Purpose: To establish age-related, normal limits of monocular and binocular spatial vision under photopic and mesopic conditions. Methods: Photopic and mesopic visual acuity (VA) and contrast thresholds (CTs) were measured with both positive and negative contrast optotypes under binocular and monocular viewing conditions using the Acuity-Plus (AP) test. The experiments were carried out on participants (age range from 10 to 86 years), who met pre-established, normal sight criteria. Mean and ± 2.5σ limits were calculated within each 5-year subgroup. A biologically meaningful model was then fitted to predict mean values and upper and lower threshold limits for VA and CT as a function of age. The best-fit model parameters describe normal aging of spatial vision for each of the 16 experimental conditions investigated. Results: Out of the 382 participants recruited for this study, 285 participants passed the selection criteria for normal aging. Log transforms were applied to ensure approximate normal distributions. Outliers were also removed for each of the 16 stimulus conditions investigated based on the ±2.5σ limit criterion. VA, CTs and the overall variability were found to be age-invariant up to ~50 years in the photopic condition. A lower, age-invariant limit of ~30 years was more appropriate for the mesopic range with a gradual, but accelerating increase in both mean thresholds and intersubject variability above this age. Binocular thresholds were smaller and much less variable when compared to the thresholds measured in either eye. Results with negative contrast optotypes were significantly better than the corresponding results measured with positive contrast (p < 0.004). Conclusions: This project has established the expected age limits of spatial vision for monocular and binocular viewing under photopic and high mesopic lighting with both positive and negative contrast optotypes using a single test, which can be implemented either in the clinic or in an occupational setting.
A hospital visit is often an anxious and uncertain event for patients andtheir relatives. Patients are often concerned about a diagnosis and/or thetreatment of their disease in an outpatient or inpatient setting. In thesehospital settings, the impact of the environment on patients is still notwell understood. Knowledge regarding the inuence of the hospitalenvironment on patients is essential for facilitating the quality of healthcare. Understanding the experience of patients will allow designers anddecision-makers in hospitals to positively inuence the well-being ofpatients.The aim of this thesis was to gain an improved understanding about amore holistic experience and well-being of patients at specic focalpoints of the entire patient journey from the arrival, to the diagnosis, andto the actual treatment in a hospital. For example, results showed thatpatients sometimes experience diculties in finding their way to anoutpatient clinic, that nature projection during a CT-scan can reduceanxiety, and that (the opportunity of) interaction with other patients is apleasant distraction or, on the contrary, an invasion of their own privacy.Understanding patients' experiences during the patient journey enableshospitals to make more informed decisions about space and serviceswhich enables us to improve experiences and well-being of patients inhospitals.This thesis emphasizes the relations between the hospital environmentand the psychosocial and physical well-being of patients. The resultsshow that it is of great importance to listen carefully to patients’experiences and needs when designing a hospital as many of the resultsshowed individual dierences with patients that emphasize that one sizedoes not t all. The well-being of patients in future hospitals can beimproved by aligning the hospital environment with individual patientcharacteristics, needs, and preferences.
Background: The COVID-19 pandemic taught us how to rethink care delivery. It catalyzed creative solutions to amplify the potential of personnel and facilities. This paper presents and evaluates a promptly introduced triaging solution that evolved into a tool to tackle the ever-growing waiting lists at an academic ophthalmology department, the TeleTriageTeam (TTT). A team of undergraduate optometry students, tutor optometrists, and ophthalmologists collaborate to maintain continuity of eye care. In this ongoing project, we combine innovative interprofessional task allocation, teaching, and remote care delivery. Objective: In this paper, we described a novel approach, the TTT; reported its clinical effectiveness and impact on waiting lists; and discussed its transformation to a sustainable method for delivering remote eye care. Methods: Real-world clinical data of all patients assessed by the TTT between April 16, 2020, and December 31, 2021, are covered in this paper. Business data on waiting lists and patient portal access were collected from the capacity management team and IT department of our hospital. Interim analyses were performed at different time points during the project, and this study presents a synthesis of these analyses. Results: A total of 3658 cases were assessed by the TTT. For approximately half (1789/3658, 48.91%) of the assessed cases, an alternative to a conventional face-to-face consultation was found. The waiting lists that had built up during the first months of the pandemic diminished and have been stable since the end of 2020, even during periods of imposed lockdown restrictions and reduced capacity. Patient portal access decreased with age, and patients who were invited to perform a remote, web-based eye test at home were on average younger than patients who were not invited. Conclusions: Our promptly introduced approach to remotely review cases and prioritize urgency has been successful in maintaining continuity of care and education throughout the pandemic and has evolved into a telemedicine service that is of great interest for future purposes, especially in the routine follow-up of patients with chronic diseases. TTT appears to be a potentially preferred practice in other clinics and medical specialties. The paradox is that judicious clinical decision-making based on remotely collected data is possible, only if we as caregivers are willing to change our routines and cognitions regarding face-to-face care delivery.
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