Journal of Visual Impairment & Blindness

Introduction: This study analyzed survey responses from 114 orientation and mobility (O&M) specialists regarding the content and procedures they used in completing O&M assessments. Methods: O&M specialists completed an online survey in 2020 on their assessment practices for children and youths who are visually impaired. Results: Over 85% of participants identified that they interview the student, parent, classroom teacher, and teacher of students with visual impairments as part of the assessment. The only visual skills addressed by at least 80% of participants were depth perception, distance acuity, scanning, and peripheral visual fields. Students without additional disabilities in kindergarten through 12th grade were more likely to be taught the two-point touch cane technique when compared to students with additional disabilities, who were more likely to be taught constant contact. Discussion: Participants identified that O&M assessments for students in 9th–12th grade were more likely to focus on skills that would be needed for employment or post-secondary education or both, such as the use of public transportation. For students with additional disabilities or children under the age of five years, participants were more likely to conduct assessments focused on safety and immediate needs and environments. Implications for Practitioners: Appropriate O&M assessments need to be conducted in natural environments that provide equal challenges to the environments where students need to travel. O&M specialists must adapt the assessment content and procedures to address the current and future travel needs of all students with visual impairments.

Introduction: One of the greatest challenges dog guide handlers face after completing training is interference with their dogs’ work, both from people and other dogs. The Seeing Eye surveyed its active dog guide handlers to gain a better understanding of the types and severity of interference they were currently experiencing and to develop strategies to better equip handlers to deal with that interference. Methods: For one month (October 2019), an online survey was made available to the 1,761 active Seeing Eye handlers concerning the interference they had experienced while working their dogs in public within the past 5 years. The survey questions were designed to elicit information about the types, frequency, and severity of interference handlers experience both from people and other dogs, as well as the settings in which the interference took place. Descriptive statistics were used to analyze the data. Results: Eighty-nine percent of handlers had experienced people interfering with the work of their dogs at least occasionally by talking to or making eye contact with them, and 78% had experienced interference from other dogs regularly. Interference from other dogs was usually nonaggressive, but 36% reported other dogs making aggressive physical contact with their dogs. Interference of all types mostly occurred in public places. Discussion: A robust, multifaceted public awareness campaign is necessary to address the persistent problem of interference with dog guide teams. Implications for Practitioners: Many factors influence a person's decision about whether to work with a dog guide. This study provides practitioners with a more realistic picture of the challenges handlers are likely to face in their encounters with the public. Practitioners and dog guide schools can use the information in the study to better equip and support dog guide handlers to proactively engage the public and manage interference when it does occur.

Introduction: Braille literacy for students who are visually impaired (i.e., those who are blind or have low vision) can be a critical component for school and postsecondary transition success. This survey study was a modified replication of previous studies that examined the instruction of literary braille in university preparation programs for professionals who work with students with visual impairments. Methods: Nineteen university instructors of literary braille responded to a survey about instructional formats, books, and tools, as well as assessment issues, such as test formats, scoring, and requirements for demonstrating proficiency. Results: Survey responses indicated that some instructional strategies at the university level have remained the same over the last 20 years, but there are also some changes. Most notably, updated books and resources are being used and instructors represent the same demographic group, Caucasian females over 45 years old. But, the level of experience has substantially dropped and there has been a shift to increased online learning. All programs indicated focusing instruction on Unified English Braille (UEB) code. Discussion: Prior concerns about the challenges of teaching UEB have been somewhat satisfied. Proficiency exams are now required by programs, which could contribute to better prepare teachers for students with visual impairments. Implications for Practitioners: The shift to online learning affects practice. The use of braille simulation software might alter the way practitioners think about erasures. In preparing for distance learning, instructors must consider how to make courses accessible, rigorous, and of high quality. Although university braille proficiency exams should continue to be used to evaluate the skills of future professionals, educators might advocate for tests at the state or province level prior to licensure and common standards for minimal competency.

Introduction: The purpose of this study was to characterize functional impairments and human factor considerations that affect perceptions and preferences for head-mounted display (HMD) technology for adults with low vision and chronic eye disease. Methods: Through a convergent mixed-methods design, participants with visual impairments (age-related macular degeneration, diabetic retinopathy, glaucoma, or retinitis pigmentosa) were recruited. Participants completed the Impact of Vision Impairment (IVI) questionnaire, used commercially available HMDs (eSight, NuEyes, and Epson Moverio), and were interviewed. The IVI was used to identify groups with low, moderate, and high vision–related quality of life (VRQOL). Transcribed interviews were analyzed using a thematic approach. The survey and qualitative findings were integrated using mixed-methods joint display analysis. Results: Twenty-one participants were enrolled (mean age of 58.2 years, 57% male, median Snellen acuity of 20/40 [range: 20/20–hand movement]). An equal number (n = 9) expressed a preference for eSight and NuEyes, while (n = 3) preferred the Moverio. Participants emphasized ease of use, including HMD controls and screen, as common reasons for preference. Those with lower IVI well-being scores preferred eSight due to vision improvement. Those with moderate IVI well-being scores preferred NuEyes due to comfort and size. Those with high IVI well-being scores cited usability as the most important feature. Discussion: User preferences for HMD features were associated with VRQOL. A mixed-methods approach explained how varying degrees of visual impairment and HMD preferences were qualitatively related to usability at the individual level. Implications for Practitioners: To increase acceptance, new HMD development for low vision should focus on performance, usability, and human factors engineering. Although HMD technology can benefit individuals with low vision, device features and functions vary in meaningful ways based on vision parameters. Practitioners should be aware of how patient and device variations influence preferences when they recommend wearable systems and optimize training to harness these systems.

Introduction: This article describes the field test of 4to24, a transition application (app) for parents of and students with visual impairments. In this stage of the development process, researchers evaluated the app's usability and gained feedback on app use and experience from end users. Methods: Participants, including 27 parents of and 19 students with visual impairments, used 4to24 for 6 months. They completed a baseline survey, a survey about the account setup process, and three additional surveys at 2-month intervals (i.e., 2, 4, and 6 months). Results: Participants found the app account setup process quick and easy to complete. Parents and students used the app more frequently during the first 2 months, and then app usage decreased over time. Participants’ average ratings for app enjoyability, ease of use, understandability of information, and relevance of information were generally high and consistent across time points. Participants found 4to24 useful to track activities to help students prepare for college and work, and most planned to continue using it after the study. Discussion: Findings indicate that the app was usable, enjoyable, easy to use, and helpful. The decline in app usage over the 6 months may signify that participants lost interest, were impacted by the COVID-19 pandemic, or spent more time working on activities within the modules. Students rated app enjoyability and relevance higher than parents, which may relate to the language and tone of the student-focused modules. Introductory topics may have been unnecessary for some parents, which could have contributed to their lower relevance ratings. Implications for Practitioners: Service providers can inform parents and students about 4to24 and its potential benefits. 4to24 can encourage conversations about college and work, provide resources and activity suggestions, and serve as a resource for parents who are not connected or knowledgeable about services.

Introduction: Visual impairment is a major public health challenge for diabetics who have ocular comorbidities. In Ethiopia, data are lacking on the prevalence of visual impairment among diabetics as well as information on causes and predisposing factors. The current study was designed to assess the causes, risk factors, and levels of diabetes-related visual impairment within an Ethiopian population. Methods: The study enrolled a total of 296 diabetic patients at the Debre Tabor General Hospital (DTGH). Data were ascertained through face-to-face interview, from patients’ medical folder, and through comprehensive ocular health assessment. Descriptive and analytical statistics were performed. Result: Generally, the prevalence of visual impairment among adult diabetic patients was 39.5% (95% confidence interval [CI]: 33.8–45.6). Visual impairment was primarily due to diabetic retinopathy (44.4%), followed by refractive error (20.6%), cataract (13.9%), other ocular conditions (6.1%), and glaucoma (5.4%). Age >45 years (adjusted odds ratio [AOR] = 7.8, 95% CI: 3.5–18), female gender (AOR = 3.0, 95% CI: 1.4–7.7), low educational status (AOR = 8.1, 95% CI: 2.4–26.0), and longer span of diabetes (AOR = 3.7, 95% CI: 2.1–6.8) had a notable association with visual impairment among diabetic patients. Discussion: This study observed a high prevalence of visual impairment in diabetic patients. Diabetic retinopathy, refractive error, and cataract were the most common causes of visual impairment, followed by other ocular conditions and glaucoma. Older age, female gender, low educational status, and longer span of diabetes were important risk factors of visual impairment among diabetic patients. Implications for Practitioners: This result could alert health care professionals to inform their diabetic clients about the serious impacts of diabetes and the need for a regular eye check-up. Health care providers and policy makers should work to integrate the diabetic clinics into a general hospital with an eye care unit for an effective screening of diabetic eye disease and prevention of blindness.

Introduction: The Workforce Innovation and Opportunity Act of 2014 reinforced the state federal vocational rehabilitation program's commitment to job retention and career advancement for persons with disabilities. We continue to have limited information about what job-related skills are most helpful to persons with visual impairments in retaining or advancing in employment. Method: Descriptive statistics and logistic regression were used to investigate the association between current employment status and skills among persons with visual impairments who had a competitive employment history. Data were from a national volunteer survey of persons with visual impairments born between 1950 and 1991. Snowball sampling methods generated the sample. Results: Persons with professional licensure or certificates were more than twice as likely to be employed as those who did not possess these qualifications. Employed participants were less likely to need job-related training to find or keep a job. Discussion: Though additional research to explore the relationships between skills and employment is indicated, persons with visual impairments should be encouraged to explore and pursue job skills training and professional licensure or certification in fields compatible with their career goals. Implications for Practitioners: Even persons with a work history may need additional job skills training to continue employment. Professional licensure or certification may be of value in obtaining employment, but persons with visual impairments may need support to obtain those credentials. Careful career planning to promote positive employment outcomes should include research about the credentials associated with employment goals.

Introduction: Employment in the culture and arts sector has multiple psycho-socioeconomic benefits for people with visual impairments. However, a study in this area is rare in Ethiopia. The current study explored barriers to employment of young cultural practitioners with visual impairments in the cultural industries of Ethiopia. Method: Eight young cultural practitioners who have visual impairments were interviewed and the qualitative data were thematically analyzed. Results: The results indicated that personal, attitudinal, and environmental barriers hinder the meaningful participation of young cultural practitioners with visual impairments in the job market of the cultural industries of Ethiopia. Discussion: Although the study found differences in geographic and sectoral barriers to employment the results of the current study supported previous research findings. Implications: The current study has implications for future research as well as policymakers concerning employment and labor affairs. Besides highlighting the need for an increased understanding of identified barriers to cultural employment, the study revealed that there is also a need for further research on the numerous benefits that employment and participation in culture and arts provide for people with and without impairments at individual, community, and national levels.

Introduction: Limited research has examined the experience and psychosocial effect of vision impairment in older adults. We examine the relationship between vision impairment and stigma using guided interviews among older adults with age-related eye disease. Methods: Thirty-six participants with vision impairment were recruited from glaucoma (n = 18) (better eye visual fields mean deviations: >5 and <15 decibels) or retina (n = 18) (better eye visual acuity: <20/40 and >20/400) clinics of the Johns Hopkins Wilmer Eye Institute between 2015 and 2020. Participants completed interviews to examine stigma surrounding age-related vision impairment. Interviews were transcribed and analyzed using directed content analysis. Results: Content analyses of interview transcripts revealed underlying stigma within our cohort. Starting with categories of (1) interpersonal relationships and (2) evolving self-perception, specific domains of stigma were realized in this study. Although both enacted (external) stigma and perceived stigma were acknowledged by a subset of participants, few endorsed internalized stigma. In the face of stigma, participants demonstrated notable resiliency in adapting to and living with age-related vision impairment, captured in an additional category of (3) behavioral adaptations. Discussion: In-depth interviews revealed that older adults with vision impairment confront specific domains of stigma, including enacted and perceived stigma. Features protective against internalized stigma included older age, community support, and assistive technologies. Implications for Practitioners: A recognition of the subtypes of stigma that older adults with age-related vision impairment face is necessary to tailor support and target interventions.

Introduction: This study examined the naturally occurring social interactions of adolescents with visual impairments during lunch. Methods: We observed nine middle and high school students with visual impairments during multiple lunch periods (i.e., 44 total observations). We used interval recording (15 s observe, 15 s record) to collect data on our three primary variables: social interactions, social engagement, and proximity to others. We also took notes on quality of interaction (i.e., degree of reciprocity, appropriateness of content, affect of students and their peers, response relevance). Results: Students sat in close proximity to peers without disabilities for more than half of the observed lunch periods. However, students interacted with another person during only one-third of lunch periods. Interactions were more common with peers than with adults. Moreover, students without an additional cognitive impairment had higher quality and more frequent interactions with peers than adults; the opposite was true for students who had cognitive impairments in addition to visual impairments. Discussion: The findings of this study demonstrate that some students with visual impairments are very socially engaged during lunch, while others, namely those with additional cognitive impairments, have infrequent or low-quality interactions with peers during lunch. Implications for Practitioners: This study should prompt educators to consider the cafeteria as a context for supporting peer interaction and social skill development.

Introduction: Research is needed to support accuracy and safe self-management of prescriptions among individuals living with low vision or blindness. This study evaluated user accuracy & satisfaction with the ScripTalk® device, an audible prescription reader, among participants with low vision and blindness. Methods: This mixed methods study utilized snowball and convenience sampling through low vision support groups in Indiana. Researchers trained 23 participants (69.6% female, 30.4% male, M age = 64.04, SD = 14.7 years) to use the ScripTalk® device for reading three empty prescription bottles, equipped with radio-frequency ID labels. Accuracy represented correct responses to 12 questions about the labels’ content. The QUEST 2.0's Device Subscale (intraclass correlation coefficient = 0.82) evaluated user satisfaction with the device. Participants answered six qualitative questions about their perceptions of the device. Results: Statistical analysis indicated highest frequencies of satisfaction occurred for Ease in Adjusting (100%), Comfort (100%), Ease of Use (95.6%), and the Weight (95.6%) of the device. Spearman rank order correlation coefficient tests revealed inverse relationships between participants’ accuracy rates and their satisfaction with the device's durability (rho = −0.690, p < .001) and safety & security (rho = −0.834, p < .001). Participants perceived the device as easy to use, adjustable, comfortable, and lightweight for reading prescription labels. However, the auditory quality posed challenges to identify unfamiliar prescription names. Health care professionals may need to provide additional training and practice opportunities with audible prescription readers to support consumers with low vision or blindness, particularly when new medications are prescribed.

Introduction: The Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) are useful measures to assess how children with visual impairments are meeting the nine areas of the expanded core curriculum (ECC). Each item of the CAPE and PAC includes an activity with an accompanied image to illustrate it. However, the measures do not provide standardized image descriptions for each item, which limits its validity and reliability for this population. Thus, the purpose of this Delphi study was to validate and standardize image descriptions for the CAPE and PAC so they can be used more effectively with children with visual impairments. Methods: The expert panel consisted of 11 professionals with extensive knowledge and experience with individuals with visual impairments and six dyads of parents and their child with a visual impairment. Each panel member assessed the accuracy of wording for 57 image descriptions on a 4-point Likert scale and provided feedback on items rated below 3. Results: Consensus on all image descriptions was reached after two rounds. Discussion: The results of this study help to increase the validity and reliability of the CAPE and PAC for children with visual impairments. Implications for Practitioners: The CAPE and PAC can be used more effectively by practitioners and researchers to assess the areas of the ECC for children with visual impairments.