Abstract
Purpose :
To investigate whether peripheral retinal pathology and visual function impacts independent navigation of the built environment
Methods :
The study included people with varying levels of diabetic retinopathy (DR) and retinitis pigmentosa (RP). Participants completed a short walk discussing their confidence, anxiety and difficulty and any issues they encountered. In addition, each participant attended for widefield retinal imaging, OCT, OCTA, visual field and dark adaptation tests. Diabetes distress scales, quality of life and a medical/study questionnaire were also completed.
Optos images were graded using a Boston Grid overlay on MATLAB software and heatmaps were made using a pre-existing code. Clinical and grading results were compared against confidence, difficulty and anxiety levels during the walkaround using Spearman's correlation.
Results :
In total, there were 33 participants (64 eyes) - 22 (66.7%) with diabetes (DM) and 11 (33.3%) with RP. Most (69.7%) were male, with a mean age of 49 (range 18-76). A majority (72.7%) had type 1 DM, 22.7% had type 2 DM and 1 was in DM remission. DM duration ranged from 2-67 years, mean 25 years. Fifteen eyes had no DR, 25 had mild-severe DR and 3 had proliferative DR. Fifteen eyes had been treated with laser.
Results showed a majority (80%) of people with RP had problems navigating the built environment, while only 5 (22.7%) with DM stated problems. Despite this, many with DM stated issues with light levels and shared space. Analysis showed average difficulty during the walkaround was associated with visual acuity, RetDQol, dark adaptation, visual field loss and percentage of the retina affected. Similarly, confidence was affected by visual acuity, RetDQOL and visual field loss. Anxiety was not seen to be significantly associated. It was also found those without an intact ellipsoid zone (EZ) had more difficulty navigating the built environment.
The most common barriers to navigation were pavement issues, bollards, parked cars on pavements, uneven pavements, alfresco dining, light levels, and street furniture.
Conclusions :
Our results show visual functionality, quality of life and percentage of pathology in the retina (especially in the periphery) causes difficulty navigating the built environment and can cause confidence issues. In the future, more needs to be done to ensure people with visual pathology/impairments can navigate freely and independently.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.