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Sight unseen : an exploration of conscious and unconscious vision
Vision, more than any other sense, dominates our mental life. Our conscious visual experience of the world is so rich and detailed that we can hardly distinguish it from the real thing. But as Goodale and Milner make clear in their prize-winning book, Sight Unseen, our visual experience of the world is not all there is to vision. Some of the most important things that vision does for us never reach our consciousness at all. In this updated and extended new edition, Goodale and Milner explore one of the most extraordinary neurological cases of recent years--one that profoundly changed scientific views on the visual brain. It is the story of Dee Fletcher--a young woman who became blind to shape and form as a result of brain damage. Dee was left unable to recognize objects or even tell one simple geometric shape from another. As events unfolded, however, Goodale and Milner found that Dee wasn't in fact blind -- she just didn't know that she could see. They showed, for example, that Dee could reach out and grasp objects with amazing dexterity, despite being unable to perceive their shape, size, or orientation. Taking us on a journey into the unconscious brain, the two scientists who made this incredible discovery tell the amazing story of their work, and the surprising conclusion they were forced to reach. Written to be accessible to students and popular science readers, this book is a fascinating illustration of the power of the 'unconscious' mind.
Book
Cognitive Level Enhancement through Vision Exams and Refraction (CLEVER): study protocol for a randomised controlled trial
Background
Longitudinal observational studies have found an association between vision impairment and accelerated decline in cognition. However, no randomised trials have assessed the possible benefit of vision correction on cognitive change. We present the protocol for a three-year randomised controlled trial designed to assess the impact of spectacles for distance and/or near vision correction on cognitive change among community-dwelling elderly participants in India.
Methods
Cognitive Level Enhancement through Vision Exams and Refraction (CLEVER) is a single-centre, open-label, parallel-group, individually-randomised trial. Participants (760 total, 380 in each arm) aged ≥ 60 years with correctable vision impairment at distance and/or near (presenting visual acuity < 6/18 in the better-seeing eye and improving to > = 6/18 with spectacles and/or presenting near vision worse than N6 at 40 cm and improving to N6 with spectacles), normal hearing (able to repeat at least three out of six words whispered from a 50 cm distance in the better ear) and normal cognition (Hindi Mini-mental Status Examination score > 18/31) will be enrolled. After a comprehensive eye examination, intervention group participants will receive distance, near, or bifocal spectacles, while controls will receive a prescription and spectacles at the end of the trial. The primary outcome will be the three-year change in Longitudinal Aging Study in India–Diagnostic Assessment of Dementia (LASI DAD) global cognitive factor score, with and without adjustment for baseline score, age, gender, education and other potential confounders.
Conclusion
CLEVER is designed to assess the effectiveness of spectacles as a low-cost intervention to prevent or delay cognitive decline.
Trial registration
This trial is registered with ClinicalTrials.gov, number NCT05458323, February 15, 2023.
Journal Article
The pirate of kindergarten
Ginny's eyes play tricks on her, making her see everything double, but when she goes to vision screening at school and discovers that not everyone sees this way, she learns that her double vision can be cured.
Book
Digital therapeutics using virtual reality‐based visual perceptual learning for visual field defects in stroke: A double‐blind randomized trial
Introduction Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double‐blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL‐based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs. Methods Stroke outpatients with VFDs (>6 months after stroke onset) were randomized into NV (defective field training) or Nunap Vision‐Control (NV‐C, central field training) groups. Both interventions provided visual perceptual training, consisting of orientation, rotation, and depth discrimination, through a virtual reality head‐mounted display device 5 days a week for 12 weeks. The two groups received VFD assessments using Humphrey visual field (HVF) tests at baseline and 12‐week follow‐up. The final analysis included those completed the study (NV, n = 40; NV‐C, n = 35). Efficacy measures included improved visual area (sensitivity ≥6 dB) and changes in the HVF scores during the 12‐week period. Results With a high compliance rate, NV and NV‐C training improved the visual areas in the defective hemifield (>72 degrees2) and the whole field (>108 degrees2), which are clinically meaningful improvements despite no significant between‐group differences. According to within‐group analyses, mean total deviation scores in the defective hemifield improved after NV training (p = .03) but not after NV‐C training (p = .12). Conclusions The current trial suggests that VPL‐based digital therapeutics may induce clinically meaningful visual improvements in patients with poststroke VFDs. Yet, between‐group differences in therapeutic efficacy were not found as NV‐C training exhibited unexpected improvement comparable to NV training, possibly due to learning transfer effects.
Journal Article
Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants
In this open, randomized, multicenter trial involving extremely-low-birth-weight preterm infants, the use of a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity.
Journal Article
Coping with vision loss : understanding the psychological, social, and spiritual effects
Through literature, media, and cinema across the ages, the authors focus attention on how the masses worldwide who are sighted view, and treat, the blind and legally blind. Coping with Vision Loss: Understanding the Psychological, Social, and Spiritual Effects also includes non-fiction written about and by the blind that gives great insight into their condition. The text explains what the visually impaired and blind can do to stay strong and live their lives to the fullest, as well as what family members and friends can do to help when needed, or to back off when one wants to be as independent as possible. Technological advances to assist the blind and legally blind are reviewed, as are websites for a host of organizations created to assist people with vision loss.
Book
Olfactory and other sensory impairments in Alzheimer disease
The vast increase in Alzheimer disease (AD) worldwide has grave implications for individuals, family support systems and the health-care systems that will attempt to cope with the disease. Early markers of the disease are essential for efficient selection of clinical trial participants for drug development and for timely treatment once an intervention becomes available. There is avid interest in noninvasive, inexpensive markers that have the potential to identify prodromal AD. This Review considers sensory impairments that have the potential to serve as early indicators of AD, with a focus on olfaction, hearing and vision. Current evidence regarding the potential markers of AD in each modality is examined, with a particular emphasis on olfaction and current findings that olfactory function is associated with prodromal AD. Research suggests that olfactory impairment is associated with other markers that signal the emergence of prodromal AD. Auditory impairment is associated with dementia in epidemiological studies and visual system deficits have been reported in AD; however, the emergence of these deficits in prodromal AD is unclear. Further research is necessary to address the relative sensitivity and specificity of olfactory, auditory and visual measures for the detection of prodromal AD.
Journal Article
A novel device for accurate and efficient testing for vision-threatening diabetic retinopathy
To evaluate the performance of the RETeval device, a handheld instrument using flicker electroretinography (ERG) and pupillography on undilated subjects with diabetes, to detect vision-threatening diabetic retinopathy (VTDR).
Performance was measured using a cross-sectional, single armed, non-interventional, multi-site study with Early Treatment Diabetic Retinopathy Study 7-standard field, stereo, color fundus photography as the gold standard. The 468 subjects were randomized to a calibration phase (80%), whose ERG and pupillary waveforms were used to formulate an equation correlating with the presence of VTDR, and a validation phase (20%), used to independently validate that equation. The primary outcome was the prevalence-corrected area under the receiver operating characteristic (ROC) curve for the detection of VTDR.
The area under the ROC curve was 0.86 for VTDR. With a sensitivity of 83%, the specificity was 78% and the negative predictive value was 99%. The average testing time was 2.3min.
With a VTDR prevalence similar to that in the US, the RETeval device will identify about 75% of the population as not having VTDR with 99% accuracy. The device is simple to use, does not require pupil dilation, and has a short testing time.
Journal Article