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.

Medicine-To examine associations between interpersonal relationships in work settings and burnout, a cross-sectional survey was conducted on home care workers in Sapporo, Japan, by using the Maslach Burnout Inventory (MBI) and scales of interpersonal conflict and social support developed by the authors. Questionnaires were distributed among 303 subjects and returned by 243 subjects (80%). Complete answers were obtained from 106 subjects and were used for analysis. In multiple regression analyses, conflict with clients and their families significantly related to emotional exhaustion and depersonalization of the MBI (p<.05). Supervisory conflict significantly related to emotional exhaustion (p<.05), whereas coworker conflict significantly associated with depersonalization (p<.01). It is suggested that conflicts with clients' families, as well as clients, are important i n d i c a t o r s f o r e m o t i o n a l e x h a u s t i o n a n d depersonalization of home care workers. (J Occup Health 2003; 45: 313-320)

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Purpose Pedestrians with low vision have identified crossing the street as a difficult task. With the increasing complexity of the crossing environment (actuated signals, roundabouts), the challenges are increasing. The purpose of this study was to evaluate the effect of two types of vision loss (central or peripheral) on the ability to detect gaps in traffic. Methods 41 subjects participated with 14 being fully sighted, 10 having central vision loss from age-related macular degeneration (AMD), and 17 having peripheral vision loss from either retinitis pigmentosa (RP) or glaucoma (GL). Standing at entry and exit lanes of a roundabout, subjects depressed a hand held trigger to indicate when there was a sufficient gap in traffic to cross the street. A total of 12 two minute intervals were completed including four of those intervals with occluded hearing. Results No difference was found in the ability of the three subject groups to identify crossable or short gaps. There were significant differences in latency and safety margin. The AMD subjects did not perform as well as the fully sighted or the subjects with RP/GL. When hearing was occluded the two vision loss groups did not show a change in sensitivity but the fully sighted group did, being more sensitive when hearing was occluded. Conclusions The purpose of this study was to evaluate the effect of low vision on the ability to detect crossable gaps in traffic. The findings suggest that subjects with AMD have an increased risk because they show significant latency in their identification of gaps and this in turn results in a reduction of safety margin.