Purpose In an observational clinical outcome study, we tested the effectiveness and use of the combination of two innovative approaches to magnification: a virtual bioptic telescope and a virtual projection screen, implemented with digital image processing in a head-mounted display (HMD) equipped with a high-resolution video camera and head trackers. Methods We recruited 30 participants with best-corrected visual acuity <20/100 in the better-seeing eye and bilateral central scotomas. Participants were trained on the HMD system, then completed a 7- to 10-day in-home trial. The Activity Inventory was administered before and after the home trial to measure the effect of system use on self-reported visual function. A simulator sickness questionnaire (SSQ) and a system-use survey were administered. Rasch analysis was used to assess outcomes. Results Significant improvements were seen in functional ability measures estimated from goal difficulty ratings (Cohen's d = 0.79, P < 0.001), and reading ( d = 1.28, P < 0.001) and visual information ( d = 1.11, P < 0.001) tasks. There was no improvement in patient-reported visual motor function or mobility. One participant had moderately severe discomfort symptoms after SSQ item calibration. The average patient rating of the system's use was 7.14/10. Conclusions Use of the system resulted in functional vision improvements in reading and visual information processing. Lack of improvement in mobility and visual motor function is most likely due to limited field of view, poor depth perception, and lack of binocular disparity. Translational Relevance We determine if these new image processing approaches to magnification are beneficial to low vision patients performing everyday activities.

Head-mounted video display systems and image processing as a means of enhancing low vision are ideas that have been around for more than 20 years. Recent developments in virtual and augmented reality technology and software have opened up new research opportunities that will lead to benefits for low vision patients. Since the Visionics low vision enhancement system (LVES), the first head-mounted video display LVES, was engineered 20 years ago, various other devices have come and gone with a recent resurgence of the technology over the past few years. In this article, we discuss the history of the development of LVESs, describe the current state of available technology by outlining existing systems, and explore future innovation and research in this area. Although LVESs have now been around for more than two decades, there is still much that remains to be explored. With the growing popularity and availability of virtual reality and augmented reality technologies, we can now integrate these methods within low vision rehabilitation to conduct more research on customized contrast-enhancement strategies, image motion compensation, image-remapping strategies, and binocular disparity, all while incorporating eye-tracking capabilities. Future research should use this available technology and knowledge to learn more about the visual system in the low vision patient and extract this new information to create prescribable vision enhancement solutions for the visually impaired individual.

Background and Objectives Dementia and vision impairment (VI) are common among older adults but little is known about caregiving in this context. Research Design and Methods We used data from the 2011 National Health and Aging Trends Study, a nationally representative survey of Medicare beneficiaries, linked to their family/unpaid helpers from the National Study of Caregiving. VI was defined as self-reported blindness or difficulty with distance/near vision. Probable dementia was based on survey-report, interviews, and cognitive tests. Our outcomes included: hours of care provided, and number of valued activities (scored 0-4) affected by caregiving, per month. Results Among 1,776 caregivers, 898 (55.1%, weighted) assisted older adults without dementia or VI, 450 (21.9%) with dementia only, 224 (13.0%) with VI only, and 204 (10.0%) with dementia and VI. In fully-adjusted negative binomial regression analyses, caregivers of individuals with dementia and VI spent 1.7-times as many hours (95% CI=1.4-2.2) providing care than caregivers of those without either impairment; however, caregivers of individuals with dementia only (95% CI=1.1-1.6) and VI only (95% CI=1.1-1.6) spent 1.3-times more hours. Additionally, caregivers of individuals with dementia and VI had 3.2-times as many valued activities affected (95%CI=2.2-4.6), while caregivers of dementia only and VI only reported 1.9-times (95% CI=1.4-2.6) and 1.3-times (95% CI=0.9-1.8) more activities affected, respectively. Discussion and Implications Our results suggest that caring for older adults with VI involves similar time demands as caring for older adults with dementia, but that participation impacts are greater when caring for older adults with both dementia and VI. Translational Significance As compared to caring for older adults with either dementia or vision impairment, caring for older adults with both dementia and vision impairment involves more hours of caregiving per month and further limits caregivers' ability to participate in social activities. Low vision rehabilitation and integration of low vision services into the care of older adults with dementia and vision impairment may reduce caregiver burden.