers are people who happen to be blind – and have much to say about the simple act of being deeply human.
This week, I'd like you to meet two talented and thought-provoking bloggers whose subject matter ranges from fashion and beauty to living well with deafblindness.
Bold Blind Beauty
Stephanae (Steph) McCoy is the spirited fashionista who blogs about fashion and beauty at Bold Blind Beauty: Style Concepts for the Visually Impaired:
My name is Stephanae (Steph) McCoy, the Blind Style Blogger. Welcome to Bold Blind Beauty, a place where we can talk anything style-related. As blind and vision impaired women, we can face seemingly insurmountable challenges. I believe that style should not be one of these obstacles. After all, we too can be Bold Blind Beautiful and stylish fashionistas!
Of course, as a red lipstick maven, I'm understandably partial to Steph's "Makeup Mondays" feature. At first glance, Life's Lessons, Lemonade & a Little Liner, one of my favorite makeup posts, seems to be discussing the ins and outs of eyeliner application; however, upon further reflection, Stephanae's words reveal a deeper and more poignant truth about the universal human condition:
I was desperately downcast and despondent. It really doesn't get any worse than this. When my good eye became suddenly defunct, yes, I was understandably upset. My whole world became a state of confusion.
Applying eyeliner, especially liquid eyeliner, is not for the faint of heart. In my early days of attempting to apply liquid eyeliner my hand would literally shake as the tip of the brush would near my eye. It took some time, but once I perfected my technique, in a flash I could do both eyes with one hand tied behind my back.
That cliché, "When life hands you lemons, make lemonade," didn't work for me when I lost my vision. As a matter of fact, it was during my first crack at what used to be my makeup regimen that had I possessed a few lemons I would have thrown them down to the ground, stomped them, and then put them in the garbage disposal for good measure.
For a woman who would never consider leaving home without makeup, I was now faced with a major life decision: continue down the road of self-pity or, and this is huge, go without.
I chose self-pity because, quite frankly, I was good at it. I mean, I couldn't see, couldn't put on my "face," so the solution was to wallow in it and wallow I did. But as all good things must eventually come to an end, so did my little pity party.
Learning to do my makeup again within the constraints of my vision loss was a bit of a challenge. A few familiar products just needed minor tweaks, and others I had to replace.
Using the pencil liner under the eye was easy; however, the liquid liner I was accustomed to gave me serious grief so I gave it up. It's been about five years since I've gone without liner on my eyelids. While I feel comfortable without it, in my last Sephora order I bought some eye pencils to give it one more try. To my delight it works!!! Yay!!! I'm back!!!
Confessions of a DeafBlind Mother
Tracy Stine is a frugal homemaker, thrifty crafter, amateur cook, and author of the blog Confessions of a Deafblind Mother:
My name is Tracy Stine, I'm a Deaf, legally Blind mother, and this is my story! I've been Deaf and legally Blind since birth. I have two children, a boy 14 and a girl 12. I've been married for 15 years. Born and raised in Ontario, Canada, now living in Oklahoma for seven years.
Here you'll find my stories as a Deafblind woman and mother, my views on life, fun videos, helpful information, and inspiration. My goal for this site is to educate people on various disabilities and showcase their accomplishments; help those "newly diagnosed" and their families with coping, skills, and resources; and just have fun with crafts, cooking, and family humor.
Because I greatly admire Tracy's writing, I found it difficult to select a favorite post; however, In Between Worlds, in which she talks about feeling "stuck" between two worlds (deaf and hearing), participating in both, but not fitting in either, resonated with me:
In the Deaf world, I sometimes felt different. Not exactly an "outcast" because I was never shunned, I was welcomed in to an extent. Since English is my first language and I didn't learn ASL 'til I was 12, I still signed in "English Grammar." I also could not really follow signing that quickly because of my low vision.
But I was never part of a clique one way or another. Don't get me wrong, I had lots of friends and such, and when everyone's in their groups, I wander from group to group, chit-chatting and all. But when there are group plans to head somewhere, I'm sometimes forgotten behind.
In the Hearing world, I can lipread well, speak well somewhat (you tell me, you've seen some of my videos), but pretty much on a one-on-one basis. If I'm with one person, I have no problems. The problems start when you throw in two or more people. First I'd have to find out who's talking (usually by that time, they're done speaking), sometimes I have to go over where they are (if sitting around a room), or I just sit and try to just concentrate on one person (which is like listening to only one side of a phone conversation).
Maybe it's a combination of being an introvert and my fear of "imposing" on people. The fear that people are put out and inconvenienced if I ask for help, whether they're Deaf or not. I'm always ready early so the other party doesn't have to wait - they're doing a lot just going out of their way for me already. I've been scolded by Randy, "What time is your ride?" "Ten o'clock." "It's only 9:15 and you've got your coat and watching the door? Sit down and relax!" Irrational? Maybe, but I can't shake it.
The "world" I'm most comfortable in has been the online world. Chat rooms, Twitter, Facebook, have been my quiet domain for years. I even met Randy in an online chat! Think about it: No one cares about me being Deafblind, I can keep up with everyone chatting, and I don't have to impose on anybody!
Talk To Me
If you'd like to be added to the VisionAware blogroll, just leave a note in the comments section.