Vision assessment using the NIH Toolbox

Abstract

Vision is a sensation that is created from complex processes and provides us with a representation of the world around us. There are many important aspects of vision, but visual acuity was judged to be the most appropriate vision assessment for the NIH Toolbox for Assessment of Neurological and Behavioral Function, both because of its central role in visual health and because acuity testing is common and relatively inexpensive to implement broadly. The impact of visual impairments on health-related quality of life also was viewed as important to assess, in order to gain a broad view of one's visual function. To test visual acuity, an easy-to-use software program was developed, based on the protocol used by the E-ETDRS. Children younger than 7 years were administered a version with only the letters H, O, T, and V. Reliability and validity of the Toolbox visual acuity test were very good. A 53-item vision-targeted, health-related quality of life survey was also developed. Neurology Vision is a complex sensation that provides us with a personal representation of our surrounding environment. The process resulting in vision begins when the cornea and lens refract light from objects and surfaces in the world to form a panoramic, hemispheric image on the retina, the thin layer of nerve cells that lines the inside surface of the eye. Like pixels in a digital camera, photoreceptor cells sample the light in the retinal image and photochemically transform the absorbed light energy into neural signals that are processed first by neurons in the retina and then by neurons in the visual parts of the brain.The important aspects of visual sensation that may vary in the general population or that can be impaired by diseases or disorders of the visual system include resolution of detail, field of view, appearance of contrast, appearance of colors, appearance of motion, resolution of depth, seeing in dim light, and seeing in glaringly bright light.Vision was identified as the highest-ranking sensory subdomain for inclusion in the NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox) on an online request for information from the expert research community (primarily NIH-funded investigators actively involved in neurologic or behavioral research; n 5 232). Reasons that experts ranked vision highly included its impact on independence, function, safety, and well-being for individuals of all ages, and the fact that vision may affect the quality of other senses. Two aspects of vision that were prioritized for testing in the NIH Toolbox vision subdomain were visual acuity and the impact of visual function on health-related quality of life. The selection criteria emphasized tests that would be reliable, valid, cost-and time-efficient, portable, and appropriate for a broad age range (3-85 years), and would not overly burden the test participants. Visual acuity was selected for testing in the NIH Toolbox because loss of visual acuity is the most common and important form of visual impairment that may reduce ...

A framework for identifying the adaptations responsible for differences in pegboard times between middle-aged and older adults

“…Functional capabilities were assessed in one session using NIH Toolbox measures of manual dexterity (Wang et al, 2011), muscle strength (Reuben et al 2013), cognition (Weintraub et al, 2013), and tactile discrimination (Carey et al, 1997). In the other session, force steadiness was measured during single-(Marmon et al, 2011b) and double-action (Almuklass et al, 2016) tasks that involved submaximal isometric contractions.…”

“…Maximal hand grip strength was measured with a hand dynamometer (Hydraulic Hand Dynamometer, Baseline Evaluation Instruments, Irving, TX) (Reuben et al 2013). Three maximal voluntary contractions (MVC) were performed for each hand, starting with the right hand and alternating trials between right and left hands.…”

“…The motor domain includes tests to assess performance in dexterity, balance, endurance, locomotion, and strength (Reuben et al, 2013). Manual dexterity, a measure of the ability to manipulate an object through skillful coordination of the hands and fingers, is often quantified by time to complete tests such as the Rolyan 9-hole Peg Test and the Lafayette Grooved Pegboard Test (Wang et al, 2011).…”

“…The current study used a similar approach to identify age- and test-specific descriptors of pegboard times for middle-aged and older adults, but in addition examined the contribution of measures that assessed tactile sensation (Cole et al 1998; Bowden & McNulty, 2013; Dunn et al 2013) and cognitive function (Ashendorf et al 2009; Guillery et al 2013). The purpose of the study was to identify the latent variable descriptors underlying age-associated differences in time to complete the 9-hole and grooved pegboard tests.…”

Input on NIH Toolbox inclusion criteria

“…Subdomain selection for each of these areas is discussed in the domain-specific articles found later in this supplement. [3][4][5][6][7][8][9][10][11][12][13][14] Request for information #2. This sample of experts was asked how much cost there should be for the equipment needed to administer the NIH Toolbox, as well as persubject costs to gather data.…”