Correctable visual impairment in older people: a major unmet need

Geographical inequalities in uptake of NHS-funded eye examinations: small area analysis of Leeds, UK

BACKGROUND

Preventable sight loss is an indicator within the Public Health Outcome Framework 2013-2018 for England. Routinely available optometric data do not permit small area analysis of access inequalities.

METHODS

Data were extracted from 17 680 General Ophthalmic Services (GOS1) claim forms for eye examinations conducted in Leeds during February and March 2011. The expected number of GOS1 uptake for each lower super output area was based on the GOS1 national annual uptake. A Poisson regression model was used to explore associations in the GOS1 uptake ratio with deprivation and gender.

RESULTS

People aged 60 or over or under 16 living in the least deprived quintile are 71 and 23%, respectively, more likely to have an NHS-funded eye examination than someone in that age group in the most deprived quintile, although all are equally entitled. Uptake is higher in the more deprived quintiles among 16-59 year olds, as means tested social benefits are the main eligibility criteria in this age group. There were no statistically significant gender differences in uptake.

CONCLUSIONS

Interventions are needed to address eye examination uptake inequalities. However, in order to better inform commissioning and planning eye care services more complete data with additional detail are required. GOS1 forms ought to be submitted electronically linked to additional demographic and clinical data to allow public health analysis. Ideally, private eye examination data should also be captured.

Vision impairment and dual sensory problems in middle age

PURPOSE

Vision and hearing impairments are known to increase in middle age. In this study we describe the prevalence of vision impairment and dual sensory impairment in UK adults aged 40-69 years in a very large and recently ascertained data set. The associations between vision impairment, age, sex, socioeconomic status, and ethnicity are reported.

METHODS

This research was conducted using the UK Biobank Resource, with subsets of UK Biobank data analysed with respect to self-report of eye problems and glasses use. Better-eye visual acuity with habitually worn refractive correction was assessed with a logMAR chart (n = 116,682). Better-ear speech reception threshold was measured with an adaptive speech in noise test, the Digit Triplet Test (n = 164,770). Prevalence estimates were weighted with respect to UK 2001 Census data.

RESULTS

Prevalence of mild visual impairment (VA >0.1 logMAR (6/7.5, 20/25) and ≥0.48 (6/18, 20/60)) and low vision (VA >0.48 (6/18, 20/60) and ≥1.3 (6/120, 20/400)) was estimated at 13.1% (95% CI 12.9-13.4) and 0.8% (95% CI 0.7-0.9), respectively. Use of glasses was 88.0% (95% CI 87.9-88.1). The prevalence of dual sensory impairment was 3.1% (95% CI 3.0-3.2) and there was a nine-fold increase in the prevalence of dual sensory problems between the youngest and oldest age groups. Older adults, those from low socioeconomic and ethnic minority backgrounds were most at risk for vision problems.

CONCLUSIONS

Mild vision impairment is common in middle aged UK adults, despite widespread use of spectacles. Increased likelihood of vision impairment with older age and with ethnic minorities is of concern given ageing and more ethnically diverse populations. Possible barriers to optometric care for those from low socioeconomic and ethnic minority backgrounds may require attention. A higher than expected prevalence of dual impairment suggests that hearing and vision problems share common causes. Optometrists should consider screening for hearing problems, particularly among older adults.

Influence of uncorrected refractive error and unmet refractive error on visual impairment in a Brazilian population

BACKGROUND

The World Health Organization (WHO) definitions of blindness and visual impairment are widely based on best-corrected visual acuity excluding uncorrected refractive errors (URE) as a visual impairment cause. Recently, URE was included as a cause of visual impairment, thus emphasizing the burden of visual impairment due to refractive error (RE) worldwide is substantially higher. The purpose of the present study is to determine the reversal of visual impairment and blindness in the population correcting RE and possible associations between RE and individual characteristics.

METHODS

A cross-sectional study was conducted in nine counties of the western region of state of São Paulo, using systematic and random sampling of households between March 2004 and July 2005. Individuals aged more than 1 year old were included and were evaluated for demographic data, eye complaints, history, and eye exam, including no corrected visual acuity (NCVA), best corrected vision acuity (BCVA), automatic and manual refractive examination. The definition adopted for URE was applied to individuals with NCVA > 0.15 logMAR and BCVA ≤ 0.15 logMAR after refractive correction and unmet refractive error (UREN), individuals who had visual impairment or blindness (NCVA > 0.5 logMAR) and BCVA ≤ 0.5 logMAR after optical correction.

RESULTS

A total of 70.2% of subjects had normal NCVA. URE was detected in 13.8%. Prevalence of 4.6% of optically reversible low vision and 1.8% of blindness reversible by optical correction were found. UREN was detected in 6.5% of individuals, more frequently observed in women over the age of 50 and in higher RE carriers. Visual impairment related to eye diseases is not reversible with spectacles. Using multivariate analysis, associations between URE and UREN with regard to sex, age and RE was observed.

CONCLUSION

RE is an important cause of reversible blindness and low vision in the Brazilian population.

Health risk appraisal in older people 6: factors associated with self-reported poor vision and uptake of eye tests in older people

BACKGROUND

Although free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. A recent review identified this unmet need as a priority for further investigation, highlighting the need to understand public perceptions of eye services and barriers to service access and utilisation. This paper aims to identify risk factors for (1) having poor vision and (2) not having had an eyesight check among community-dwelling older people without an established ophthalmological diagnosis.

METHODS

Secondary analysis of self-reported data from the ProAge trial. 1792 people without a known ophthalmological diagnosis were recruited from three group practices in London.

RESULTS

Almost two in ten people in this population of older individuals without known ophthalmological diagnoses had self-reported vision loss, and more than a third of them had not had an eye test in the previous twelve months. In this sample, those with limited education, depressed mood, need for help with instrumental and basic activities of daily living (IADLs and BADLs), and subjective memory complaints were at increased risk of fair or poor self-reported vision. Individuals with basic education only were at increased risk for not having had an eye test in the previous 12 months (OR 1.52, 95% CI 1.17-1.98 p=0.002), as were those with no, or only one chronic condition (OR 1.850, 95% CI 1.382-2.477, p<0.001).

CONCLUSIONS

Self-reported poor vision in older people without ophthalmological diagnoses is associated with other functional losses, with no or only one chronic condition, and with depression. This pattern of disorders may be the basis for case finding in general practice. Low educational attainment is an independent determinant of not having had eye tests, as well as a factor associated with undiagnosed vision loss. There are other factors, not identified in this study, which determine uptake of eye testing in those with self-reported vision loss. Further exploration is needed to identify these factors and lead towards effective case finding.

Why is tractable vision loss in older people being missed? Qualitative study

BACKGROUND

There is compelling evidence that there is substantial undetected vision loss amongst older people. Early recognition of undetected vision loss and timely referral for treatment might be possible within general practice, but methods of identifying those with unrecognised vision loss and persuading them to take up services that will potentially improve their eyesight and quality of life are not well understood. Population screening does not lead to improved vision in the older population. The aim of this study is to understand why older people with vision loss respond (or not) to their deteriorating eyesight.

METHODS

Focus groups and interviews were carried out with 76 people aged 65 and over from one general practice in London who had taken part in an earlier study of health risk appraisal. An analytic induction approach was used to analyse the data.

RESULTS

Three polarised themes emerged from the groups and interviews. 1) The capacity of individuals to take decisions and act on them effectively versus a collection of factors which acted as obstacles to older people taking care of their eyesight. 2) The belief that prevention is better than cure versus the view that deteriorating vision is an inevitable part of old age. 3) The incongruence between the professionalism and personalised approach of opticians and the commercialisation of their services.

CONCLUSIONS

The reasons why older people may not seek help for deteriorating vision can be explained in a model in which psychological attributes, costs to the individual and judgments about normal ageing interact. Understanding this model may help clinical decision making and health promotion efforts.

Spectacle coverage and spectacles use among elderly population in residential care in the south Indian state of Andhra Pradesh

Background. There is limited research conducted on uncorrected refractive errors, presbyopia, and spectacles use among the elderly population in residential care in developing countries such as India. We conducted a cross-sectional study among elderly in residential care to assess the spectacle coverage and spectacles usage in the south Indian state of Andhra Pradesh. Methods. All 524 residents in the 26 “homes for aged” institutions in the district were enumerated. Eye examination was performed that included visual acuity (VA) assessment for distant and near vision. A questionnaire was used to collect information on spectacles use. Results. 494/524 individuals were examined, 78% were women, and 72% had no education. The mean age of participants was 70 years. The spectacle coverage for refractive errors was 35.1% and 23.9% for presbyopia. The prevalence of current use and past use of spectacles was 38.5% (95% CI: 34.2–42.8; n = 190) and 17.2% (95% CI: 13.9–42.8), respectively. Conclusions. There is low spectacle coverage for both refractive errors and presbyopia among elderly individuals in residential care in the south Indian state of Andhra Pradesh. Appropriate service delivery systems should be developed to reach out this vulnerable group of seniors on a priority basis.

Effects of induced astigmatism on foot placement strategies when stepping onto a raised surface

PURPOSE

Large changes in spectacle prescription can increase falls risk in older people. We investigated the effect of induced astigmatism (a common cause of distorted or blurred vision in older people) on locomotor stepping patterns to determine whether the orientation of astigmatic changes could have differential effects on gait safety when negotiating steps and stairs.

METHODS

10 older adults (mean age 76.0±6.4 years) walked up to and stepped onto a raised block whilst wearing their spectacle prescription and when blurred with ±3.00D cylinders at axes 45°, 90°, 135° and 180°. Gait measurements included foot placement before the block, toe clearance over the block edge and foot placement on the block.

RESULTS

Induced astigmatism with axes at 90°, providing magnification in the horizontal meridian only, caused no change in stepping pattern. Induced astigmatism with axes at 180° caused foot placement changes in the anterior or posterior direction according to whether magnification was positive or negative in the vertical meridian (block perceived higher or lower respectively). Induced astigmatism with axes oblique at 45° and 135° (causing the block to be perceived as a parallelogram sloping downwards either to the right or left) caused gait changes in the anterior and posterior, vertical and lateral directions. Changes in lateral foot placement appeared to be an attempt to maintain constant foot clearance levels over the block edge by stepping over the perceived 'lower' side of the 'sloping' block.

CONCLUSIONS

Astigmatic changes with oblique axes had the greatest effect on gait. Clinicians, including optometrists, physiotherapists, occupational therapists and nurses should counsel older patients about the effects of astigmatism on gait safety. Furthermore, partial prescribing of astigmatic corrections should be considered to reduce the risk of falling.

Visual functioning in nursing home residents: information in client records

AIM AND OBJECTIVES

To improve (eye)care in nursing homes by reporting and assessing visual functioning to enhance professional caregivers' awareness of visual problems.

BACKGROUND

Older adults experience visual problems owing to biological ageing or eye disease. In the Netherlands, the prevalence of visual impairments is the highest in the subgroup of nursing home residents (41.3%). These impairments influence quality of life in terms of limiting daily activities and participation in social activities. Furthermore, 63% of visual problems are defined as 'avoidable blindness'. For this reason, screening of visual functioning in the nursing home is of major importance. Moreover, visual functioning should also be taken into account to prevent the incidence of falls.

DESIGN

A field study on recorded information of visual functioning and visual assessment in nursing homes.

METHODS

Assessment of visual functioning of 259 residents in nursing homes. Subsequently, recorded information in client files is related to the assessment outcome.

RESULTS

Only in 101 (39%) of the 259 client records was some information on visual functioning found in client files. Whether a prescription for new glasses was dispensed made no difference in reporting on visual functioning in the client record. In more than half of the cases assessed as 'low vision or blindness', no information about visual functioning was found. Furthermore, no information was found in 31% (80/259) cases of suspected visual problems (referrals). A significant proportion of client records (p < 0.05) showed no recorded information in cases of referral for further check-up.

CONCLUSIONS

In this study, one-third of nursing homes residents have visual problems, needing examination by an ophthalmologist. Problems with visual functioning should be assessed and captured in client records. Awareness of residents' visual functioning is a prerequisite for adapting basic daily care to the residents' needs.

The development & evaluation of two vision screening tools for correctable visual loss in older people

OBJECTIVES

In the UK, 20-50% of older people have undetected reduced vision and in most cases this results from correctable problems (refractive error and cataract). Many older people are not availing themselves of state-funded community optometric care. We assessed the efficacy of two vision screening instruments at detecting correctable visual problems and investigated the effect of optometric intervention on quality of life.

METHODS

A computerised vision screener (CVS) was developed and refined after a preliminary study of 180 older people to include tests of: monocular presenting distance high contrast and low contrast visual acuities (VAs), binocular near acuities, and monocular visual fields. The modified CVS and a flip-chart vision screener (FVS) were evaluated on a second sample of 200 people aged 65+ (mean age 77 years). All participants in both studies were given an optometric eye examination, including high and low contrast VAs, refraction, binocular vision tests, tonometry, automated perimetry, and dilated fundoscopy including cataract grading and ARM grading. The target conditions were significant gain in monocular distance VA or binocular near VA with new refractive correction, significant cataract, or macular degeneration at risk of rapid progression. The Low Vision Quality of Life Questionnaire (LVQoL) was administered before and up to 3 months after testing.

RESULTS

For the CVS, the best sensitivity (80.3%, 95% CI 72.4-86.4; specificity 66.7%, 95% CI 55.6-76.1) was obtained for a screener test combination of a fail on high contrast VA (>0.19 LogMAR) OR low contrast VA (>0.39 LogMAR) OR near VA (>N11.9). A screener test combination of high contrast VA OR near VA gave sensitivity of 79.5% (71.5-85.7) and specificity 67.9% (57-77.3). For the FVS, the best sensitivity was obtained for a test combination of a fail on high contrast VA OR low contrast VA OR near VA (sensitivity 82%, 95% CI 74.2-87.8; specificity 61.5%, 95% CI 50.4-71.6). A screener test combination of low contrast VA alone gave sensitivity of 75.4% (67.1-82.2) and specificity 76.9% (66.4-84.9). Significant improvements in LVQoL were found, with a significant correlation between gain in VA with new spectacles and improvement in LVQoL.

CONCLUSIONS

The vision screeners are effective tools for detecting those with reduced vision. Further work is required to determine their effectiveness as a tool for encouraging older people to engage in regular eyecare.

Unmet refractive need and its determinants in Shahroud, Iran

Uncorrected refractive error plays a significant role in poor vision and blindness, and its correction is the most cost-effective intervention in eye care. In this study, we report the status of the unmet refractive need and the role of economic inequality in determining the level of this need in Shahroud, Iran. This cross-sectional nested case-control study was performed on 5,190 individuals aged 40-64 years. Cases and controls were individuals with uncorrected visual acuity worse than 0.3 LogMAR in the better eye who showed at least 0.2 LogMAR improvement after correction. Cases were individuals whose presenting vision was worse than 0.3 in the better eye but improved by at least 0.2 LogMAR after correction. Controls were individuals in whom the difference between the presenting and corrected vision was less than 0.2 LogMAR. The prevalence of the unmet need was 5.7 % and it was more prevalent in women (6.5 %) than in men (4.6 %) (p = 0.003). There was a gap of 19.6 % between the two groups of high and low economic status. The Oaxaca-Blinder decomposition method revealed that differences in the education level of the two groups accounted for half of this gap. Spectacle usage is better in Iran than in some other developing countries; however, in this study, about 40 % of those who required spectacles did not have them.

Non-standard vision measures predict mortality in elders: the Smith-Kettlewell Institute (SKI) study

PURPOSE

To determine which vision tests predict mortality within 10 years in a community-based elderly sample.

METHODS

Nine hundred residents of Marin County, California 58 to 101 years of age (mean 75 years at baseline), underwent a battery of tests, including high contrast acuity, low contrast acuity, low contrast/low luminance acuity, acuity in glare, contrast sensitivity, color vision, stereopsis, standard and attentional fields. The association between the vision tests and mortality within 10 years of baseline was assessed with Cox Proportional Hazards models controlling for age, sex, education level, depression, cognitive status and self-reported medical conditions.

RESULTS

Forty-three percent of the sample died within 10 years of baseline. When controlling for mortality-related covariates, impairment in any of the vision measures was associated with increased risk of death. However, non-standard vision measures (ie, impairment in low contrast/low luminance acuity, standard field integrity and the impact of the attentional task on field integrity) were more highly associated with mortality than standard high contrast acuity.

CONCLUSIONS

In agreement with other studies, we find that visual impairment is a significant predictor of death. However, the strongest relationship was found for measures other than high contrast acuity. These results suggest that non-standard vision measures may be more sensitive indicators of generalized aging in the most elderly.

Habitual vs optimal distance visual acuity

PURPOSE

The maintenance of a good level of vision is desirable for developmental and social reasons; it is also a requirement that should not be overlooked in the clinical research environment. This study set out to quantify and analyse any difference between 'habitual' (pre-sight test) and 'optimal' (post-refraction) distance visual acuity in an optometric population. It is intended that the outcome of this work will inform not only clinicians but also those undertaking vision research.

METHODS

Binocular logMAR visual acuity was determined at 6 m before and after optometric intervention in patients attending optometric practice for a routine sight test. Cases were recorded seriatim but restricted to the 'core' refraction range representative of typical optometric practice; three further exemption criteria included subject illiteracy, the necessity for a non-standard test distance and contact lens wear. Over a 12-month period, two-thirds of patients examined satisfied the study inclusion criteria; it is the clinical data of these 1288 individuals that are described and analysed here.

RESULTS

These data provide a quantitative demonstration that an optometric intervention will most likely improve the habitual distance visual acuity of subjects, irrespective of gender, age group, time interval since last test, refractive status and whether or not the subject is a habitual spectacle wearer. The improvement found was typically within one logMAR chart line (<5 letters), being greatest in spectacle-wearing teenagers and in individuals beyond retirement age (increasing to eight letters in elderly habitual non-spectacle wearers); also in non-wearers who left an interval of 2 years or more between sight tests.

CONCLUSIONS

Clinical and laboratory-based investigators are advised that a current and optimal refractive correction should be worn by subjects of all ages enrolled in vision-related studies. Refractive defocus may introduce or exaggerate test outcome variability.

Prevalence of refractive error in the United States, 1999-2004

OBJECTIVE

To describe the prevalence of refractive error in the United States.

METHODS

The 1999-2004 National Health and Nutrition Examination Survey (NHANES) used an autorefractor to obtain refractive error data on a nationally representative sample of the US noninstitutionalized, civilian population 12 years and older. Using data from the eye with a greater absolute spherical equivalent (SphEq) value, we defined clinically important refractive error as follows: hyperopia, SphEq value of 3.0 diopters (D) or greater; myopia, SphEq value of -1.0 D or less; and astigmatism, cylinder of 1.0 D or greater in either eye.

RESULTS

Of 14,213 participants 20 years or older who completed the NHANES, refractive error data were obtained for 12,010 (84.5%). The age-standardized prevalences of hyperopia, myopia, and astigmatism were 3.6% (95% confidence interval [CI], 3.2%-4.0%), 33.1% (95% CI, 31.5%-34.7%), and 36.2% (95% CI, 34.9%-37.5%), respectively. Myopia was more prevalent in women (39.9%) than in men (32.6%) (P < .001) among 20- to 39-year-old participants. Persons 60 years or older were less likely to have myopia and more likely to have hyperopia and/or astigmatism than younger persons. Myopia was more common in non-Hispanic whites (35.2%) than in non-Hispanic blacks (28.6%) or Mexican Americans (25.1%) (P < .001 for both).

CONCLUSION

Estimates based on the 1999-2004 NHANES vision examination data indicate that clinically important refractive error affects half of the US population 20 years or older.

Vision screening of older people

A recent systematic review found that between 20% and 50% of older people in the UK have undetected reduced vision and in most cases this is caused by refractive error or cataracts, and is correctable. Two approaches to improve the detection of these problems are to better publicise optometric services and to carry out community-based vision screening of older people. Screening programmes should pass the Wilson criteria and a consideration of these highlights three inter-related questions: 'Is vision screening effective at detecting correctable low vision in older people?'; 'Which tests should be included?' and 'Which venues are most appropriate?' We carried out a systematic review to investigate these questions. For the first question, only one study was found which met our selection criteria. The 'gold standard' eye examination in this study lacked several important components, and the vision screening method that was used was not found to be very effective. The review revealed other studies, which, although not meeting our selection criteria, included relevant information. The screening studies highlight the lack of agreement on the content of a gold standard eye examination and of the test(s) that should be used to screen vision. Visual function in older people is not adequately described by high contrast visual acuity (VA), nor by self-reports of visual difficulties. Other tests that may be relevant include visual field testing, low contrast VA, contrast sensitivity and stereo-acuity. The pinhole test has often been used in attempts to detect uncorrected refractive errors, but results from this test can be problematic and possible reasons for this are discussed. Appropriate venues for vision screening are contingent upon the format of the vision screening programme. There is still uncertainty over the battery of vision tests that are most appropriate. This, and optimum venues for screening, require further research before it can be fully determined whether vision screening of older people meets the Wilson criteria. If a vision screening programme using a battery of vision tests, perhaps computerised, can be established, then this should be tested to determine the sensitivity and specificity for detecting the target conditions. Ultimately, longitudinal studies are necessary to determine whether such a screening programme will lead to improved visual performance and quality of life in older people.

The impact of blurred vision on cognitive assessment

The purpose of this study was to systematically assess the effect of blurred vision on several nonverbal neuropsychological measures commonly used as part of test batteries to assess the cognitive status of different patient populations. A total of 30 highly educated and healthy participants aged between 21 and 33 years were placed in one of three blurred vision groups, defined by their maximal visual acuity (20/20 or control group, 20/40, and 20/60). Blurred vision was simulated using positive diopters at a distance of 40 cm, the same distance as that at which tests were administered. Each participant was then assessed on a predetermined battery of nonverbal and verbal neuropsychological tests demanding different levels of acuity for optimal performance (i.e., tests whose items varied in terms of size and spatial frequency characteristics). In general, blurred vision significantly affected performance on nonverbal tests defined by small-sized/high-spatial-frequency items to a greater extent than on tests defined by larger sized/lower spatial-frequency items. As expected, blurred vision did not affect verbal test performance (Similarities, Information, and Arithmetic WAIS subtests). Our results are a clear indication of how even a "minimal" loss of visual acuity (20/40) can have a significant effect on the performance for certain nonverbal tests. In conclusion, such inferior performance is hypothetically interpretable as reflecting impaired cognitive functioning (i.e., attentional) targeted by a specific task (i.e., visual search) and suggests that the precision of the cognitive assessment and subsequent diagnosis are significantly biased when visuo-sensory abilities are not optimal, particularly for older patient populations where blurred vision resulting from correctable visual impairment is quite common.

Sensory impairment in older adults: part 2: Vision loss

A decline in vision occurs naturally with age; more severe impairment can result from medical conditions such as age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Nurses can pick up signs of visual impairment and suggest certain environmental modifications to prevent injury, such as keeping floors free of clutter and rooms well lit. Although assistive technologies such as optical devices, magnifiers, telescopes, and electronic magnification can help, some forms of impairment, such as that caused by cataracts and uncorrected refractive error, can be corrected.

Optometric and ophthalmic contact in elderly hip fracture patients with visual impairment*

AIM

To describe previous contact with optometry and ophthalmic services in a group of elderly patients with and without visual impairment (VI) who had fallen and sustained a fractured neck of femur.

METHOD

A cross sectional study of 537 patients aged 65 and over who had undergone hip fracture surgery in four Scottish centres (Glasgow, Ayr, Dundee and Fife). All patients had an in-depth optometric history, ophthalmic history and examination.

RESULTS

Three hundred and ninety-three (79%) patients reported optometric contact in the 3 years preceding surgery and 107 (21%) patients had not seen an optometrist for more than 3 years. In the latter group, 64 had VI, which was due to uncorrected refractive error in 17 (27%) and untreated cataract in 20 (31%). VI (best binocular visual acuity of 6/18 or less) was found in 239 (46%) patients. A past ophthalmic history was present in 257 (50%) patients. Only 39 (16%) patients with VI were under ophthalmic care at the time of the study.

CONCLUSIONS

There was significantly poor optometric and ophthalmic contact in patients who had VI and had fallen and sustained hip fracture. A proportion of the VI (66%) was due to uncorrected refractive error and untreated cataract. Public health providers should be made aware of the fact that current optometric and ophthalmic care pathways are not accessed by this group of elderly patients with VI and at risk of falling.

Four different types of client attitudes towards purchasing spectacles in optometric practice

BACKGROUND

Unmet expectations are a major cause of client dissatisfaction, yet very little is known about the expectations and health values that clients in optometry practice hold about having an eye examination and purchasing spectacles. This study identified different attitudes and behaviours held by presbyope clients in optometric practices.

METHOD

A total of 158 presbyope clients, recruited from 14 practices, completed a questionnaire which was developed from the theory of planned behaviour. The questionnaire examined attitudes towards spectacles and visiting the optician, motivation to visit the optician, perceptions of barriers to attending the opticians, information requirements, and preferences for shared decision-making. Responses were analysed using principal components analysis.

RESULTS AND CONCLUSIONS

Four factors were identified, which were labelled style, vision, avoiding and seeking. Style is concerned with the importance of appearing fashionable or stylish, and desiring approval from others. Vision relates to clients' attitudes towards obtaining clear vision and to maintaining healthy eyesight. Avoiding describes the perceived difficulties associated with visiting the optician and purchasing new spectacles. Seeking corresponds to the desire for information on the technical details of lenses. Practitioners could use these characteristics to tailor information to meet the needs and address the expectations of individual clients. This may make the information provided more personally relevant, and could enhance client satisfaction.