The impact of blurred vision on functioning and well-being

Visual Impairment, Major Eye Diseases, and Mortality in a Multi-Ethnic Asian Population and a Meta-analysis of Prospective Studies

PURPOSE

Vision impairment (VI) is associated with poor quality of life and increased risk of falls. Few prospective data are available on Asians. This study investigates the longitudinal impact of VI and the major eye diseases on mortality risk in Asians.

DESIGN

Prospective cohort study with meta-analysis.

METHODS

We conducted a multi-ethnic prospective study of adults (40-80 years old) in the Singapore Epidemiology of Eye Diseases Study (baseline: 2004-2011). All-cause mortality was obtained from the National Death Registry until May 2017. VI was defined by best-corrected visual acuity (BCVA) <20/40 in the better eye. Major eye diseases were assessed using standard protocols. We examined associations using multivariate-adjusted Cox proportional hazards regression models. Finally, we conducted a meta-analysis of the associations between VI and mortality.

RESULTS

Of 9,986 participants, 1,210 deaths occurred (12.1%) over a median follow-up of 8.8 years. Compared to participants with normal vision, persons with VI had increased risk of mortality (hazards ratio [HR]: 1.53; 95% confidence interval [CI:] 1.30-1.81) in multivariate models. In ethnicity-specific analyses, this association was significant across Chinese (HR: 1.63; 95% CI: 1.08-2.48); Malays (HR: 1.31; 95% CI: 1.06-1.62); and Indians (HR: 2.25; 95% CI: 1.61-3.15). Cataract, under-corrected refractive errors (URE), and diabetic retinopathy (DR) were significantly associated with mortality (HRs: 1.30, 1.22, and 1.54, respectively). In a meta-analysis of 12 studies including 58,034 persons, VI was associated with 30% increased risk of mortality (HR: 1.3; 95% CI: 1.2-1.5).

CONCLUSIONS

In this multi-ethnic Asian population, VI and preventable eye conditions (cataract, URE, and DR) were associated with mortality, emphasizing the need for early detection and intervention to prevent and treat VI and major eye diseases.

Hypothetical molecular interconnection between type 2 diabetes and dyslexia

BACKGROUND

Dyslexia is one of the most common learning disabilities, especially among children. Type 2 diabetes is a metabolic disorder that affects a large population globally, with metabolic disorders. There have been several genes that are identified as causes of Dyslexia, and in recent studies, it has been found out that some of those genes are also involved in several metabolic pathways. For several years, it has been known that type 2 diabetes causes several neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease. Furthermore, in several studies, it was suggested that type 2 diabetes also has some associations with learning disabilities. This raises the question of whether "Is there a connection between type 2 diabetes and dyslexia?". In this study, this question is elaborated by linking their developmental processes via bioinformatics analysis about these two diseases individually and collectively.

RESULT

The literature review for dyslexia and type two diabetes was completed. As the result of this literature review, the genes that are associated to type 2 diabetes and dyslexia were identified. The biological pathways of dyslexia, and dyslexia associated genes, type 2 diabetes, and type 2 diabetes associated genes were identified. The association of these genes, regarding to their association with pathways were analysed, and using STRING database the gene associations were analysed and identified.

CONCLUSION

The findings of this research included the interaction analysis via gene association, co-expression and protein-protein interaction. These findings clarified the interconnection between dyslexia and type 2 diabetes in molecular level and it will be the beginning of an answer regarding to the relationship between T2D and dyslexia. Finally, by improving the understanding this paper aims to open the way for the possible future approach to examine this hypothesis.

Relationships among visual acuity, risk of acute myocardial infarction, and stroke: a nationwide cohort study in south korea

Purpose: Visual impairment (VI) is highly prevalent in the elderly and is associated with functional decline. Previous research demonstrated an association between VI and cardiovascular events, but investigations have yet to be conducted in general population samples. We evaluated the relationship between visual acuity (VA) and development of cardiovascular diseases (CVD) in a nationwide Korean population.Methods: This is a nationwide retrospective cohort study. We used the National Health Information Database of the National Health Insurance Service of Korea to identify subjects who participated in the National Health Insurance Service health screening program in 2012. We monitored 5,941,761 subjects for the development of cardiovascular diseases for a period of 5 years.Results: After adjustments for age, sex, and other covariates, with subjects having a visual acuity better than 20/20 as the reference group, the adjusted hazard ratios (HRs) and 95% confidential intervals (CI) for acute myocardial infarction and stroke were visual acuity between 20/20 and 20/60, 1.073 (95% CI 1.053, 1.094) and 1.151 (95% CI 1.132, 1.171), respectively; for visual acuity between 20/60 and 20/200, 1.236 (95% CI 1.197, 1.277), and 1.336 (95% CI 1.302, 1.371), respectively; and for visual acuity worse than 20/200, 1.325 (95% CI 1.285, 1.366) and 1.383 (95% CI 1.349, 1.418), respectively.Conclusion: Subjects with lower VA had higher risks of acute myocardial infarction and stroke. These results suggest that low VA is an independent risk factor for CVD.

Estimating Burden of Disease Among Blind Individuals With Non-24-Hour Sleep-Wake Disorder

Purpose: To quantify the burden of disease in blind patients with Non-24-H Sleep- Wake Disorder (N24HSWD), utilizing longitudinal sleep diary data. N24HSWD is a circadian disorder characterized by a cyclical pattern of aberrant circadian and sleep-wake cycles that are associated with increased frequency of sleep episodes during the school/work day hours. Daytime sleep episodes would be predicted to decrease the opportunity for school/work participation, significantly impacting the quality of life of the patient. Methods: We used the sleep diary data of daytime sleep from a period of ~90 days in blind individuals that presented with a sleep complaint. These subjects were identified from a group of blind individuals with N24HSWD (n = 121) and a control group of blind individuals without N24HSWD (n = 57). Results: N24HSWD patients had more frequent and longer episodes of daytime sleep as compared to a control group. Using duration of daytime sleep as a surrogate for defining a healthy or unhealthy day, N24HSWD patients also had significantly fewer healthy days, defined by daytime sleep free days (DSFD), days without a sleep episode between 9:00 a.m. and 5:00 p.m, as compared to the control group. Conclusion: Daytime sleep free day (DSFD) is a useful and specific measure of disease burden in patients with N24HSWD and it is predicted to be correlated with the standardized HRQOL-4, Healthy Days measurement.

Psychological contribution to understanding the nature of dry eye disease: a cross-sectional study of anxiety sensitivity and dry eyes

Dry eye disease (DED) represents a common health problem in the general population. Previous studies have demonstrated that the subjective symptoms of dry eye are associated with several psychological factors, including depression, anxiety and post-traumatic stress disorder. However, there is a lack of empirical information about the mechanisms underlying the relationships between DED and various psychological symptoms. In light of emerging evidence of its trans-diagnostic nature, anxiety sensitivity (i.e. AS) represents one promising factor for further understanding DED. The present study aimed to explore whether anxiety sensitivity plays a role in the perception of DED symptoms in a community-based sample of adults aged 20-89 years (N = 381; M = 39.72, SD = 12.6). A dry ocular surface was reported by 22.8% of the participants. As expected, women more often reported symptoms of dry eye that could be categorized as moderate to severe. The findings demonstrated that AS, and the AS-psychological concerns dimension in particular, predict the intensity of dry eye symptoms above and beyond depressive and anxiety symptoms. These findings add to a growing body of work underscoring the relevance of AS in increasing the risk of chronic medical conditions.

Occupational Health Needs and Predicted Well-Being in Office Workers Undergoing Web-Based Health Promotion Training: Cross-Sectional Study

BACKGROUND

Office workers face workplace-related health issues, including stress and back pain, resulting in considerable cost to businesses and health care systems. Workplace health promotion attempts to prevent these health issues, and the internet can be used to deliver workplace health promotion interventions to office workers. Data were provided by Fitbase GmbH, a German company, which specializes in workplace health promotion via the internet (Web-based health). The Web-based health intervention allowed workers to focus on different health categories by using information modules (reading health information) and/or completing practical exercises (guided, interactive health tutorials).

OBJECTIVE

This study aimed to identify the extent to which office workers have workplace-related health issues, assess whether office workers who differ in their health focus also differ in their improved well-being, and assess whether completing practical exercises is associated with improved well-being compared with reading information modules.

METHODS

Fitbase GmbH collected data for the period of February 2016 to May 2017 from health insurance employees undergoing Web-based health training in Hamburg, Germany. The data consisted of a needs assessment examining health issues faced by office workers, a wellness questionnaire regarding one's perception of the Web-based health intervention, and activity logs of information modules and practical exercises completed. Through logistic regression, we determined associations between improved well-being from Web-based health training and differences in a worker's health focus and a worker's preferred intervention method.

RESULTS

Nearly half of the office workers had chronic back pain (1532/3354) and felt tense or irritated (1680/3348). Over four-fifth (645/766) of the office workers indicated that the Web-based health training improved their well-being (P<.001). Office workers who preferred practical exercises compared with information modules had 2.22 times greater odds of reporting improved well-being from the Web-based health intervention (P=.01; 95% CI 1.20-4.11). Office workers with a focus on practical exercises for back health had higher odds of improved well-being compared with other health foci. Office workers focused on practical exercises for back pain had at least two times the odds of having their well-being improved from the Web-based health intervention compared with those focused on stress management (P<.001), mindfulness (P=.02), stress management/mindfulness (P=.005), and eye health (P=.003). No particular health focus was associated with improved well-being for the information modules.

CONCLUSIONS

Office workers frequently report having back pain and stress. A focus on Web-based health training via practical exercises and practical exercises for back health predict an improvement in office workers' reported well-being.

[Cataract Surgery in Very Old Patients]

BACKGROUND

In recent years, there has been an increase in the number of very old patients requiring a cataract operation. However, there is little information on the intraoperative complications and safety in these patients. For various reasons, operations on patients from age 85 may be demanding: dense nuclear cataract, narrow pupils, low count of endothelial cells, loose zonula, and other ocular or systemic diseases. The aim of this retrospective study was to compare very old to younger cataract patients with respect to intraoperative complications and the maturity of the cataract.

PATIENTS AND METHODS

This was a retrospective study on 4065 cataract patients treated in our department with IOL implantation with the corneal small incision technique between January 2015 and January 2018. The patients were split by age (from 85 and under 85).

RESULTS

Of the 4065 cataract operations, 10.6% (431/4065) were performed on patients aged at least 85, 1.7% (69/4065) on patients aged at least 90 and 0.1% (4/4065) on patients of at least 95 years. There were statistically significant differences between the younger and older patients with respect to pupil dilatation (4.6 vs. 6.0%), use of the capsule tension ring (0.4 vs. 0%) and in capsule staining (5.5 vs. 7.0%). There were no intraoperative complications (e.g. anterior capsule laceration) in patients aged at least 85 and in 0.71% of patients aged under 85; loss of vitreous fluid was recorded in none of the patients in the older group and in 0.41% of patients in the younger group.

CONCLUSION

Our study confirms that advanced age alone is not a contraindication for a cataract operation and is not associated with a greater rate of intraoperative complications. Cataract operations on very old patients are generally successful, but should be undertaken early - particularly on multimorbid patients or those with dementia - in order to support the psychological status. The age of the patient is irrelevant.

The Greatest Generation Meets Its Greatest Challenge: Vision Loss and Depression in Older Adults

Having lived through the Great Depression and World War II, older adults now face the challenge of vision loss in record numbers. Depression is closely associated with functional loss and social isolation in late-life vision loss. The principles of assisting those who are aging will also benefit those who are aging with a visual impairment. They include recognizing depression, addressing multiple health concerns, promoting well-being, using a client-centered approach, and working collaboratively with the medical community and aging network.

Evaluation of Quality of Life in the Brazilian Graves' Disease Population: Focus on Mild and Moderate Graves' Orbitopathy Patients

Background: Quality of life (QoL) studies in patients with mild to moderate Graves' orbitopathy (GO) are scarce. Methods: The original GO-QoL questionnaire was translated to Portuguese and administered to 323 patients with Graves' disease. The clinically active score (CAS) was used to evaluate GO activity, and the NO SPECS and EUGOGO classifications were used to estimate GO severity. Results: The internal consistency of the GO-QoL, evaluated using Cronbach's alpha, was optimal. In people with Graves' disease and long-duration GO, both visual function and appearance scores were negatively associated with the CAS and NOSPECS and EUGOGO classifications (P < 0.001). Asymmetry and proptosis were significantly associated with the visual function and appearance domains, and diplopia was related to the visual function score. In addition, multivariate regression stepwise analysis revealed that disease severity, according to the EUGOGO classification, was associated with the visual function and appearance scores; asymmetry, presence of proptosis, and young age were associated with the appearance score (P < 0.001). The visual function and appearance scores were negatively correlated with the CAS and NOSPECS and EUGOGO classifications (P < 0.001). Conclusion: Graves' orbitopathy has a negative impact in QoL in patients with mild to moderate disease, even after an extended period, rendering GO a chronic disease. The GO-QoL questionnaire can be helpful in identifying patients in need of attention and support.

Eye Symptom Questionnaire to Evaluate Anterior Eye Health

OBJECTIVES

Ophthalmologists assess eye complaints with a careful history and eye examination; however, other types of physicians have limited tools to evaluate anterior segment (AS) eye diseases. We identified the eye symptom questions that providers should ask to help determine the presence and urgency of AS eye diseases.

METHODS

Persons with and without AS disease completed a self-report eye symptom questionnaire (ESQ) based on the National Institutes of Health Toolbox symptom items in an academic center's corneal and comprehensive eye clinics. Gold standard ophthalmic examination determined the presence and urgency of AS disease. The association between reported symptom severity and the probability of AS disease, or urgent AS disease, was evaluated using logistic regression models, and sensitivity and specificity of the ESQ were also calculated.

RESULTS

A total of 324 eyes of 162 subjects were included in the study. Of these, AS disease was present in 255 eyes (79%); of which, 111 eyes showed urgent disease. Increasing symptom severity for eye pain (odds ratio [OR]=2.58; P<0.001), glare (OR=2.61; P=0.001), and blurry vision (OR=1.98; P<0.001) were associated with increased odds of AS disease. Increasing symptom severity for eye pain (OR=2.02; P<0.001), eye redness (OR=1.69; P=0.02), and blurry vision (OR=1.41, P=0.01) were associated with increased odds of urgent AS disease. For the primary analysis with mild symptoms considered relevant, the sensitivity of the ESQ to detect AS disease was 83% and to detect urgent AS disease was 92%.

CONCLUSION

Symptoms of eye pain, glare, redness, and blurry vision indicate the presence and urgency of AS disease.

Visual acuity improvement after phacoemulsification cataract surgery in patients aged ≥90 years

Background

Visual acuity (VA) outcomes after phacoemulsification cataract surgery in the very elderly (≥90 years) compared to those in younger patients remain unclear till date.

Methods

We retrospectively investigated 138 (group 1) and 152 (group 2) eyes in patients aged ≥90 and < 80 years, respectively, with senile cataracts who underwent phacoemulsification and intraocular lens implantation between 2014 and 2016. Four highly experienced ophthalmic surgeons performed the procedures. Intra- and post-operative complications were compared between the two groups. To investigate the effectiveness of cataract surgery in improving best-corrected VA (BCVA) at 1 and 3 months postoperatively, multiple regression analysis was performed with variables of age, cataract grades, sex, and history of diabetes mellitus (DM) and hypertension.

Results

The intra- and post-operative complication rates were similar between the two groups. After adjusting for the difference in cataract grades, multiple regression analysis indicated that BCVA improvement was equally favorable in both groups at 1 and 3 months postoperatively but was less favorable in patients with a history of DM at 3 months postoperatively (P = 0.042).

Conclusion

Phacoemulsification in patients aged ≥90 years improves VA as effectively and safely as it does in younger patients, at least when performed by experienced surgeons.

Ophthalmologic evaluation in geriatric patients: Assessment of consistency between patients' complaints and ocular diagnoses

PURPOSE

This study aimed to assess the consistency between patients' complaints and their eye diseases.

DESIGN

Cross-sectional study.

METHODS

RESULTS: The frequencies of at least one newly diagnosed visually important ocular disease were 25.9%, 27.0%, and 45.3% in groups 1, 2, and 3, respectively (p<0.001). The same frequencies were significantly higher in patients >75 years of age compared with the younger group (59.1% vs. 22.0%, p<0.001). Although these values were statistically significant in patients ≤75 years of age (p<0.001), they were insignificant in patients >75 years of age according to type of complaints (p=0.773). Patients with diabetes mellitus exhibited significantly lower vision, higher rate of visually important ocular diseases, and higher intraocular pressure readings than patients without diabetes mellitus (p=0.009, 0.015, and 0.002, respectively).

CONCLUSIONS

Visually important ocular diseases were diagnosed approximately in a quarter of patients who had no complaints about decrease in vision and in more than half of the oldest geriatric patients (>75years) irrespective of the type of complaints.

The Association of Health-Related Quality of Life with Severity of Visual Impairment among People Aged 40-64 Years: Findings from the 2006-2010 Behavioral Risk Factor Surveillance System

PURPOSE

To examine the association of health-related quality of life (HRQoL) with severity of visual impairment among people aged 40-64 years.

METHODS

We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six measures of HRQoL: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, or moderate/severe. We examined the association between visual impairment and HRQoL using logistic regression accounting for the survey's complex design.

RESULTS

Overall, 23.0% of the participants reported a little difficult seeing, while 16.8% reported moderate/severe difficulty seeing. People aged 40-64 years with moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days, as well as greater life dissatisfaction, greater disability, and poorer health compared to people reporting no or a little visual impairment. After controlling for covariates (age, sex, marital status, race/ethnicity, education, income, state, year, health insurance, heart disease, stroke, heart attack, body mass index, leisure-time activity, smoking, and medical care costs), and compared to people with no visual impairment, those with moderate/severe visual impairment were more likely to have fair/poor health (odds ratio, OR, 2.01, 95% confidence interval, CI, 1.82-2.23), life dissatisfaction (OR 2.06, 95% CI 1.80-2.35), disability (OR 1.95, 95% CI 1.80-2.13), and frequent physically unhealthy days (OR 1.69, 95% CI 1.52-1.88), mentally unhealthy days (OR 1.84, 95% CI 1.66-2.05), and activity limitation days (OR 1.94, 95% CI 1.71-2.20; all p < 0.0001).

CONCLUSION

Poor HRQoL was strongly associated with moderate/severe visual impairment among people aged 40-64 years.

The Association of Visual Impairment With Clinical Outcomes in Hemodialysis Patients

Visual impairment limits people's ability to perform daily tasks and affects their quality of life. We evaluated the impact of visual impairment on clinical outcomes in hemodialysis (HD) patients.HD patients were selected from the Clinical Research Center registry a prospective cohort study on dialysis patients in Korea. Visual impairment was defined as difficulty in daily life due to decreased visual acuity or blindness. The primary outcome was all-cause mortality and the secondary outcomes were cardiovascular and infection-related hospitalization.A total of 3250 patients were included. Seven hundred thirty (22.5%) of the enrolled patients had visual impairment. The median follow-up period was 30 months. The Kaplan-Meier curve and log-rank test showed that all-cause mortality rates (P < 0.001) as well as cardiovascular and infection-related hospitalization rates (P < 0.001 and P < 0.001) were significantly higher in patients with visual impairment than in patients without visual impairment. In the multivariable analysis, visual impairment had significant predictive power for all-cause mortality (Hazard ratio [HR], 1.77, 95% confidence interval [CI], 1.21-2.61, P = 0.004) and cardiovascular hospitalization (HR 1.45 [1.00-1.90], P = 0.008) after adjusting for confounding variables. Of these 3250 patients, 634 patients from each group were matched by propensity scores. In the propensity score matched analysis, patients with visual impairment had independently significant associations with increased all-cause mortality (HR 1.69 [1.12-2.54], P = 0.01) and cardiovascular hospitalization (HR 1.48 [1.08-2.02], P = 0.01) compared with patients without visual impairment after adjustment for confounding variables.Our data demonstrated that visual impairment was an independent risk factor for clinical adverse outcomes in HD patients.

Seven-year incidence of uncorrected refractive error among an elderly Chinese population in Shihpai, Taiwan: The Shihpai Eye Study

PURPOSE

To report the 7-year incidence of uncorrected refractive error in a metropolitan Chinese elderly population.

METHODS

The Shihpai Eye Study 2006 included 460/824 (55.8%) subjects (age range 72-94 years old) of 1361 participants in the 1999 baseline survey for a follow-up eye examination. Visual acuity was assessed using a Snellen chart, uncorrected refractive error was defined as presenting visual acuity (naked eye if without spectacles and with distance spectacles if worn) in the better eye of <6/12 that improved to no impairment (≥6/12) after refractive correction.

RESULTS

The 7-year incidence of uncorrected refractive error was 10.5% (95% confidence interval (CI): 7.6-13.4%). 92.7% of participants with uncorrection and 77.8% with undercorrection were able to improve at least two lines of visual acuity by refractive correction. In multivariate analysis controlling for covariates, uncorrected refractive error was significantly related to myopia (relative risk (RR): 3.15; 95% CI: 1.31-7.58) and living alone (RR: 2.94; 95% CI 1.14-7.53), whereas distance spectacles worn during examination was protective (RR: 0.35; 95% CI: 0.14-0.88).

CONCLUSION

Our study indicated that the incidence of uncorrected refractive error was high (10.5%) in this elderly Chinese population. Living alone and myopia are predisposing factors, whereas wearing distance spectacles at examination is protective.

The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from Medicaid adult vision benefits

Increasing the proportion of adults that have regular, comprehensive eye exams and reducing visual impairment due to uncorrected refractive error and other common eye health problems are federal health objectives. We examine the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. Using a difference-in-difference-in-difference approach, we find that Medicaid beneficiaries with vision coverage are 4.4 percentage points (p<0.01) more likely to have seen an eye doctor in the past year, 5.3 percentage points (p<0.01) less likely to report needing but not purchasing eyeglasses or contacts due to cost, 2.0 percentage points (p<0.05) less likely to report difficulty seeing with usual vision correction, and 1.2 percentage points (p<0.01) less likely to have a functional limitation due to vision.

Efficacy and safety of low dose oral prednisolone as compared to pulse intravenous methylprednisolone in managing moderate severe Graves' orbitopathy: A randomized controlled trial

BACKGROUND

High dose oral prednisolone (100 mg/day) in Graves' orbitopathy (GO) is limited by lesser response, and greater side-effects compared to intravenous (iv) methylprednisolone. Low dose oral prednisolone has not been evaluated in GO. This study aimed to evaluate the safety and efficacy of low dose oral prednisolone in GO.

MATERIALS AND METHODS

A total of 114 consecutive GO patients were screened of which 65 patients with previously untreated moderate-severe GO, clinical activity score (CAS) >2, without co-morbid states were randomized into treatment Group-A (iv methylprednisolone 0.5 g for 3 days/month for 4 months) and Group-B (oral prednisolone 1 mg/kg/day for 6 weeks then tapered stopped), and followed-up. Thirty-one patients in each group with at least 1-year follow-up were analyzed. Responders were defined as improvement in ≥ 1 major response criteria or ≥ 2 minor response criteria. The trial is registered at ctri.nic.in (CTRI/2013/12/004264).

RESULTS

At 1-year, 27/31 (87.10%) patients were responders in Group-A compared to 17/31 (54.84%) in Group-B (P = 0.005). There was a greater improvement in CAS score in patients of Group-A as compared to Group-B (P < 0.001). Responders (n = 44) had significantly higher baseline intra-ocular pressures and left eye proptosis as compared to nonresponders. Cox-regression revealed baseline T4 levels, diplopia, and smoking history were predictive of remission. Low dose prednisolone was well tolerated, and the occurrence of adverse events were comparable in both groups.

CONCLUSIONS

Low dose oral prednisolone is inferior to iv pulse methylprednisolone in managing GO, having a comparable side-effect profile. It can be a safe second line alternative in patients intolerant to pulse iv methylprednisolone.

Safety of pregabalin among hemodialysis patients suffering from uremic pruritus

Objectives: The aim of this study was to assess the safety and probability of adverse events associated with the use of 75 mg pregabalin post hemodialysis (pHD) among patients with UP. Methods: A cross-sectional study done among the hemodialysis patients suffering from uremic pruritus (UP) Aljaber Kidney Center (AJKC), Al-Ahsa, Eastern Province, Saudi Arabia. Assessment for the safety profile of pregabalin was done using Naranjo’s algorithm. A predictive model was developed using binary multiple logistic regression to explore association of patients’ demographics and risk factors with the occurrence of AEs. Throughout statistical significance level was considered significant at 0.05. Key findings: Assessment of safety of pregabalin revealed that somnolence and dizziness were the two frequent adverse events followed by constipation, weight gain and edema. However, it was noticed that female patients aged less than 50 years were found to be at a higher risk in comparison with men. Moreover, those patients having one comorbid complication (i.e. hypertension or diabetes mellitus alone) were at a higher risk of somnolence, weight gain and dry mouth. Conclusion: Naranjo’s quantification for the possibility and probability of adverse events reflect that all the events were probable. Age, gender and comorbid medical conditions are some of the factors that might have clinical association with the occurrence of the AEs.

Health-related quality of life among people aged ≥65 years with self-reported visual impairment: findings from the 2006-2010 behavioral risk factor surveillance system

PURPOSE

To examine the association between health-related quality of life (HRQoL) and visual impairment among people aged ≥65 years.

METHODS

We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six HRQoL measures: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, and moderate/severe. We examined the association between self-reported visual impairment and HRQoL using logistic regression accounting for the survey's complex design.

RESULTS

People with self-reported moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days compared to those reporting a little or no visual impairment. After controlling for all covariates (age, sex, marital status, race/ethnicity, education, income, diabetes, heart disease, stroke, heart attack, body mass index, leisure time activity, smoking, and medical care cost concerns) and comparing to those with no self-reported visual impairment, people reporting a little visual impairment were more likely to have fair/poor health (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1-1.3), life dissatisfaction (OR 1.6, 95% CI 1.3-2.0), and disability (OR 1.5, 95% CI 1.3-1.6), and those with self-reported moderate/severe visual impairment had more fair/poor health (OR 1.8, 95% CI 1.6-2.0), life dissatisfaction (OR 2.3, 95% CI 1.8-2.9), and disability (OR 2.0, 95% CI 1.8-2.2). They also had more frequent physically unhealthy days (OR 1.9, 95% CI 1.7-2.1), mentally unhealthy days (OR 1.8, 95% CI 1.5-2.1), and activity limitations days (OR 1.9, 95% CI 1.6-2.2).

CONCLUSION

Poor HRQoL is strongly associated with the severity of self-reported visual impairment among people aged ≥65 years.

Psychological adaptation to visual impairment: The traditional grief process revised

The objective of this study was to explore the pattern of adaptation in patients who have been diagnosed with visual impairment. Participants ( N = 700), recruited in the Montreal area (Canada), underwent a structured interview in order to collect information on the duration of the acquired visual impairment and answered the ‘Brief Cope’, ‘Satisfaction with Life Scale’ and ‘Center for Epidemiologic Studies–Depression Scale’ (CES-D). Multivariate analysis of covariance (MANCOVA) revealed that patients who have lived with vision impairment for over 2 years reach significantly higher acceptance and lower denial levels compared to those of patients who had recent vision loss (≤2 years). We also found that acceptance was positively correlated with well-being and denial with depression, while acceptance was negatively correlated with depression and, likewise, denial with well-being. Our study results suggest that patients who have been diagnosed with visual impairment engage in an adaptative coping style early in the grief process.

Impact of obesity and diabetes on arthritis: An update

The incidence of obesity and diabetes has been increased with alarming rate in recent years and became a common problem around the globe including developing as well as in developed countries with incalculable social costs. Obesity and type 2 diabetes are two common co-morbidities occur together. Obesity and diabetes is closely associated with many diseases, osteoarthritis, hypertension, certain form of cancer, sleep-breathing disorders and coronary heart disease. Impacts of obesity and diabetes (insulin resistance) on arthritis have been seen in patients that we associated with combination of various factors like increased availability of high- energy foods, genetic susceptibility and decreased physical activity in modern society. Arthritis is becoming pandemic around the globe and its occurrence with obesity and diabetes has been observed more common than ever. Combination of these two chronic conditions makes these diseases more vulnerable for human health. Till now very limited information is established about the pathological and mechanistic correlation among these health ailments. In this review article we aimed to survey the literature covering the influence of obesity and diabetes on arthritis pathology and tried to establish correlation with these diseases.

The impact of sensory impairment on social interaction between residents in care homes

Aim.  The aim was to draw on older people's narratives to illuminate the experience of living in a care home and the impact that vision and hearing impairments have on the individual's ability to engage in social interactions with other residents. Methods.  The paper draws on two research studies, first, a hermeneutic inquiry examining the meaning ascribed to living in a care home, the second, a constructivist study, exploring relationships between residents, families and staff. Both studies drew on older people's narrative accounts to explore their experiences of living in a care home. On independently interpreting the narratives a similar theme emerged around the challenges to social interactions experienced by residents with sight and/or hearing impairment. This resulted in a cross study analysis to further illuminate this theme. Findings.  The cross study analysis highlighted the difficulties residents experience in interacting with others, in the home, as a consequence of sight and/or hearing impairment, and the potential impact this had on feelings of social isolation. This is illustrated through narratives from two residents, one with sight impairment and the other with hearing loss. The narratives highlight the problems these people encountered and how resilient they were in adjusting to their sensory loss and maintaining social interactions. One conclusion from the study is the need for more empirical work in this area. Relevance to clinical practice.  The paper identifies a number of issues for practice including staff taking a more proactive role in screening for, and managing, visual and hearing impairments in residents. Also the vital role staff play in ensuring the environment optimizes the residents' ability to fully engage in the residential community.

Brow ptosis: are we measuring the right thing? The impact of surgery and the correlation of objective and subjective measures with postoperative improvement in quality-of-life

INTRODUCTION

To assess the effect of brow ptosis on visual function and quality-of-life (QoL), and to determine what measures are associated with post-surgical change in functional status.

METHODS

Prospective longitudinal study. Fifteen consecutive patients undergoing brow-lift surgery from February 2009 to August 2010.

MAIN OUTCOME MEASURES

pre- and post-operative eyelid position (ie, distance mm from corneal reflex to upper skin fold (FRD1), lowest brow hair to lower limbus (LLB), centre of lower lid to upper lid skin fold (LLF)) and number of points missing in 'superior' and 'superior plus elsewhere' Humphrey 120-point visual field, as well as a Quality-of-life and Visual Function questionnaire before and after brow lift surgery.

RESULTS

The strongest correlation between pre-op functional index score and any pre-op objective measure was visual fields (r=-0.46, P<0.085). There was a mean 36-point increase in functional index score after brow lift surgery (P<0.001).Self-reported preoperative functional impairment was the only outcome measure significantly (and strongly) associated with post-surgical improvement in functional status (r=-0.833, P<0.001).

CONCLUSIONS

Surgical repair of brow ptosis results in a measurable increase in health-related QoL. The preoperative QoL score is the best predictor of postoperative improvement in QoL. The best available objective preoperative parameter for indicating postoperative QoL improvement is visual fields. These two measures should be used to better predict successful surgical outcomes.

Associations of eye diseases and symptoms with self-reported physical and mental health

PURPOSE

To study the associations of eye diseases and visual symptoms with the most widely used health-related quality-of-life (HRQOL) generic profile measure.

DESIGN

HRQOL was assessed using the short form-36 (SF-36) version 1 survey administered to a sample of patients receiving care provided by a physician group practice association.

METHODS

Eye diseases, ocular symptoms, and general health were assessed in a sample of patients from 48 physician groups. A total of 18,480 surveys were mailed out and 7,093 returned; 5,021 of these had complete data. Multiple linear regression models were used to examine the decrements in self-reported physical and mental health associated with eye diseases and symptoms, including trouble seeing and blurred vision.

RESULTS

Nine percent of the respondents had cataracts, 2% had age-related macular degeneration, 2% glaucoma, 8% blurred vision, and 13% trouble seeing. Trouble seeing and blurred vision both had statistically unique associations with worse scores on the SF-36 mental health summary score. Only trouble seeing had a significant association with the SF-36 physical health summary score. While these ocular symptoms were significantly associated with SF-36 scores, having an eye disease (cataracts, glaucoma, and macular degeneration) was not, after adjusting for other variables in the model.

CONCLUSIONS

Our results suggest an important link between visual symptoms and general HRQOL. The study extends the findings of prior research to show that both trouble seeing and blurred vision have independent, measurable associations with HRQOL, while the presence of specific eye diseases may not.

The association between low vision and function

OBJECTIVE

This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability.

METHODS

Guided by the World Health Organization's International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study.

RESULTS

The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities.

DISCUSSION

The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.

Psychological implications of Graves' orbitopathy

Patients with thyroid eye disease, Graves' orbitopathy (GO), often appear distressed and it is likely that features of the condition such as disturbances in visual function, orbital discomfort and alterations in facial appearance can impart significant psychological morbidity upon the patient, which in turn can be detrimental to their quality of life. When considering the psychological impact of GO, two elements of the disease are important. The disfiguring changes to the eyes and face can have a direct effect upon psychological health, while physical aspects of the disease such as altered visual acuity, diplopia, orbital pain and lacrimation may influence psychological function as a secondary phenomenon, due to interference with daily living. Evidence appears to confirm the anecdotal impression of many clinicians dealing with GO patients that the prevalence of psychological morbidity in this patient group is high. A 'biopsychosocial' approach to care that addresses biological and psychosocial functioning as major determinants of health is an appropriate strategy when treating patients with GO.

Validation and test characteristics of a 10-item neuro-ophthalmic supplement to the NEI-VFQ-25

PURPOSE

To determine whether a 10-Item Neuro-Ophthalmic Supplement increases the capacity of the 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) to capture self-reported visual dysfunction in patients with neuro-ophthalmologic disorders.

DESIGN

A cross-sectional survey to examine the characteristics of a 10-Item Neuro-Ophthalmic Supplement to the 25-Item NEI-VFQ-25 in a cohort of patients with neuro-ophthalmologic disorders.

METHODS

The 10-Item Neuro-Ophthalmic Supplement was designed previously by our research group by survey and focus-group methods. In the present study, the NEI-VFQ-25 and 10-Item Supplement were administered concurrently to patients and disease-free control subjects. High-contrast visual acuities with patient usual distance correction were measured with the use of Early Treatment Diabetic Retinopathy Study (ETDRS) charts.

RESULTS

Diagnoses for patients (n = 215) included optic neuritis, multiple sclerosis, idiopathic intracranial hypertension, ischemic optic neuropathy, stroke, ocular myasthenia gravis, ocular motor palsies, and thyroid eye disease. Scores for the 10-Item Supplement had a significant capacity to distinguish patients vs disease-free control subjects that was independent of the NEI-VFQ-25 composite score (odds ratio in favor of patient vs control status for 10-point worsening in Supplement scores: 2.7 [95% confidence interval [CI], 1.6, 4.6]; P < .001, logistic regression models that account for NEI-VFQ-25 composite score, age, and gender). Patients with visual dysfunction (binocular Snellen equivalents worse than 20/20) had significantly lower mean scores (9-21 points lower); these differences remained significant after accounting for age and gender (P >or= .001, linear regression). Supplement items and composite scores demonstrated appropriate degrees of internal consistency reliability.

CONCLUSION

The 10-Item Neuro-Ophthalmic Supplement demonstrates a capacity to capture self-reported visual dysfunction beyond that of the NEI-VFQ-25 alone, which supports validity for this new scale. The use of the 10-Item Supplement in clinical trials and epidemiologic studies will examine its capacity to demonstrate treatment effects in longitudinal cohorts.

Longitudinal analysis of the relationship between regular eye examinations and changes in visual and functional status

OBJECTIVES

To determine whether regular eye examinations are associated with a greater or lesser rate of loss of ability to read newsprint, onset of blindness or low vision, or onset of limitations in instrumental activities of daily living (IADLs) and activities of daily living (ADLs).

DESIGN

A sample of 14,215 Medicare beneficiaries observed between 1994 and 1999 linked to the 1994 and 1999 National Long-Term Care Surveys (NLTCS). Effects of annual examinations were assessed using instrumental variables.

SETTING

The Medicare-linked NLTCS is representative of U.S. elderly persons from 1994 to 1999.

PARTICIPANTS

Longitudinal observational study of persons aged 65 and older.

MEASUREMENTS

Change in self-reported and provider-reported vision and change in functional limitations associated with vision related to the number of years with eye examinations and other factors.

RESULTS

Persons with more-regular eye examinations between 1994 and 1998 were less likely to have experienced a decline in vision or in functional status between 1994 and 1999. On average, an additional year with an eye examination was associated with a decrease in the probability of becoming unable to read newsprint of 0.12 (P=.03), a lower probability of onset of low vision or blindness of 0.009 (P=.06), and a decrease in the probability that the number of functional limitations increased of 0.13 (P=.002) for IADLs and 0.05 (P=.003) for ADLs.

CONCLUSION

Elderly persons who have regular eye examinations experience less decline in vision and functional status.

Psychosocial morbidity of Graves' orbitopathy

OBJECTIVE

Ocular diseases markedly impair daily function. In Graves' orbitopathy (GO), an associated psychosocial burden is present due to disfiguring proptosis and/or diplopia, signs with significant impact on functional status and well-being. We have therefore surveyed and assessed the psychosocial morbidity of GO.

DESIGN

A prospective controlled study on subjects with GO using internationally validated, self-reporting questionnaires.

PATIENTS

One hundred and two consecutive patients with varying degrees of severity and activity of GO. Measurements Emotional distress, coping styles and quality of life (QoL) were assessed by the Hospital Anxiety and Depression Scale, by a German adaptation of the Ways-of-Coping Checklist, and with the 36-item Short Form, respectively. Stressful events in the 6 months preceding diagnosis were registered with the Life Experience Survey. QoL findings were compared to German reference values, as well as to 102 age- and gender-matched patients, each with type 1 diabetes (insulin-dependent diabetes mellitus, IDDM) and inflammatory bowel disease (IBD), respectively.

RESULTS

Compared to the German reference population, all QoL scales were at a lower rate and were especially decreased in subjects with active and/or severe GO, orbital pain, diplopia and stressful life events. Compared to diabetics, psychosocial scales were considerably reduced in GO (z = -1 vs. 0.1, P < 0.001) and higher scores for depressive coping (2.32 vs. 1.71, P < 0.001) and trivializing (2.37 vs. 1.97, P < 0.006) were noted. In GO, depressive coping and trivializing were negatively correlated with the mental (r = -0.603 and r =-0.411, both P < 0.001) and physical (r = -0.487 and r = -0.354, both P < 0.001) components of QoL. Depressive coping also positively correlated with anxiety (r = 0.636) and depression (r = 0.590), respectively, both P < 0.001. Emotional distress noted in 46 subjects, mostly with active and severe GO, was associated with poor QoL. Anxiety and depression were present in 41 and 24 GO patients, respectively. The number of stressful events positively correlated with the scores of anxiety (r = 0.3335) and depression (r = 0.3178), both P = 0.001. Foremost emotional distress, but also diplopia, stressful events and depressive coping had a major impact on QoL (proportion of variance explained = 13.1%, P < 0.001, multiple regression analysis). More than 75% of the psychosocial impairment in GO (R2= 0.76, P < 0.001) was associated with seven variables only (e.g. depression and anxiety). Six months prior to GO onset, 74 patients experienced a mean of 4 (range 0-13) stressful life events. Subjects with optic neuropathy had more stressful events than those without nerve involvement (5.1 vs. 2.7, P = 0.0425).

CONCLUSIONS

Psychosocial morbidity is present in severe and/or active GO, which negatively affects QoL. The patients are not only physically ill, they also exhibit emotional distress. Accompanying psychosomatic treatment is indicated among about half of all GO patients.

Impact of stereopsis on quality of life

PURPOSE

To investigate the impact of stereopsis on vision-related quality of life and general health status of the elderly.

METHODS

A quota of 200 subjects aged 65 years or older and had their households registered in Guando district was recruited for a general physical examination including ophthalmic evaluation. A structured questionnaire consisting of seven vision-specific items as well as 36-item short-form survey of the Medical Outcomes Study (SF-36) was administered. Stereoscopic level was divided into three groups: no stereopsis, gross stereopsis, and fine stereopsis. Fisher's exact test was used to detect any difference in subjective visual functioning and Mann-Whitney U test was used for analyses of SF-36 scores.

RESULTS

A total of 187 volunteers were recruited and 150 were analysed for stereoscopic levels. There was no significant difference in vision-specific difficulty among the three stereoscopic groups. For SF-36, having no stereopsis scored significantly less than having gross (P=0.005) and fine (P<0.0001) stereopsis in the vitality/energy dimension. General health perception dimension fared significantly lower in the group with no stereopsis compared to the fine stereoscopic group (P=0.01). In multivariate analysis, having fine stereopsis scored significantly higher in the energy/vitality dimension than having no stereopsis (P=0.02). On the other hand, visual impairment imposed significant adverse effect on five vision-specific items and had no significant relationship with the eight dimensions of SF-36.

CONCLUSIONS

Defective stereopsis in the elderly imposes no significant adverse effect on vision-related quality of life. However, subjects may feel more exhausted in accomplishing their usual tasks.

The influence of diabetic retinopathy on quality of life: interviews to guide the design of a condition-specific, individualised questionnaire: the RetDQoL

An individualised measure of the impact of diabetic retinopathy on quality of life (QoL) was developed, using a four-phase iterative approach, incorporating qualitative and quantitative methods. In semi-structured interviews, eleven people with diabetic retinopathy in each of two UK and two German hospitals described how QoL would be different without diabetic retinopathy. They completed and commented on the latest Retinopathy Dependent QoL (RetDQoL) draft. Interviews were content analysed before questionnaire revision and translation for the next centre. Twenty-six men and 18 women were interviewed: median age 60.5 (28-82) years; severity ranged from untreated background diabetic retinopathy to proliferative diabetic retinopathy requiring photocoagulation in both eyes, and vitrectomy. The resulting 26-domain RetDQoL asks about the impact of 'diabetic eye problems'. Iterative methodology ensured good understanding, face and content validity. It can be self- or interviewer-completed. Visual impairment, worries and movement restrictions impaired many aspects of QoL, with impacts before vision loss. Practice implications relate to using the RetDQoL and improving practitioner-patient communication.

Screening for visual impairment in elderly patients with hip fracture: validating a simple bedside test

AIMS

1. To assess the prevalence of visual impairment in those patients who sustain proximal hip fracture after a simple fall. 2. To test the validity of a simple screening test to identify patients with visual impairment.

METHODS

Patients on the orthopaedic rehabilitation ward recuperating from proximal hip fracture were recruited. The nurse screener and examining Ophthalmologist independently assessed the patients' distance visual acuity and visual field to confrontation. In addition, the nurse screener assessed for the presence of cataract in the red reflex and the examining Ophthalmologist performed a dilated slit-lamp examination. On completion of the examination, the Ophthalmologist documented the cause(s) of any visual impairment found.

RESULTS

A total of 89 patients were assessed. In all, 29 patients (33%) could be classified as visually impaired using the United States criteria and 52 patients (58%) had a distance visual acuity of 6/18 or worse in at least one eye. The test reliably identified those patients with visual impairment (sensitivity 94% (+/-5%), specificity 92% (+/-6%)), but was less reliable at identifying those patients with potentially remedial visual impairment (sensitivity 70% (+/-10%), specificity 92% (+/-6%)).

CONCLUSION

The level of visual impairment in this group of patients is high and screening for visual impairment in the elderly with a history of falls is justified. We have demonstrated that a suitably trained member of the rehabilitation team can identify over 94% of those patients with impaired vision. We believe this simple test should now be incorporated into the assessment of all patients requiring rehabilitation after a proximal hip fracture.

Research Agenda-Setting Program for Geriatric Ophthalmology

The healthcare needs of an aging population of "baby boomers" (persons born between 1946 and 1964) will disproportionately affect ophthalmology. To meet this emerging need, the American Geriatrics Society and the John A. Hartford Foundation developed a research agenda-setting process for geriatric ophthalmology. A systematic literature search was performed using Medline from the years 1990 to 2000. The literature review (168 papers) was performed to determine the current state of information regarding selected issues in geriatric ophthalmology. A needs assessment for each of the identified topics was performed, gaps in the existing knowledge base were identified, and key questions for future research were proposed. A research agenda-setting process for geriatric ophthalmology might provide a structural framework for future research efforts in the field.

Impact of cataract surgery on the visual ability of the very old

PURPOSE

To compare the functional outcome of cataract surgery in terms of visual ability between patients ages younger than 84 years, 85 to 89 years, and 90+ years. Survival time will be estimated at 4 years.

DESIGN

Population-based, observational case series.

METHODS

We prospectively evaluated elderly cataract patients' self-assessed visual ability regarding reading, TV viewing, orientation ability, activities of daily life, satisfaction, and visual acuity (VA) before and approximately 3 months after cataract surgery. All patients operated on during a 1-year period from our geographically defined admitting area that participated with a questionnaire were included (n = 837). Survival was checked after 4 years.

RESULTS

Before surgery, the most elderly were significantly more dissatisfied with their visual function (P =.007). Seventy-six percent of 85+ improved their subjective ability to read, and two-thirds of those unable to read newspaper print were able to read after surgery. A total of 79% of 90+ experienced improved postoperative ability to manage their daily lives. Best-corrected VA (BCVA) improved in 94% (90+ years of age), 90% (85 to 89 years of age), and 97% (younger than 84 years of age), respectively. After surgery, VA was significantly worse with increasing age, also after adjustment for ocular comorbidity (P <.0001). Patients with a BCVA improvement of less than 0.3 logarithm of the minimal angle of resolution units, patients with comorbidity, and patients aged 90+ had approximately 3 times the odds of being dissatisfied with vision after surgery. A total of 43% of 90+ years and 62% of 85 to 89 years were alive 4 years after surgery.

CONCLUSIONS

Most patients aged 85 and older had improved visual ability, acuity, and satisfaction after cataract surgery. In terms of visual function, surgery of significant cataracts in the very old is beneficial also when life expectancy is taken in account.

Epidemiologic study of age-related cataracts among an elderly Chinese population in Shih-Pai, Taiwan

PURPOSE

The purpose of this study was to determine the prevalence and risk factors for age-related cataracts in a metropolitan elderly Chinese population in Shihpai, Taipei, Taiwan.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

A total of 2045 subjects at least 65 years of age were invited to participate, and 1361 (66.6%) participated in the survey.

METHODS

An eye examination, including lens opacity grading, was conducted by ophthalmologists using the Lens Opacity Classification System III (LOCS III). A structured questionnaire was used for data collection. Interviewers also collected information on subjects' blood pressure, lifestyle (cigarette smoking and alcohol intake), medical history, and waist and hip circumferences.

MAIN OUTCOME MEASURES

Subjects were defined as having age-related cataracts if there was any type of lens opacity with an LOCS III grade of more than 2 in one or both eyes. When both eyes of an individual had age-related cataracts, the more affected eye was used for analysis.

RESULTS

Among the 1361 participants, 806 were diagnosed with age-related cataracts. The prevalence was 59.2% (95% confidence interval, 56.6%-61.8%). Women had a higher prevalence of cataracts than men (64.0% vs. 56.1%, P = 0.004). The prevalence of age-related cataracts increased with age (P = 0.001). Nuclear opacity was the most prevalent type (38.9%), followed by cortical opacity (21.9%) and posterior subcapsular opacity (9.2%). On the basis of the final logistic regression model, after controlling for all other covariates, increased age and female gender were factors that were associated with an increased risk for all types of cataracts. Besides age and gender, the most significant risk factor for nuclear cataracts was current cigarette smoking; the significant predictors for cortical cataracts were higher systolic blood pressure, a history of cigarette smoking in the past, and history of diabetes; the significant predictor for posterior subcapsular cataracts was higher systolic blood pressure.

CONCLUSIONS

The increasing prevalence of age-related cataracts with age highlights the need to seek appropriate medical services and for preventative interventions. Elderly people often ignore the importance of seeking vision services and care to prevent blindness or visual impairment. These findings suggest that the elderly need to be educated regarding the importance of eye care by physicians and hygiene authorities in Taiwan.

Quality of life in patients with malignant choroidal melanoma after radiotherapy

BACKGROUND

Patient-orientated endpoints have attracted little attention in patients with malignant choroidal melanoma. This study was conducted to explore the long-term effects of malignant choroidal melanoma and radiotherapy on QOL by means of a differentiated and modular QOL approach, including global QOL, social support, and mental health, in comparison with sociodemographically matched healthy controls.

METHODS

A random sample of 100 outpatients treated by radiotherapy were asked by mail to take part in a psychodiagnostic study [instruments: Short-Form 36 Health-Survey (SF-36), Symptom Checklist-90-Revised, German Social Support Questionnaire]. The same instruments were applied to a healthy control group, which was matched to patients with regard to age, gender, and vocational situation.

RESULTS

93 patients (average age 61.2 years) responded at an average of 5.5 years (+/-3.7) after diagnosis. Visual acuity in the affected eye decreased considerably from diagnosis (0.49+/-0.30) to participation in the study (0.09+/-0.21). Compared with healthy controls, patients reported on average statistically significantly lower global QOL (SF-36), whereas social support and mental distress did not differ. Frequencies of clinically relevant mental distress were significantly higher in patients than in controls (35.5% vs. 16.1%). Mental distress was associated with poorer visual acuity, but not with the extent of loss of visual acuity or number of follow-up treatments.

CONCLUSION

Patients with choroidal melanoma suffer from low long-term global QOL, and every third patient suffers from relevant mental distress. Regular screening for mental distress should be implemented along with psychological counseling. Additional follow-up treatment does not seem to induce mental distress.

Diabetes and incidence of functional disability in older women

OBJECTIVE

To examine the relationship between diabetes and the incidence of functional disability and to determine the predictors of functional disability among older women with diabetes.

RESEARCH DESIGN AND METHODS

We analyzed data from 8,344 women enrolled in the Study of Osteoporotic Fractures, a prospective cohort of women aged > or =65 years. Diabetes (n = 527, 6.3% prevalence) and comorbidities (coronary heart disease, stroke, arthritis, depression, and visual impairment) were assessed by questionnaire and physical examination. Incident disability, defined as onset of inability to do one or more major functional tasks (walking 0.25 mile, climbing 10 steps, performing household chores, shopping, and cooking meals), was assessed by questionnaire over 12 years.

RESULTS

The yearly incidence of any functional disability was 9.8% among women with diabetes and 4.8% among women without diabetes. The age-adjusted hazard rate ratio (HRR) of disability for specific tasks associated with diabetes ranged from 2.12 (1.82-2.48) for doing housework to 2.50 (2.05-3.04) for walking two to three blocks. After adjustment for potential confounders at baseline (BMI, physical activity, estrogen use, baseline functional status, visual impairment, and marital status) and comorbidities (heart disease, stroke, depression, and arthritis), diabetes remained associated with a 42% increased risk of any incident disability and a 53-98% increased risk of disability for specific tasks. Among women with diabetes, older age, higher BMI, coronary heart disease, arthritis, physical inactivity, and severe visual impairment at baseline were each independently associated with disability.

CONCLUSIONS

Diabetes is associated with an increased incidence of functional disability, which is likely to further erode health status and quality of life.

Vision-specific instruments for the assessment of health-related quality of life and visual functioning: a literature review

Clinically objective measures such as visual acuity or visual field provide an assessment of a patient's visual status. However such measures may not reflect the degree of visual impairment the patient experiences in his or her daily activities. Visual impairment has been shown to have negative effects on health-related quality of life (HR-QOL) and a significant impact on daily functioning, including social activities. As such, there is a growing recognition of the importance of patient-reported outcomes of visual functioning. This review examines the development and psychometric properties of 22 vision-specific instruments assessing visual functioning and/or the impact of visual impairment on HR-QOL or daily activities. Issues relevant to assessing vision-specific subjective outcomes are reviewed, with specific application of the reviewed instruments. Three instruments, the Activities of Daily Vision Scale, National Eye Institute Visual Function Questionnaire, and Visual Function Index have been well validated and widely used, but others also show promise. To fully capture the benefits of a new ophthalmology treatment (or new treatment for eye disease) a valid and reliable visual instrument, in which the psychometric performance has been demonstrated in the particular ocular condition being treated, should be utilised.

Clinical outcome measures for research in multiple sclerosis

The development of new and more sensitive clinical outcome measures for research in multiple sclerosis (MS) has been fueled by the development of effective therapies. As such, active arm comparison studies that require more sensitive clinical outcome measures are now commonplace. The Kurtzke Expanded Disability Status Scale (EDSS), the most widely used measure of neurologic impairment in MS, is particularly designed for classifying patients with respect to disease severity but has been criticized for its noninterval scaling, emphasis on ambulation status, relatively reduced sensitivity in the mid and upper ranges of scores, and absence of adequate cognitive and visual components. In response to perceived difficulties with the EDSS, the National Multiple Sclerosis Society Clinical Outcomes Assessment Task Force has developed the Multiple Sclerosis Functional Composite (MSFC). The MSFC includes three components that yield objective and quantitative results: 1) the timed 25-ft walk, 2) the nine-hole peg test, and 3) the 3-second paced auditory serial addition test. This scale has the advantages of continuous scoring with a composite Z score, standardized protocols, and high degrees of reliability and validity. Candidate visual function outcome measures for the MSFC, including the low-contrast Sloan letter chart, are currently under investigation. In addition to measures of neurologic impairment, health-related quality of life (HRQOL) measures have gained increasing importance as clinical trial outcome measures. The MS Quality of Life Inventory, a disease-specific HRQOL measure, has been developed to capture self-reported neurologic dysfunction and the impact of MS upon activities of daily living. MS clinical trials of the future, particularly active-arm comparison studies, will require more sensitive clinical outcome measures such as the MSFC. Measures of visual function and HRQOL should also be incorporated to capture the broad scope of neurologic impairment and disability in MS populations.

Quality of life in newly diagnosed glaucoma patients : The Collaborative Initial Glaucoma Treatment Study

OBJECTIVE

The Collaborative Initial Glaucoma Treatment Study (CIGTS) was designed to determine whether patients with newly diagnosed open-angle glaucoma are better treated initially by medicine or immediate filtering surgery. This paper describes the quality-of-life (QOL) measurement approach, instruments included, and the CIGTS participants' QOL findings at the time of diagnosis.

DESIGN

Baseline results from a randomized, controlled clinical trial.

PARTICIPANTS

Six hundred seven patients from 14 clinical centers were enrolled.

INTERVENTION

Patients randomized to initial medication received a stepped medical regimen (n = 307). Those randomized to initial surgery underwent a trabeculectomy (n = 300). The baseline interview was conducted before treatment initiation. All baseline and posttreatment QOL assessments were conducted by telephone from a centralized interviewing center.

MAIN OUTCOME MEASURES

The primary outcome measure described in this paper was QOL. The QOL instrument is multidimensional and incorporates both disease-specific and generic measures, including the Visual Activities Questionnaire, Sickness Impact Profile, and a Symptom and Health Problem CHECKLIST:

RESULTS

The correlations between QOL measures and clinical outcomes were in the expected direction, but relatively weak. At initial diagnosis, difficulty with bright lights and with light and dark adaptation were the most frequently reported symptoms related to visual function, whereas visual distortion was the most bothersome. Approximately half of the patients reported at least some worry or concern about the possibility of blindness. Within the Visual Activities Questionnaire, higher scores on the Peripheral Vision subscale were associated with more field loss (P < 0.01). In regression analyses controlling for sociodemographics and nonocular comorbidities, increased visual field loss was significantly associated with higher dysfunction among five disease-specific QOL measures (P < 0.05).

CONCLUSIONS

Newly diagnosed glaucoma patients reported experiencing some visual function symptoms at the time of diagnosis that would not be intuitively expected based on clinical testing. Some discussion about the association between clinical presentation and worry about blindness may reduce unnecessary concern. These results provide the basis for long-term comparisons of the QOL effects of initial medical and surgical treatment for open-angle glaucoma.

Self-reported visual dysfunction in multiple sclerosis: results from the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25)

Visual impairment is one of the most common clinical manifestations of Multiple Sclerosis (MS), and is strongly related to overall health-related quality of life (HRQOL) in MS and other disorders. However, the assessment of vision-specific HRQOL in patients with MS has been limited. The purpose of this study was to examine self-reported visual dysfunction in a clinically heterogeneous MS cohort using the 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25). The VFQ-25 was administered by telephone interview to a subset of participants in a follow-up study to a phase III trial of interferon beta-1a for relapsing-remitting MS. Mean VFQ-25 composite scores and selected sub-scale scores were significantly lower (worse) among patients in our MS cohort (n=35) compared with a published reference group of patients with no history of chronic eye disease (n= 118). These differences were observed despite a relatively younger age and tighter distribution of binocular visual acuities in the MS cohort Patients with MS in this study thus demonstrated a greater degree of self-reported visual dysfunction, as measured by the VFQ-25, compared with an eye disease-free reference group. The VFQ-25 is a potentially useful measure of vision-specific HRQOL in patients with MS.