A School Eye Health Rapid Assessment (SEHRA) planning tool: Module to survey the magnitude and nature of local needs

BACKGROUND

Eye conditions in children can have negative consequences on visual functioning and quality of life. There is a lack of data on the magnitude of children with eye conditions who need services for effective planning of school eye health programmes. To address this, the School Eye Health Rapid Assessment (SEHRA) tool is being developed to collect data to support school eye health programme planning.

METHODS

The module, 'the magnitude and nature of local needs in school children' is the first of six modules in the SEHRA tool. The module outlines a school-based cluster survey designed to determine the magnitude of eye health needs in children. This paper outlines the survey sampling strategy, and sample size calculations.

RESULTS

The requirements for the SEHRA survey indicate that in regions where a larger sample size is required, or where fewer schools are recruited to the survey, confidence in the accuracy of the data will be lower.

CONCLUSIONS

The SEHRA survey module 'the magnitude and nature of local needs in school children' can be applied in any context. In certain circumstances, the confidence in the survey data will be reduced.

Status of Visual Impairment among Children with Special Needs in Rural China

INTRODUCTION

Previous studies have reported a high prevalence of visual defects in children with special needs. However, routine ocular examinations for these children in rural areas of China are lacking. This study aimed to evaluate the status of visual impairment (VI) in children at special education schools in rural China.

METHODS

A total of 316 students from two special schools in Zunyi city, Guizhou province, were enrolled. Full ophthalmic examinations were performed, and gene-sequencing services were offered to potential patients.

RESULTS

The mean age of the 316 participants was 12.27 ± 3.49 years and 75 showed abnormal ophthalmic manifestations on slit-lamp examination. Visual acuity (VA) was assessed in 232 eyes, and the mean VA (logarithm of the minimum angle of resolution, logMAR) was 0.27 ± 0.34. Whole-exome sequencing identified 19 mutations in these children, which might explain their visual complaints. Children with Down syndrome had a significantly higher prevalence of ocular disorders than those without.

CONCLUSION

VI is common among children at special education schools in rural areas; however, routine screening and effective interventions have not been consistently implemented. Efforts should be made to address this issue in these already disadvantaged children.

Can we scale up a comprehensive school-based eye health programme in Zambia?

BACKGROUND

Globally, 19 million children have preventable vision impairment simply because refractive and eye health services are inaccessible to most of them. In Zambia, approximately 50,000 school children need spectacle provision. The School-based Eye Health Programme (SEHP) has been identified worldwide as a proven strategy to address childhood blindness. Given its great benefits, the Zambian government intends to scale up the programme. This scalability assessment aims to identify and evaluate the essential components of an effective SEHP, determine roles, assess existing capacities within user organisations, identify environmental facilitating and inhibiting factors, and estimate the minimum resources necessary for the scaling up and their proposed scale-up strategies.

METHODS

Five elements (innovation, user organisation, resource team, environment, and strategies for horizontal and vertical scaling-up) were assessed guided by the ExpandNet-WHO Nine Steps for Developing a Scaling-Up Strategy. Literature review on proven strategies to reduce childhood blindness and the credibility of SEHP implemented in resource-limited settings, document review on the pilot project, questionnaires, and stakeholders' interviews were conducted to collect data for this assessment. Subsequently, twenty questions in the Worksheets for Developing a Scaling-up Strategy were used to report the assessment outcome systematically.

RESULTS

Additional components of SEHP incorporated in Zambia's model enhanced the innovation's credibility and relevance. The resource team was relatively competent in the pilot project, and the same team will be employed during the scaling-up. Potential change in political parties, the lack of supply chain, and unstable financial support were identified as inhibiting factors. The objectives of SEHP were aligned with the National Eye Health Strategic Plan 2017-2021, which supports the institutionalisation of the SEHP into the existing School Health and Nutrition Programme. For the pace of expansion, replicating SEHP to another district rather than a province will be more realistic.

CONCLUSION

Scaling up a comprehensive SEHP in Zambia is feasible if sufficient funding is available. Additionally, the pace must be adapted to the local context to ensure that every component within the SEHP is intact.

The "In It Together" digital intervention to treat distress among older adults with sensory loss and their spouses: Study protocol for a randomized controlled trial study

Sensory impairment is common in older age and may be associated with intra- and interpersonal struggles. Treatment and intervention efforts may be hampered by functional difficulties or unwillingness to receive face-to-face mental health services. The current study seeks to assess the efficacy of an online psychological intervention for older adults with sensory loss and their spouses in Denmark, using a two-arm, parallel-group, randomized controlled trial study design. Participants will be randomly assigned to the intervention group or waiting list control group. The intervention consists of four digital, sequential modules that contain psychoeducation and Acceptance and Commitment Therapy inspired therapeutic activities. Individuals will be assessed at baseline, 6 weeks, and 10 weeks post-baseline, and for the intervention group only, at 18-weeks. The outcomes are well-being (primary), relationship satisfaction (secondary), and depressive symptoms (tertiary). The data will be analyzed using multilevel modeling to account for non-independence of data (nesting within participant and within couple). This is the first randomized controlled trial study of an online psychological intervention for older adults with sensory loss and their spouses and it will provide valuable knowledge regarding whether internet-delivered intervention is effective for this population group.

Childhood Vision Impairment and Refractive Error in Zimbabwe: A Hospital-based Retrospective Study

Background

The objective of this study was to determine the causes and distribution of vision impairment and refractive error among children in Zimbabwe.

Methods

A hospital-based retrospective cross-sectional study was conducted among children (3–16) who attended the Eye Institute, Harare, Zimbabwe, from January 2010 to December 2020. Patients' records were collated, and variables such as visual acuity, ocular morbidities, and vision impairment were analysed.

Results

During this time, 1038 children with mean age of 10.63 ± 3.54 years visited the facility. The majority of them were males (53.2%). Prior to treatment, 9.9% of the children had vision impairment which reduced to 3.5% after intervention. Uncorrected refractive error accounted for the majority of vision impairment (67.0%), followed by keratoconus (7.8%), corneal opacity/ulceration (6.8%), and amblyopia (6.8%), among other conditions. Astigmatism (60.6%) was the most prevalent type of refractive error followed by myopia (37.5%).

Conclusion

The prevalence of childhood vision impairment is higher than that found in similar hospital-based studies conducted in Africa. The most common reason for childhood vision impairment was uncorrected refractive error.

Associations of self-reported vision impairment with depression symptoms among middle-aged and older Chinese

BACKGROUND

Vision impairment (VI) and depression are highly prevalent among adults. However, few nationally representative studies from China on the self-reported VI and its association with depression symptoms.

AIMS

This study re-estimated the relationship between self-reported VI and depression symptoms.

METHODS

In this analysis, 62,525 respondents from the China Health and Retirement Longitudinal Study 2011-2018 were included. Based on self-reports, respondents with VI were allocated to distance VI (DVI), near VI (NVI), both distance and near VI (DNVI), or a blindness group. Multivariable pooled logistic regression models were used to evaluate the groups' odds ratios (ORs) for depression symptoms and self-reported VI.

RESULTS

Overall, 35.9% of the respondents were self-reported VI. DVI (OR: 1.51, 95% confidence interval [95% CI]: 1.28-1.79) and DNVI (OR: 1.51, 95% CI: 1.21-1.88) showed the highest ORs for depression symptoms, followed by NVI (OR: 1.31, 95% CI: 1.11-1.54). Depression symptoms were associated with a significantly increased risk of DVI (OR: 1.49, 95% CI: 1.26-1.76), DNVI (OR: 1.49, 95% CI: 1.20-1.86), and NVI (OR: 1.29, 95% CI: 1.10-1.52), respectively. However, these associations between self-reported blindness and depression symptoms were not significant. All models provided similar results by excluding respondents aged 45-59 years.

CONCLUSION

Self-reported DVI, NVI, and DNVI are associated with depression symptoms. A strong reverse association was found between depression and self-reported DVI, NVI, and DNVI, but not for blindness. Our findings emphasize the urgent need for depression screening for self-reported VI among Chinese adults.

Improved intention, self-efficacy and social influence in the workspace may help low vision service workers to discuss depression and anxiety with visually impaired and blind adults

Background

Depression and anxiety are common in visually impaired and blind adults, but often remain untreated in those who receive support from low vision service (LVS) organizations. This study aims to determine factors associated with discussing mental health by LVS workers.

Methods

A self-administered cross-sectional survey in one hundred LVS workers was performed. Data on current practice, symptom attribution, and determinants of the Integrated Change Model (i.e. predisposing and environmental factors, awareness, attitude, self-efficacy, social influence, confidence and barriers) were investigated. Multivariable logistic regression analysis was performed to determine predictors of discussing mental health problems in this population. Subsequently, internal validation was conducted using a bootstrapping method.

Results

Around 80% of the participants often discussed mental health with clients. Five factors were found to predict discussion of mental health: female gender (OR = 4.51; 95% confidence interval (CI) 0.98 to 21.61), higher education (OR = 3.39; CI 1.19 to 9.66), intention to discuss mental health problems (OR = 3.49; CI 1.20 to 10.15), higher self-efficacy (OR = 1.11; CI 1.02 to 1.20), and higher perceived social influence (OR = 1.15; CI 1.05 to 1.27). Good discrimination after internal validation was reflected by the area under the curve (0.850).

Conclusions

Previous studies indicate clients want healthcare providers to initiate discussions about mental health. However, still 20% of LVS workers do not discuss suspected depression or anxiety. In order to improve this, LVS organizations could address mental health as part of their care and provide training to ensure intention to discuss mental health problems, improve self-efficacy and create a supportive environment between colleagues.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07944-0.

Capacity Building of Frontline Workers for Detection of Children (0-6 Years) with Developmental Delays in a Rural Setting: A Cluster-Randomized Trial

INTRODUCTION

Development during the early stage of life i.e. in the first 1000 d is crucial in determining the psychosocial productivity of a child in the future. Frontline workers (FLWs) are not trained to detect of developmental delays (DDs) in children under the national programme of Rashtriya Bal Swasthya Karyakram (RBSK) in India.

OBJECTIVE

To train the FLWs and assess the effectiveness of a training strategy in detection of DDs in children less than 6 y of age using a cluster-randomized trial approach.

METHODS

A community-based interventional study was conducted in Khurdha district of Odisha. Training was imparted to FLWs in intervention arm using a training module developed in regional language. Knowledge level of FLWs was assessed before and after the training in both study arms using a structured questionnaire, and data were analyzed in IBM SPSS 22. Outcomes were compared using chi square, Student t (both paired and unpaired) and Man-Whitney U test. After 3 mo of intervention, the investigator examined a sample of children (intervention arm: 870, control arm: 847) for DDs using the Denver Developmental Screening Test II.

RESULTS

The mean difference in knowledge scores of FLWs was found to be 7.26 (8.8 to 5.7) and 1.11 (1.38 to 0.84) in intervention and control arm, respectively. Case detection rate by FLWs in intervention and control arm was 61.5% and 9.09%, respectively.

CONCLUSION

Capacity building of the FLWs should be considered by the government for integrating them in the Rashtriya Bal Swasthya Karyakram (RBSK) programme for screening children.

Economic evaluations of vision screening to detect amblyopia and refractive errors in children: a systematic review

OBJECTIVE

To synthesize and appraise economic evaluations of vision screening to detect vision impairment in children.

METHODS

Literature searches were conducted on seven electronic databases, grey literature, and websites of agencies conducting health technology assessments. Studies were included if they (1) were full, comparative economic evaluations that used cost-utility, cost-benefit, cost-effectiveness, cost-consequence, or cost-analysis methods; (2) described screening services designed to detect amblyopia, strabismus, or uncorrected refractive errors in children under 6 years of age; and (3) published after 1994. High-quality studies were synthesized descriptively. Currencies were reported in 2019 Canadian dollars. Quality was assessed with the Pediatric Quality Appraisal Questionnaire (PQAQ).

RESULTS

Vision screening services were conducted by paid staff, volunteers, or health care professionals in schools or clinics. Thirteen studies were published from five countries: China (n = 1), United States (n = 4), United Kingdom (n = 1), Canada (n = 1), and Germany (n = 6). Analytical techniques included cost-utility/cost-effectiveness combination (n = 2), cost-effectiveness analysis (n = 7), cost-utility analysis (n = 1), cost-benefit analysis (n = 1), cost-consequence analysis (n = 1), and cost analysis (n = 1). Incremental cost-effectiveness ratios ranged from C$1,056 to C$151,274 per additional case detected/prevented and from C$9,429 to C$30,254,703 per additional QALY gained, depending on the type of screening service and comparator. Six studies were determined to be of high quality.

CONCLUSION

Vision screening to detect amblyopia for young children may be cost-effective compared with no screening if amblyopia reduced quality of life. Studies varied significantly in the type of screening services and comparators used. Methodological limitations were common. Future studies would be aided immensely by prospective studies on the impact of amblyopia on the health-related quality of life of young children and guidelines on the effective conduct of vision screening.

Self-Reported Vision Impairment and Psychological Distress in U.S. Adults

PURPOSE

Examine the relationship between vision impairment and psychological distress in adults ≥18 years.

METHODS

Using the 2016-2017 cross-sectional, U.S. National Health Interview Survey, we analyzed self-reported data (n = 57,644) on: Kessler psychological distress scores; general vision impairment (GVI), defined as difficulty seeing even when wearing glasses or contacts; and visual function impairment (VFI), measured using six visual function questions. Multinomial logistic regression was used to estimate adjusted odds ratios (aOR) for mild/moderate and serious psychological distress, by GVI and VFI status, and identify predictors of psychological distress among those with GVI or VFI.

RESULTS

Among adults, 10.6% (95% CI: 10.2, 11.0) had GVI; 11.6% (CI: 11.1, 12.0) had VFI. One in four adults with GVI had psychological distress (14.9% [CI: 13.8, 16.0] reported mild/moderate and 11.2% [CI: 10.2, 12.3] reported serious). Individuals with GVI, versus those without, had higher odds of mild/moderate (aOR = 2.24; CI: 2.00, 2.52) and serious (aOR = 3.41; CI: 2.96, 3.93) psychological distress; VFI had similar findings. Among adults with GVI, odds of serious psychological distress were higher for those aged 18-39 (aOR = 4.46; CI: 2.89, 6.90) or 40-64 (aOR = 6.09; CI: 4.33, 8.57) versus ≥65 years; smokers (aOR = 2.45; CI: 1.88, 3.18) versus non-smokers; physically inactive (aOR = 1.61; CI: 1.22, 2.11) versus active; and with arthritis (aOR = 2.18; CI: 1.66, 2.87) or chronic obstructive pulmonary disease (aOR = 1.65; CI: 1.15, 2.37) versus without.

CONCLUSION

Adults with self-reported vision impairment had higher odds of psychological distress. These findings may inform screening interventions to address psychological distress, particularly among younger working-age adults vision impairment.

Impact of vision and hearing impairments on risk of cardiovascular outcomes and mortality in patients with type 2 diabetes: A nationwide cohort study

AIMS/INTRODUCTION

The purpose of this study was to investigate the impact of vision and hearing impairments on the risk of adverse cardiovascular outcomes and mortality in patients with type 2 diabetes using a nationwide longitudinal cohort.

MATERIALS AND METHODS

We enrolled 771,128 patients with type 2 diabetes who underwent the National Health Screening Program in 2009. We carried out Cox proportional hazards regression analyses to calculate the hazard ratios (HR) of myocardial infarction (MI), stroke, and mortality in those with or without vision and hearing impairments. Subgroup analyses of patients stratified by age, sex and diabetic retinopathy were carried out.

RESULTS

Diabetes patients with either vision or hearing impairment showed higher risk of MI, stroke or death compared with those without. Among the combinations of impairments, patients with both vision and hearing impairments had the highest risk for MI (adjusted HR [aHR] 1.362, 95% confidence interval [CI] 1.252-1.481) and mortality (aHR 1.591, 95% CI 1.532-1.651). Those with only vision impairment showed higher risk of MI (aHR 1.324, 95% CI 1.275-1.375 and aHR 1.117, 95% CI 1.066-1.170, respectively), stroke (aHR 1.318, 95% CI 1.276-1.362 and aHR 1.134 95% CI 1.089-1.180, respectively) and mortality (aHR 1.417, 95% CI 1.390-1.446 and aHR 1.163, 95% CI 1.135-1.191, respectively) compared with those with only hearing impairment.

CONCLUSIONS

Vision and hearing impairments are independently important risk factors for adverse cardiovascular events and mortality in patients with type 2 diabetes. Vision and hearing impairments synergistically increased the risk of MI and all-cause deaths, but not stroke. In addition, in patients aged <65 years, the HR of vision impairment was higher than those with vision and hearing impairments.

Evaluation of away-from-home excursion patterns after falling among individuals with glaucoma: a longitudinal study

Background

Unintentional falls among older adults are associated with an ensuing decline in physical activity. Our objective is to evaluate the associations between fall status and changes in excursions after a fall.

Methods

Prospective cohort study of older adults with glaucoma or suspected glaucoma who reported falls for 1 year and wore a GPS device for 1-week at the baseline and 1 year later. GPS data were quantified into average: daily excursions, daily time away from home, and time per excursion. Fall status was categorized as fallers, injurious fallers, recurrent fallers, and recurrent injurious fallers. Multivariable negative binomial regression and generalized estimating equations models were employed to evaluate relationship between excursion parameters and fall status.

Results

A total of 192 eligible participants were included in the analyses. Approximately half were males (50.5%) with a mean age of 70.1 years and one-fourth were Black (28.1%). There were no significant associations between fall status and end-of-study excursion parameters (p > 0.06 for all), and visual field damage did not modify these relationships (p > 0.07 for all). For instance, patients with multiple falls during a one-year study period did not demonstrate more daily excursions (incident rate ratio [IRR] = 1.16, 95% confidence interval [CI] = 0.85 to 1.57), longer time per excursion (IRR = 0.79, 95% CI =0.59 to 1.06), or more average daily time away (IRR = 1.05, 95% CI = 0.84 to 1.30) conducted at the end-of-the study. Excursion parameters at the final assessment were not significantly different from those at baseline (p > 0.09 for all) and the changes did not vary by fall status (p > 0.23 for all).

Conclusions

Older adults with glaucoma did not modify their travel away from home after experiencing a fall. Additional research is necessary to understand how often maintenance of travel outside the home after a fall reflects proper compensation for greater fall risk or continued activity despite the risk of falling.

The Relationship Between Visual Function and Performance in Para Swimming

BACKGROUND

Paralympic swimmers with vision impairment (VI) currently compete in one of the three classes depending on their visual acuity (VA) and/or visual field. However, there is no evidence to suggest that a three-class system is the most legitimate approach for classification in swimming, or that the tests of VA and visual field are the most suitable. An evidence-based approach is required to establish the relationship between visual function and performance in the sport. Therefore, the aim of this study was to establish the relationship between visual function and performance in VI Para swimming. The swimming performance of 45 elite VI swimmers was evaluated during international competitions by measuring the total race time, start time, clean swim velocity, ability to swim in a straight line, turn time, and finish time. Visual function was measured using a test battery that included VA, contrast sensitivity, light sensitivity, depth perception, visual search, and motion perception.

RESULTS

Results revealed that VA was the best predictor of total race time (r = 0.40, p < 0.01), though the relationship was not linear. Decision tree analysis suggested that only two classes were necessary for legitimate competition in VI swimming, with a single cut-off between 2.6 and 3.5 logMAR. No further significant association remained between visual function and performance in either of the two resulting classes (all |rs|< 0.11 and ps > 0.54).

CONCLUSIONS

Results suggest that legitimate competition in VI swimming requires one class for partially sighted and another for functionally blind athletes.

Self-Reported Vision Impairment and Frailty among Older People with Low Cognitive Performance in Central Africa: EPIDEMCA Population-Based Study

INTRODUCTION

Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance.

METHODS

It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models.

RESULTS

Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%-69.1%] and 23.7% [95% CI: 20.1%-27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1-4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9-3.7).

CONCLUSION

In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

Vision impairment, vision correction, and cognitive decline among middle-aged and older Chinese: results from the China health and retirement longitudinal study

OBJECTIVES

To investigate the associations between vision impairment (VI), vision correction (VC), and cognitive function.

METHOD

We included 20,677 participants aged ≥45 years from the China Health and Retirement Longitudinal Study (2011-2015). Participants were grouped into no VI, distance VI (DVI) only, near VI (NVI) only, or both distance and near VI (DNVI), and VI(+)/VC(-), VI(+)/VC(+), VI(-)/VC(-), or VI(-)/VC(+) further at baseline. Cognitive function at baseline and subsequently every two years was applied as a dependent variable in a generalized estimating equation model.

RESULTS

DVI only, NVI only, and DNVI had significantly worse cognitive function over time than no VI (all p < .05). DNVI had significantly worse cognitive function over time than DVI only and NVI only (all p < .001). VI(+)/VC(+), VI(-)/VC(-), and VI(-)/VC(+) had significantly better cognitive function over time than VI(+)/VC(-) (all p < .05). VI(-)/VC(+) had significantly better cognitive function over time than VI(+)/VC(+) and VI(-)/VC(-) (all p < .05).

CONCLUSION

Cognitive function was worse in middle-aged and older Chinese with VI, especially in those with DNVI. VC was associated with better cognitive function over time regardless of the status of vision.

The association between objective vision impairment and mild cognitive impairment among older adults in low- and middle-income countries

AIM

The association between visual impairment and mild cognitive impairment (MCI) has not been investigated to date. Thus, we assessed this association among older adults from six low- and middle-income countries (LMICs) (China, India, Ghana, Mexico, Russia, and South Africa) using nationally representative datasets.

METHODS

Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Visual acuity was measured using the tumbling ElogMAR chart, and vision impairment (at distance and near) was defined as visual acuity worse than 6/18 (0.48 logMAR) in the better-seeing eye. The definition of MCI was based on the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression was conducted.

RESULTS

Data on 32,715 individuals aged ≥ 50 years [mean (SD) age 62.1 (15.6) years; 51.2% females] were analyzed. Compared to those without far or near vision impairment, those with near vision impairment but not far vision impairment (OR = 1.33; 95% CI = 1.16-1.52), and those with both far and near vision impairment (OR = 1.70; 95% CI = 1.27-2.29) had significantly higher odds for MCI. Only having far vision impairment was not significantly associated with MCI.

CONCLUSIONS

Visual impairment is associated with increased odds for MCI among older adults in LMICs with the exception of far vision impairment only. Future longitudinal and intervention studies should examine causality and whether improvements in visual acuity, or early intervention, can reduce risk for MCI and ultimately, dementia.

Longitudinal changes in daily patterns of objectively measured physical activity after falls in older adults with varying degrees of glaucoma

BACKGROUND

Visually impaired older adults have a greater risk of falling, making them particularly susceptible to fall-related health consequences and restricted physical activity. Unclear however, is the relationship between having falls and longitudinal changes in daily patterns of objectively measured physical activity in older adults with visual impairments.

METHODS

We created a three-year prospective cohort study (Falls in Glaucoma Study) of older adults with primary or suspected glaucoma at the Johns Hopkins Wilmer Eye Institute from 2013 to 2015. Cumulative incidence of falls was determined through self-reported fall calendars over 12 months. Participants were then classified into one of three groups: multiple fallers (≥2 falls), single fallers (1 fall), and non-fallers (0). Daily physical activity was measured over 1 week using a waist-bound accelerometer during baseline and three-year follow-ups. Activity fragmentation was defined as the reciprocal of the mean activity bout length, with higher fragmentation reflecting shorter, more fractured bouts of continuous activity. Multivariate linear mixed-effects models were used to assess three-year longitudinal changes in: 1) activity fragmentation, and 2) accumulation of activity across six three-hour intervals from 5 AM to 11 PM.

FINDINGS

In adjusted models accounting for visual field damage and other factors, multiple fallers demonstrated greater annual declines (per year) in daily active bouts (-1.79 bouts/day, 95% confidence interval [CI]: -3.35, -0.22), daily active minutes (-17.15 min/day, 95% CI: -26.35, -7.94), and increased fragmentation (1%, 95% CI: 0, 2%) over the three-year follow-up period as compared to non-fallers; no such changes were seen when comparing single fallers and non-fallers. In time-of-day analyses, multiple fallers experienced greater annual declines in average hourly steps over all periods of the day, though the rate of decline was only significant between 5 PM and 8 PM (-27.07 steps/hour, 95% CI: -51.15, -2.99) compared to non-fallers.

INTERPRETATION

In an older population with visual impairment, multiple falls over 12 months were associated with more transient and fragmented activity over a subsequent three-year period, and activity declines during evening hours, compared to non-fallers. These findings suggest that multiple fallers with visual impairment may be at high risk for a decline in physical capacity and endurance, warranting clinical interventions.

FUNDING

The research was supported in part by National Institutes of Health Grant EY022976.

Association between vision impairment and cognitive decline in older adults with stroke: Health and Retirement Study

Stroke survivors may experience multiple residual symptoms post-stroke, including vision impairment (VI) and cognitive decline. Prior studies have shown that VI is associated with cognitive decline, but have not evaluated the contribution of VI to post-stroke cognitive changes. We used data from four waves (2010-2016) of the Health and Retirement Study to investigate the cognitive trajectories of stroke survivors with and without VI. Vision (excellent-very good[ref], good, fair-poor) and stroke diagnosis were self-reported. Cognition was defined using the Telephone Interview for Cognitive Status. Regression was used to model the association between vision and change in cognitive function, adjusting for confounders. The final sample included 1,439 stroke survivors and the average follow-up time was 4.1 years. Fair-poor overall (B = -1.30, p < 0.01), near (B = -1.53, p < 0.001), and distance (B = -1.27, p < 0.001) vision were associated with significantly lower baseline cognitive function. VI was not associated with the rate of cognitive decline. Future research should determine whether specific types of VI potentiate the risk of cognitive impairment and dementia in stroke survivors.

Progressive disfiguring facial masses with pupillary axis obstruction from Morbihan syndrome: A case report

BACKGROUND

Morbihan syndrome is a rare illness, which presents with recurrent pitting edema on the upper two thirds of the face causing facial contour deformities, and Morbihan syndrome obstructing the pupillary axis with ptosis was seldomly reported.

CASE SUMMARY

A 59-year-old woman presented with a 15-year history of facial swelling that progressively invaded bilaterally from the inner canthus and eyelids outwards. Imaging examination indicated that the bilateral periorbital and the left temporal soft tissues had swelling without cranium invasion. Histopathological analysis showed a large amount of lymphocyte infiltration, and immunohistochemistry showed positive expression of CD68 in clear-cut granulomas and D2-40 in the lymphatic endothelium. Finally, the clinical diagnosis of Morbihan syndrome was confirmed.

CONCLUSION

Morbihan syndrome is an infrequent and refractory disease, which is characteristic with recurrent woody facial edema on the upper two thirds of the face. Solid facial edema is persistent and non-pitting, causing facial contour deformities and even vision field impairment. The diagnosis of Morbihan syndrome depends on clinical features, imaging information, and pathology. Blepharoplasty is optional to improve the visual field for these patients with severe pupillary axis obstruction.

Barriers and facilitators to recognize and discuss depression and anxiety experienced by adults with vision impairment or blindness: a qualitative study

BACKGROUND

Depression and anxiety are highly prevalent, but often unrecognized in adults with vision impairment (VI) or blindness. The purpose of this study was to explore visually impaired and blind adults' views on facilitators and barriers in recognizing and discussing mental health problems.

METHODS

Semi-structured interviews, based on the Integrated Model for Change, were conducted with 16 visually impaired or blind adults receiving support from three Dutch low vision service organizations. Interview data was analyzed using the framework approach.

RESULTS

Participants perceived their focus on practical support with regard to their VI, lack of mental health literacy, and misattribution of symptoms of depression or anxiety as barriers for recognizing mental health problems. With regard to discussing mental health problems, they perceived difficulties in acknowledging their VI and mental health problems due to feelings of vulnerability and inequality. Participants mentioned that their social support system and healthcare providers (could) facilitate them in recognizing and discussing mental health problems. However, participants thought that healthcare providers currently often lacked the knowledge, skills and attitude to recognize and discuss this topic with their clients.

CONCLUSION

Our findings suggest that visually impaired and blind adults may experience several barriers to recognize, acknowledge and discuss mental health. Healthcare providers and social support systems seem essential for them in reducing these barriers. However, there might be a mismatch between the needs of visually impaired and blind adults and healthcare providers' knowledge, skills and attitude. Training healthcare providers may improve detection of depression and anxiety in adults with VI or blindness, and enhance clinician-patient communication on mental health.

Vision Impairment and Adverse Health Conditions in Congolese Older People: A Population-Based Study

INTRODUCTION

In sub-Saharan Africa, many older people experience vision impairment (VI) and its adverse health outcomes. In this study, we examined separately the association between VI and each adverse health conditions (cognitive disorders, vision-related quality of life [VRQoL], and daily functioning interference [DFI]) among Congolese older people. We also explored whether VI had a significant effect on VRQoL components in our population.

METHOD

We performed cross-sectional analyses on data from 660 Congolese people aged ≥65 years who participated in the 2013 survey of the EPIDEMCA population-based cohort study. VI was defined as having a near visual acuity <20/40 (assessed at 30 cm using a Parinaud chart). Cognitive disorders were assessed using neuropsychological tests and neurological examinations. VRQoL was assessed using a reduced version of the National Eye Institute Visual Function Questionnaire (VFQ-22) and DFI using 11 items of participation restrictions and activity limitations. Regarding our main objective, each association was explored separately using multivariable logistic and linear regression models. Additionally, the effects of VI on each VRQoL components were explored using univariable linear regression models.

RESULTS

VI was not associated with cognitive disorders after adjustment for residence area (adjusted odds ratio = 1.7; 95% confidence interval [CI]: 0.6; 4.7), but it was associated with a low VRQoL score (adjusted β = -12.4; 95% CI: -17.5; -7.3) even after controlling for several covariates. An interaction between VI and age (p = 0.007) was identified, and VI was associated with DFI only among people aged >73 years (adjusted β = 0.5; 95% CI: 0.2; 0.8). Our exploratory analysis showed that all components of VRQoL decreased with a decrease in visual acuity (corrected p ≤ 0.05).

CONCLUSION

VI was associated with poor VRQoL and high DFI. Residence area seems to play a confounding role in the association between VI and cognitive disorders. Our findings suggest that targeting interventions on vision could reduce DFI among older people and improve their well-being.

The experience of loneliness and living with sight loss in English care homes

Loneliness is a serious societal concern, especially the loss of social connections in later life. Those with sight loss living in care homes are thought to face particular challenges in social engagement, but research is scarce. This study aimed to examine the experience of loneliness amongst residents with sight loss; the different dimensions of loneliness; and their attitudes about the role of care homes in addressing these needs. Through in-depth interviews with 18 residents, supplemented by interviews with family members and care home managers, the research identified that residents were generally satisfied with their social situation. However, there was evidence that sight loss was not appropriately accommodated within the care home. In their efforts to enable all residents to engage in social activities, attempts to include those with sight loss could feel contrived, and residents with sight loss did not feel meaningfully involved. Residents described barriers to forming close associations, including the challenges of background noise in communal spaces and a sense that conversation in the care home lacked stimulation. Residents felt that opportunities to forge and maintain bonds with people outside the care home were limited. The research concludes that care homes should avoid inclusion-for-inclusion's sake, and future research could study the effectiveness of interventions to improve care home links to the wider community.

Genetics and therapy for pediatric eye diseases

Ocular morphogenesis in vertebrates is a highly organized process, orchestrated largely by intrinsic genetic programs that exhibit stringent spatiotemporal control. Alternations in these genetic instructions can lead to hereditary or nonhereditary congenital disorders, a major cause of childhood visual impairment, and contribute to common late-onset blinding diseases. Currently, limited treatment options exist for clinical phenotypes involving eye development. This review summarizes recent advances in our understanding of early-onset ocular disorders and highlights genetic complexities in development and diseases, specifically focusing on coloboma, congenital glaucoma and Leber congenital amaurosis. We also discuss innovative paradigms for potential therapeutic modalities.

The functional burden of diabetic retinopathy in the United States

OBJECTIVE

To study the association between diabetic retinopathy (DR) and physical functional difficulty using contemporary psychometric validation techniques, and to explore the predictors of physical difficulty among those with diabetes, non-proliferative DR (NPDR), or proliferative DR (PDR).

METHODS

Cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database from 2005-2008. Participants were classified as either (i) no diabetes no DR, (ii) diabetes without DR, (iii) mild/moderate NPDR, or (iv) severe NPDR/PDR. The presence of DR was detected by retinal imaging and severity was graded using the Early Treatment Diabetic Retinopathy Study Protocol. The physical difficulty was assessed using a 13-question self-reported questionnaire, validated using factor analysis and item response theory (graded response model) psychometric techniques. Secondary analyses of diabetes and DR populations most at risk of reporting greater physical functional difficulty were undertaken.

RESULTS

A total of 5321 participants over the age of 40 were included in our study. Of the 13 original physical difficulty questions, one latent trait was identified and 9 questions demonstrated good discrimination and were subsequently retained. In univariable analyses, participants with diabetes and any form of DR all reported significantly higher physical functional difficulty vs those with neither diabetes nor DR (p < 0.01 for all). In multivariable analyses, while those with diabetes or any form of DR remained more likely to report higher physical difficulty vs those with neither diabetes nor DR, only those with severe NPDR/PDR reported substantially higher scores (2.1 sum points higher, p = 0.002). Among participants with diabetes or any form of DR, those with 3 or more medical comorbidities and those with depression reported substantially higher sum physical difficulty scores (p < 0.05 for all).

CONCLUSIONS

Those with diabetes or DR experience greater functional physical difficulty than those without, particularly profound among those with severe forms of DR. For those with DR, the presence of concurrent depression or medical comorbidities conferred a significantly higher risk of physical difficulty. Providers and healthcare systems should be aware of particularly vulnerable DR populations at increased risk of experiencing daily functioning deficits.

Aging With Vision Loss: A Framework for Assessing the Impact of Visual Impairment on Older Adults

There is limited research examining the impact of visual impairment (VI) on older adults while considering the complexities of aging, leaving gaps in our understanding of how health consequences of VI might be averted. We created a framework integrating concepts from disability, geriatrics, and ophthalmology that conceptualizes how VI challenges successful aging. Here, VI influences multiple functional domains, and increases the risk of negative health outcomes. This model acknowledges that common causes, such as risk factors that affect eyes and other systems simultaneously, may also drive the relationship between VI and health outcomes. Finally, the model highlights how the impact of VI on aging outcomes can be addressed at multiple intervention points.