Vision-related quality of life impairment in an elderly UK population: associations with age, sex, social class and material deprivation

Disparities in Vision-Related Functional Impairments Among Adults in the United States

PURPOSE

To investigate the relationships between vision-related functional impairment (VFI) with sociodemographic and healthcare access factors in a representative sample of the United States population.

METHODS

Data from the 2017 National Health Interview Survey (NHIS) were used. The NHIS involves responses from the U.S. civilian, non-institutionalized population aged 18 years or older. It provides self-reported data on demographic characteristics, socioeconomic factors, health status, and healthcare access. NHIS participants who responded to at least one of our target questions about VFI were included in the study. VFI was defined for participants based on their 'yes' or 'no' responses to target questions about experiencing a VFI. Data analysis was performed through univariable and multivariable logistic regression.

RESULTS

Overall, 26,711 participants were included, of which 6926 (25.9%) participants reported experiencing a VFI. In univariable analysis, there were greater odds of VFI among females (OR: 1.16, 95% CI: 1.07-1.26, p < 0.001), and participants with less than a high school degree compared to those with an advanced degree (OR: 1.17, 95% CI: 1.02-1.33, p = 0.02). Among economic and healthcare access factors, greater odds of VFI was associated with public health insurance versus private coverage (OR: 1.19, 95% CI: 1.07-1.32, p = 0.001), having delayed medical care due to costs (OR: 1.86, 95% CI: 1.86-2.10, p < 0.001), and being unemployed (OR: 1.39, 95% CI: 1.26-1.53, p < 0.001). Participants whose incomes were lower than the poverty threshold (OR: 1.54, 95% CI: 1.32-1.80, p < 0.001) had higher odds of VFI than those with income >5× poverty threshold.

CONCLUSIONS

Several demographic and economic factors are associated with VFI in a representative sample of the U.S. population. These results highlight the importance of addressing social and economic factors that are associated with the development of VFI.

Randomised controlled trial of HOYA one-day multifocal contact lenses: The HOMCL trial

Trial design

Double-masked crossover RCT (Research Registry: #8136) comparison of a new HOYA one-day disposable multifocal contact lens (HOMCL) with Alcon DAILIES TOTAL1® Multifocal (ADT1).

Methods

Sixty presbyopic participants from three countries attended for baseline measurements and fitting of both lens types and then for a fortnight completed daily diaries of symptoms with habitual optical correction, and VF-14 questionnaire. Participants collected either HOMCL or ADT1, when the vision was measured again, and they wore this product for a fortnight, completing daily diaries and VF-14. Participants then collected the other type and had vision and symptoms recorded in the same way.

Results

There were no serious adverse events. Primary outcomes were no significant differences between the lens types in willingness to purchase nor stated preference; no significant differences in the daily symptom ratings of comfort; statistically significant findings with the daily symptom ratings and VF-14 of better near vision with HOMCL and better distance vision with ADT1. Secondary outcomes were better high contrast distance visual acuity with ADT1 (<1 line), better low contrast distance visual acuity with ADT1; faster Wilkins rate of reading test with HOMCL; no significant differences in near visual acuity, wearing time, or number of lenses required during fitting process. Exploratory analyses were better handling scores with ADT1; and some, but not all of the dry eye data indicating better acceptance of HOMCL by patients with relatively dry eyes. For all measures, there were some participants who preferred/performed better with each lens type.

Conclusions

The differences between the performance of the two products were small. There was a trend in some clinical measurements and the daily diary data and VF-14 questionnaire, for HOMCL to outperform ADT1 for near vision and vice versa for distance vision.

Ophthalmic quality of life in the adult Danish population: an epidemiological study

BACKGROUND

Ophthalmic quality of life (OQoL) has been investigated in selected parts of general populations and in patients with ocular disease, but OQoL in unselected general populations has not been studied in detail. The present study reports OQoL obtained from a representative sample of the adult Danish population 2020-2022.

METHODS

The FORSYN study invited 10 350 citizen representatives for the adult Danish population for a non-mydriatic eye examination and answer the National Eye Institute Visual Function Questionnaire with 39 items in the validated Danish translation. The results from the 3384 (32.7%) persons who participated in the study were weighted on the basis of relevant socio-economic factors, and data were projected to represent the total population. Binocular visual acuity was below 0.1 corresponding to legal blindness in 0.22% of this population.

RESULTS

OQoL was positively correlated with binocular visual acuity up to better than 93 ETDRS letters, negatively correlated with age for persons younger than 60 years of age and again positively correlated with age for persons older than 60 years. OQoL was negatively correlated with increasing ametropia and refractive error above 1 dioptre and encompassed more OQoL parameters for hyperopic than for myopic persons.

CONCLUSIONS

The study underlines the benefits of improving visual acuity even within the normal range and of adjusting uncorrected refraction errors in the general population. OQoL is positively correlated with age in older persons independently of visual acuity, sex, refractive power and previous cataract surgery.

Factors associated with health-related quality of life among people with visual impairments living in nursing homes in Armenia: a cross-sectional study

PURPOSE

The study aimed to examine the effect of visual impairment (VI), eye diseases, and other risk factors on health-related quality of life (HRQoL) in nursing home residents in Armenia.

METHODS

This cross-sectional study administered an interviewer-administered structured questionnaire to collect information about socio-demographics, chronic diseases, HRQoL, smoking, receiving and giving instrumental/emotional social support, and sleeping disorders among 313 nursing home residents. An ophthalmic examination of the participants was conducted.

RESULTS

The mean age was 72.5 years, ranging from 45.5 to 91.4. Women constituted 50% of the sample. The prevalence of normal vision by presenting visual acuity with available correction was 55.3%, while VI and blindness were present in 40.8% and 3.9%, respectively. Uncorrected refractive error (URE) was found in 20% of participants. The mean HRQoL score was 51.3, ranging from 7.9 to 95.0. In the adjusted analysis, having at least one chronic non-communicable disease, sleeping disorders, eye diseases, URE, VI, blindness, and giving instrumental social support were associated with HRQoL.

CONCLUSIONS

Regular eye care services could improve the eye health and HRQoL of nursing home residents. Interventions addressing vision loss and chronic non-communicable diseases could enhance the functioning and overall well-being of the target population.

Health-Related Quality of Life after Cataract Surgery in Armenia: A Cross-Sectional Survey

Cataract surgery helps to enhance visual function and improve the quality of life of cataract patients. The present study assessed visual outcomes and explored health-related quality of life (HRQoL) and factors associated with it following cataract surgery in Armenia. An interviewer-administered survey along with the ophthalmologic examination was conducted among 248 patients. It explored socio-demographic characteristics, use of eye care services, smoking status, comorbidities, and receiving and giving social support. A Short Form Health Survey (SF-36) was used to measure HRQoL. Simple and multivariable linear regression was used for the analysis. About 72.8% of examined eyes had good visual outcomes, while 17.7% had borderline outcomes. Poor visual outcomes were detected in 9.5% of the eyes. The mean composite SF-36 score for physical health was 50.8, while the mean composite score for mental health was 49.9. Gender, socioeconomic status, having a non-communicable disease, and receiving and giving tangible social support were significantly associated with SF-36 physical component in the adjusted analysis, while the variables which demonstrated significant association with the mental component included socioeconomic status, having a non-communicable disease, and giving tangible support. The visual outcome after cataract surgery in Armenian patients is below WHO-recommended standards. The quality of ophthalmological surgical care should be monitored to maximize the visual outcome in Armenian patients, with a focus on women, patients with poor socioeconomic status, and those with non-communicable diseases.

Vision-Related Quality of Life in Patients with Inherited Retinal Dystrophies

Purpose

To evaluate the effect of inherited retinal dystrophies (IRDs) on vision-related quality of life (VRQoL) among IRDs' patients in Iran.

Methods

This cross-sectional study was conducted on 192 patients with different types of IRDs who were randomly selected from registered patients in the Iranian National Registry for Inherited Retinal Dystrophy (IRDReg®). All ophthalmic findings were collected based on the recorded data in IRDReg®. Moreover, the eligible participants were interviewed to fill out the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) to assess their VRQoL. Ordinal logistic regression was used to evaluate the possible association of the different clinical and nonclinical factors such as demographic information, socioeconomic status, and visual function with VRQoL.

Results

The overall mean of a composite score of VRQoL was 45. All subscales obtained from the NEI VFQ-25 questionnaire except general health, mental health, and ocular pain had a significant negative correlation with logMAR best corrected visual acuity (BCVA) and near visual acuity variables. There was a statistically significant relationship between VRQoL and factors like age (odds ratio [OR] = 0.91, 95% confidence interval [CI]: 0.87-0.94), employment status (OR = 1.37, 95% CI: 1.05-4.74), logMAR BCVA (OR = 0.31, 95% CI: 0.19-0.49) and normal color vision (OR = 1.92, 95% CI: 1.74-5.01).

Conclusion

The VRQoL of patients with IRDs in this study was low. BCVA could be an indicator to show VRQoL.

Comparative Analysis of the Impact of Visual Impairment on Quality of Life of Patients Attending a Tertiary Hospital in South East, Nigeria

Background

Quality of life (QoL) is defined as an "individual's perception of their position in life in the context of the culture and value system in which they live and in relation to goals, expectations, standards, and concerns." Visual Impairment affects QoL because of the restrictions it imposes on everyday life activities.

Aims

This study aims to compare the QoL of visually impaired patients attending the Eye Clinic of Federal Medical Centre, Owerri with that of normally sighted persons. The findings will aid the formulation of policies guiding the management of visually impaired patients.

Patients and Methods

This was a hospital-based case-control study which recruited all consenting new patients with visual impairment, and age, and sex-matched controls who presented at the Eye Clinic, Federal Medical Centre, Imo State, Nigeria during the period of the study. Data was collected using a semi-structured closed-ended questionnaire, and the World Health Organization QoL-BREF and analyzed with the Statistical Package for Social Science version 22.

Results

Four hundred and two participants were recruited. Lower scores were recorded in all the quality of life (QoL) domains for the visually impaired compared with controls. The overall QoL and health status mean score for the visually impaired (61.10 ± 19.75) was significantly lower than that for the controls (70.90 ± 21.19) at P < 0.001. Severity of visual impairment at P < 0.001 significantly affected all the QoL domains for the visually impaired with the lowest score noted among the blind (58.21 ± 11.63) compared to controls (79.33 ± 11.74). Occupation and educational level significantly affected the QoL of the study group but not the controls.

Conclusion

Visual impairment significantly reduces the QOL of patients. Policies targeted at enhancing the QoL of the visually impaired through rehabilitation and societal integration is recommended.

The Differential Impact of Age on Vision-Related Quality of Life across the Visual Impairment Spectrum

PURPOSE

Visual impairment (VI) can have a detrimental impact on vision-related quality of life (VRQoL), but it is still unclear how this relationship varies with age across the VI spectrum. We determined the age-stratified, cross-sectional, and longitudinal associations between VI severity and VRQoL.

DESIGN

The baseline and follow-up Singapore Chinese Eye Studies (SCES-1/-2; 2009-2011 and 2015-2017).

PARTICIPANTS

A total of 3068 SCES-1 participants (mean age [standard deviation {SD}]: 59.5 [9.8] years; 50.2% female) and 1919 SCES-2 participants (mean age [SD]: 56.8 [8.3] years; 49.9% female).

METHODS

Visual impairment was defined as visual acuity (VA) of > 0.3 logarithm of the minimum angle of resolution (logMAR) units; VI severity as mild-moderate (logMAR scores less than the median of all individuals with VI) and severe (logMAR scores median or greater); and VI incidence as VI absence at baseline, but evident at follow-up. Age was stratified into 40 to 49 years, 50 to 64 years, and ≥65 years.

MAIN OUTCOME MEASURES

Rasch-transformed scores from the 32-item Impact of Visual Impairment (IVI) questionnaire were used to measure the "Reading," "Mobility," and "Emotional" domains of VRQoL. Multiple linear regression models determined the age-stratified associations of prevalent and incident VI with all 3 VRQoL outcomes, adjusted for potential confounders.

RESULTS

Of the 807 persons with prevalent VI, 55.9% had mild-moderate and 44.1% had severe VI. Compared with no VI, age-stratified analyses showed that VRQoL decrements were significant only in the older age groups (mild-moderate VI: 6.2% and 8.1% reduction in Mobility and Reading scores in those aged ≥ 65 years; severe VI: 8.5% to 13.4% reductions in the 3 VRQoL scores in those aged ≥ 50 years). This interaction with older age became more pronounced with incident VI (N = 168), where decrements in all 3 VRQoL domains were evident only in those aged ≥65 years compared with persons without incident VI.

CONCLUSIONS

Our results suggest that the VI-VRQoL associations are driven mainly by older individuals aged ≥65 years, highlighting the need for effective regular screening and early intervention modalities to prevent the presence and onset of VI, and subsequent VRQoL declines, in these individuals.

5-year longitudinal study of clinical and patient-reported outcomes in acute anterior uveitis

INTRODUCTION

Acute anterior uveitis (AAU) is a frequently encountered form of uveitis, most commonly an immune-mediated condition associated with the HLA-B27 gene with or without spondyloarthritis, or idiopathic in nature. This study's aim was to measure clinical and patient-reported outcomes 5 years after the first episode of immune-mediated AAU.

METHODS

This is a longitudinal observational study. Ninety-six patients who underwent evaluation at the time of presentation with their first episode of AAU were invited to return for evaluation 5 years later. Standardised ocular history, clinical examination and quality of life (QOL) assessment with the Short Form 36 (SF-36) and the Vision Core Measure 1 (VCM 1) questionnaire were completed and analysed.

RESULTS

Fifty-four patients (56%) returned for subsequent assessment. Physical function was the only sub scale domain of the SF-36 that had significantly deteriorated over the 5 years since the first episode of AAU (45.95 vs. 49.37, p = 0.003). Only 7.4% (n = 4) of patients expressed "more than a little concern" regarding their vision, reflected by a VCM1 score of 2.0 or more. At 5 years, the mean best corrected visual acuity (BCVA) of eyes affected by AAU was LogMAR 0.02 and only 3% (n = 2) of eyes had a BCVA of less than Logmar of 0.3. Five affected eyes (8%) had developed cataract and no patients had developed glaucoma by the 5 year review.

CONCLUSIONS

This study demonstrates that immune-mediated AAU has an excellent 5 year prognosis with minimal impact on patients' health and vision-related quality of life.

Vision-related and health-related quality of life in patients with giant cell arteritis

OBJECTIVE

To establish if there is a difference in health-related quality of life and vision-related quality of life in patients with a confirmed diagnosis of giant cell arteritis compared with those with clinical features suspicious for the disease at initial presentation but in whom giant cell arteritis is ultimately excluded.

METHODS

A cross-sectional study of 116 patients who presented to two tertiary referral hospitals in Ireland with symptoms suspicious for giant cell arteritis was performed between August 2011 and June 2017. The Vision Core Measurement 1 and Short Form-36 questionnaires were used as assessment tools.

RESULTS

The mean (standard deviation) age of all 116 participants was 69.4 (9.3) years of whom 74 (63.8%) were female. In the giant cell arteritis group, 19.7% had permanent loss of vision and 54.7% had non-permanent visual disturbance. Vision Core Measurement 1 score in the giant cell arteritis group correlated with worse eye visual acuity (r = 0.4233, p = 0.0002). The Short Form-36 subscales of role physical (p = 0.0002), role emotional (p = 0.024), and the mental composite score (p = 0.012) were significantly worse in patients with giant cell arteritis. A significant correlation was found between vision-related quality of life scores and all Short Form-36 subscale scores except bodily pain (r = -0.215 to -0.399, p < 0.05 for all), and between social functioning and visual acuity in the better eye (r = -0.242, p = 0.038).

CONCLUSION

Vision-related quality of life is an important subjective concern for both patients presenting with a suspicion of giant cell arteritis and those with a definite diagnosis of giant cell arteritis. Features of giant cell arteritis impact on patients' physical and emotional states and vision influences global quality of life in giant cell arteritis. A long-term multidisciplinary approach is warranted for clinical, physical, and psychological treatment and support.

An analysis of the impact of visual impairment on activities of daily living and vision-related quality of life in a visually impaired adult population

Previous research has shown that people with visual impairment are more likely to be malnourished and have reported to have difficulty shopping for, preparing, and eating food. They are also reported to have a poor quality of life. The present study aims to investigate the impact of visual impairment on activities of daily living and Vision-Related Quality of Life (VR-QoL) in a sample of adults with visual impairment who are living in the United Kingdom.

A 37-question survey evaluating the nutritional status and the activities of daily living, cooking and shopping, was disseminated to adults with visual impairment who were 18 years and older. VR-QoL was also assessed using the validated, Questionnaire of Vision-Related Quality of Life Measure (VCM1).

Participants reported that being visually impaired made it difficult to shop for, prepare, and cook meals, and this correlated significantly with level of visual impairment. The VCM1 score of ⩾2.1 was reported by 74% of people with visual impairment revealing VR-QoL is more than a little of a concern for most of the participants. The mean VCM1 score for females was 2.9 ± 0.98 and 2.5 ± 1.1 for males. Level of visual impairment was not found to influence the VCM1 scores. This indicates even those with visual impairment below the level required for sight impairment registration report a reduced VR-QoL.

It is the responsibility and duty of society to support people with visual impairment or other disabilities rather than blaming them for not ‘integrating’. Among other things, this can be done by incorporating norms into the marketing. These norms might help to raise and increase the awareness of suppliers to the needs of consumers with visual impairment. Furthermore, such norms may contribute to our ongoing efforts for a more inclusive and accessible environment.

Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives

The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.

Factors associated with vision-related quality of life among the adult population living in Nagorno Karabagh

OBJECTIVES

Visual impairment and blindness are major public health problems causing significant suffering, disability, loss of productivity, and diminishing quality of life for millions of people. This study explored the factors associated with the overall vision-related quality of life (VRQoL) and its different domains in the adult population of Nagorno Karabakh and assessed the independent contribution of specific eye diseases to VRQoL.

STUDY DESIGN

A cross-sectional study.

METHODS

We conducted interviewer-administered survey along with free eye screenings among adult residents of Hadrut and Martuni regions of Nagorno Karabakh (Artsakh) in 2014-2015. The study questionnaire included questions about sociodemographic characteristics, non-communicable diseases, use of eye care services, visual acuity, eye diseases, and VRQoL. National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was used to assess VRQoL. In total, 531 adults participated in the study.

RESULTS

The mean age of participants was 60.1 years (standard deviation [SD] = 13.7), ranging from 18 to 90 years. The majority of participants were female (71.4%). The most frequently diagnosed eye disorder was cataract (33.8%). The prevalence of moderate and severe visual impairment was 7.0% and 0.8%, respectively. Almost 2.8% (15) of participants were blind. The mean global score of VFQ-25 in all study participants was 71.1 ± 19.28 (SD), whereas the mean global scores of VFQ-25 among not visually impaired, visually impaired, and blind participants were 74.0 ± 16.47 (SD), 51.7 ± 21.77 (SD), and 30.9 ± 20.2 (SD), respectively. In the adjusted linear regression model having moderate/severe visual impairment or blindness, age, socio-economic status, and having eye diseases such as glaucoma and cataract were significantly associated with VFQ-25 global score. The subscales of near vision, distance vision, peripheral vision, role difficulties, and mental health had significant associations with severe/moderate visual impairment in the adjusted analysis. After adjusting for visual impairment and demographic variables, participants with cataract and glaucoma were found to have statistically significant lower subscale scores than those without eye disease.

CONCLUSION

Our data suggest that visual impairment was associated with lower scores of VRQoL. The strength of that association correlated with the increase in the level of visual impairment (from moderate/severe impairment to blindness). VRQoL was also shown to be affected by age, socio-economic status, and having eye diseases such as glaucoma and cataract. Further actions of remediation of visual impairment in this population are warranted.

The Relationship between Loneliness and Perceived Quality of Life among Older Persons with Visual Impairments

Introduction

This article explores the rate and degree of loneliness in community-dwelling older visually impaired people, and is the first study to investigate the unique contribution that social and emotional loneliness makes to perceived quality of life (PQOL) in this population.

Methods

The study constituted a secondary analysis of postal survey data from the second wave (2012) of the nationally representative New Zealand Longitudinal Study of Ageing, a longitudinal study of older New Zealanders. A total of 2,683 participants completed both the visual status screening question and all 11 loneliness items to meet the criteria for inclusion in this study.

Results

Those designated as being visually impaired ( n = 315) were found to be more likely to experience loneliness (53% vs. 36%) than their sighted peers ( n = 2,368). Increased loneliness among those who are visually impaired was found to be associated with decreased economic well-being, mental health, satisfaction with activities of daily living, satisfaction with life, and PQOL. Social loneliness, but not emotional loneliness, was found to make a unique contribution to the prediction of variance in the PQOL of older visually impaired people over and above the impact of other predictors.

Discussion

Loneliness is much more prevalent in, and occurs with greater severity among, people who are visually impaired than with those who are not. Social loneliness made a unique contribution to PQOL over and above the contribution of variables that previous research has shown are central to PQOL in this population.

Implications for practitioners

Loneliness is not often addressed in vision rehabilitation programs designed for older adults, yet it is apparent from these findings that rates of loneliness may be high in this population. Its effect, even at moderate levels, is detrimental to the PQOL of older people with visual impairments.

Impact of cataract surgery on vision-related life performances: the usefulness of Real-Life Vision Test for cataract surgery outcomes evaluation

PURPOSE

Real-Life Vision Test (RLVT) is a newly developed performance-based measures of functional vision. This present study is designed to determine whether it could be a meaningful assessment for cataract surgery outcomes evaluation.

PATIENTS AND METHODS

Age-related cataract patients (56) who scheduled for bilateral cataract surgery and 44 age-matched controls were evaluated by four types of measurements: (1) demographic, medical, cognitive and depressive evaluation, and the reaction time testing; (2) clinical measures (visual acuity, contrast sensitivity, stereopsis, and color perception); (3) the 25-item National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ); (4) the RLVT. Spearman's coefficients and multiple regression analysis were conducted to investigate the relationship among RLVT, clinical measures, and self-report assessment of visual function.

RESULTS

The results of RLVT, clinical measures, and NEI-VFQ total scores were improved significantly after cataract surgery. There were no differences between control subjects and post-surgery patients with respect to NEI-VFQ-25 total scores, self-rating depression scale scores and three tasks of RLVT. Change of RLVT was significantly associated with the change of clinical measures in the cataract group. Multiple regression analysis demonstrated that change of distance, intermediate, and near visual acuity, and binocular contrast sensitivity were significant predictors of improvements of RLVT.

CONCLUSIONS

Cataract surgery could improve real-world visual ability effectively for cataract patients. Our study highlights the potential usefulness of RLVT as an adjunct to the current outcomes evaluation system for cataract surgery. The use of RLVT combined with clinical and self-survey methods may be the comprehensive strategy to manifest the impact of cataract surgery on patients' overall vision-related quality of life.

Giant cell arteritis: a review

Giant cell arteritis is the most common vasculitis in Caucasians. Acute visual loss in one or both eyes is by far the most feared and irreversible complication of giant cell arteritis. This article reviews recent guidelines on early recognition of systemic, cranial, and ophthalmic manifestations, and current management and diagnostic strategies and advances in imaging. We share our experience of the fast track pathway and imaging in associated disorders, such as large-vessel vasculitis.

Using the real-life vision test to assess the functional vision of age-related cataract patients

PURPOSE

(1) To describe and validate a newly developed, timed performance-based measures of functional vision-the real-life vision test (RLVT). (2) To determine how RLVT relates to clinical measures and self-report assessment of visual function and the complex interactions among visual impairment, psychosocial status, and demographic factors.

METHODS

A total of 64 patients with age-related cataract and 45 age-matched controls were evaluated by four types of measurements: (1) demographic, medical, cognitive, and depressive evaluation and the reaction time (RT) testing; (2) clinical measures (visual acuity, contrast sensitivity, stereopsis, and the color perception); (3) the 25-item National Eye Institute's Visual Functioning Questionnaire; and (4) the RLVT. Spearman's coefficients, partial correlation, and multiple regression analysis were conducted to determine the relationship among RLVT, clinical measures, and self-report assessment of visual function while controlling for confounders.

RESULTS

Control subjects performed RLVT significantly better than the cataract patients. RLVT correlated well with both clinical and self-report assessments of visual function. All subscales of RLVT remained highly associated with most of the clinical measures, even after adjusting for age, years of education, depression, cognitive status, and the RT. Distance, intermediate and near visual acuity, and binocular contrast sensitivity were significant predictors of the RLVT performances.

CONCLUSIONS

Given the strong relationship among RLVT, clinical measures, and the self-report assessments, our results highlight the potential usefulness of RLVT for assessing the functional vision of cataract patients. RLVT may provide information not obtainable from clinical measures or surveys and therefore it is essential to be incorporated into future ophthalmological practice.

Visual impairment and age-related eye diseases in Florida: Findings from 2006 Behavioral Risk Factors Surveillance System (BRFSS) in Nine states

Purpose

To compare the prevalence of age-related eye disease, visual impairment, and eye care service utilization among adults aged 65 and older in Florida with eight other states.

Methods

In 2006, nine states conducted the visual impairment and access to eye care module using the Behavioral Risk Factors Surveillance System (BRFSS) survey (N = 62,750). Visual impairment was based on self-reported ability to see distant and near objects. Age-related eye diseases including cataract, glaucoma, macular degeneration, and diabetic retinopathy were self-reported with diagnosis confirmed by a health care professional. Eye care visit or examination was assessed by whether a respondent reported an eye visit or dilated eye examination within the past year.

Results

The estimated prevalence of distant and near visual impairment was lower in Florida than in the eight other states (distant: 11.5% vs 15.2%, P < 0.001; near: 22.3% vs 28.7%, P < 0.001). There was no significant difference with the prevalence of age-related macular degeneration and diabetic retinopathy between these two groups. The prevalence of glaucoma and cataract was higher in Florida. The rates of eye care visits (80.5% vs 74.8%, P < 0.01) and dilated eye examinations (74.7% vs 64.0%, P < 0.01) were higher in Florida. After controlling for demographic variables, chronic conditions, insurance, and eye examination, results for elderly in Florida continued to demonstrate less visually impaired.

Conclusion

Fewer elderly in Florida reported visual impairment in spite of comparable or higher prevalence of age-related eye diseases with other states. Health care utilization and health insurance for eye care coverage were also higher in Florida, which may account for the phenomena. More research is needed to investigate the association.

Visual impairment and vision-related quality of life in working-age adults: findings in the 1958 British birth cohort

PURPOSE

To describe the prevalence of impaired vision and its relative burden, together with the prevalence of impaired vision-related quality of life (VRQOL), and investigate associations with social outcomes in a contemporary and nationally representative population of working age adults.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

We included 9330 members of the 1958 British birth cohort at age 44 and 45 years.

METHODS

"Habitual" and "best achieved" distance visual acuity in each eye, binocular near vision acuity and stereoacuity (three dimensional/depth perception) were tested during a broader biomedical examination. VRQOL was assessed using the Vision-related Quality of Life Core Measure 1 (VCM1), a validated, 10-item, self-complete instrument. Logistic and proportional odds ordinal logistic regression were used to calculate odds ratios (ORs) of the association of VRQOL with visual acuities and social outcomes.

MAIN OUTCOME MEASURES

Distance, near, and stereo acuities and VRQOL and social outcomes.

RESULTS

Of the 1.3% (124) of those with visual loss that precluded driving, a further 0.75% (70) were visually impaired or severely visually impaired and 0.15% (14) blind, the latter accounting for 19% total population (all ages) burden of blindness. Impairment of VRQOL is strongly associated with impaired distance, near, and stereo vision, as well as with adverse occupational and other social outcomes. However, VRQOL impairment is also sometimes reported with unilateral or mild bilateral visual loss.

CONCLUSIONS

Although impaired vision in working age adults is relatively uncommon, it confers important adverse consequences for the "health and wealth" of the public. This may be captured best by assessment of VRQOL in addition to objective visual function. Ophthalmic disorders occurring or impacting in middle life should be given a higher priority than currently in national and international strategies against avoidable visual disability.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Impact of self-reported visual impairment on quality of life in the Ibadan study of ageing

BACKGROUND

Information is lacking on the impact of visual impairment on the quality of life of elderly Africans. This study aims to examine the impact of self-reported visual impairment on the quality life of an elderly Nigerian sample.

RESULTS

Four hundred and fifty-three (22.3%) of the respondents reported impairment for distant vision, 377 (18.4%) reported near vision, and 312 (15.2) reported impairment for both far and near. Impairment of near vision had a significant impact on all domains of quality of life. Distant vision had less impact, with a significant decrement only in the domain of environment. After adjusting for the possible effects of age, sex, and co-occurring chronic physical illness, near-vision impairment accounted for 3.92% decrement in the overall quality of life of elderly persons.

CONCLUSION

Impairment of vision is associated with significant decrement in diverse areas of quality of life in this elderly sample. Problems with near vision were nevertheless more likely than those of distant vision to affect quality of life.

Psychological underpinnings of metabolic syndrome

Metabolic syndrome (MS) is more common among socio-economically disadvantaged individuals and is associated with certain risky lifestyle practices. MS also appears to be triggered by adverse social circumstances and chronic stress. The present paper reviews accumulating evidence to imply that individuals who have certain personality and behaviour traits are particularly predisposed to develop MS, and brings together theories that relate to possible psychological mechanisms underlying MS. It considers how such factors might interact causally to encourage the development of MS. As part of the EU-funded LIPGENE Integrated Project, multi-level modelling will be undertaken to explore potential pathways to MS, taking into consideration the interplay between a range of psycho-social, demographic, cultural and lifestyle factors thought to contribute to the development of MS. Data will be gathered for this purpose from a representative sample of >50-year-olds living in Britain (n 1000) and Portugal (n 500). It is anticipated that this information will assist in the development and targetting of future intervention to prevent and treat MS in the normal population.

Reported symptoms and quality-of-life impacts in patients having laser treatment for sight-threatening diabetic retinopathy

AIMS

To explore the patient experience of symptoms of eye disease related to diabetes and its treatment, including increase of symptoms over time and their relation to severity of the condition and the effect of multiple treatments and symptoms on quality of life.

METHODS

A qualitative interview study was implemented at four eye clinics in the UK. This study design was intended to yield 240 interviews in patients having their first laser treatment or first follow-up and in multi-treatment patients with a clinically documented loss of visual function in at least one eye (VA </= 6/12). The intention was to have an approximately equal number of patients with proliferative diabetic retinopathy (PDR) or macular oedema (MO).

RESULTS

A total of 227 interviews were completed (54% PDR and 46% MO). The most frequently reported symptom prior to initial treatment was blurred vision (55%). First-time-treatment patients reported fewer symptoms than the multi-treatment patients. After a pronounced reduction of quality-of-life impacts after the first laser treatment, results all demonstrate an increasing impact as patients move from first treatment to multiple treatments. The main responses regarding satisfaction with laser treatment were that, although patient expectations were basically met, the treatment had less of an impact than they hoped for, and they would have the treatment again if needed.

CONCLUSIONS

The current study provides a qualitative exploration of visual symptoms, levels of self-reported visual impairment, and general description of the areas of impact or restriction that patients experienced due to their eye disease, both pre- and post-laser treatment.

Self-reported visual function in healthy older people in Britain: an exploratory study of associations with age, sex, depression, education and income

BACKGROUND

Tractable but undetected visual impairment in older people may be relatively common, particularly amongst the very old and in more deprived populations. Measurement of visual acuity is unlikely to be helpful in identifying this impairment, but targeted assessment of visual function may be beneficial. There is uncertainty about the defining characteristics of the target group.

OBJECTIVE

To explore factors associated with self-reported visual impairment in community dwelling older people.

DESIGN

secondary cross sectional analysis of baseline data from a randomised controlled trial.

SETTING

three large group practices in outer London.

PARTICIPANTS

older people aged 65 and over enrolled in a study of health risk appraisal.

METHOD

postal questionnaire using questions from the National Eye Institute Visual Function questionnaire.

RESULTS

Moderate or extreme visual function loss occurred in 4 to 12% of community-dwelling older people in this population reporting less than excellent vision, depending on which aspect of visual function is considered. Visual function loss in this subgroup increases in prevalence with advancing age, but is not associated with female sex, low educational attainment or low income. It is associated with depressed mood.

CONCLUSION

Questions about visual function identify a group of older people whose vision and mental state needs further investigation.

Risk factors for cataract subtypes waterclefts and retrodots: two case–control studies

Waterclefts and retrodots are independently associated with visual impairment, yet a review identified no data on risk factors.

PURPOSE

To investigate risk factors for these two human lens cataract subtypes.

METHOD

Two nested case-control studies: The host study comprised 1078 subjects (55 years) attending the Somerset and Avon Eye Study (SAES). In total, 197 watercleft cases (Oxford grade 0.2 in either eye) and 199 retrodot cases (Oxford grade 1.0 in either eye) were individually age/gender matched to controls. Detailed ophthalmic and potential risk factor data were collected, including body mass index (BMI), smoking, alcohol, diabetes, hypertension, analgesics, vitamin supplementation, nutrition, sunlight exposure, dehydration, hormonal (women), blood lipids, glucose, urea, creatinine, uric acid, and vitamin levels.

RESULTS

For waterclefts, univariable analysis identified BMI, alcohol intake, vitamin status, sunlight, urea, creatinine, and uric acid as possible risk factors. Multivariable analysis identified two independent associations. Total number of 'any' analgesics in the previous year: adjusted P<0.01 (U-shaped risk profile, unadjusted high vs medium use (=reference) OR 2.39, 95% CI 1.35-4.26 with medium use vs none (=reference) OR 0.43, 95% CI 0.26-0.72); total sunlight: adjusted P=0.03 (unadjusted highest exposure vs lowest (=reference) OR 3.25, 95% CI 1.11-9.50). For retrodots, univariable analysis identified alcohol, HRT, and lipids. Multivariable analysis identified two independent associations. Mean number of alcohol units consumed per month, adjusted P=0.02 and HDL cholesterol levels, adjusted P=0.02 (unadjusted ORs NS both).

CONCLUSION

This is the first available published information on risk factors for the human cataractous lens features waterclefts and retrodots.

Quality of life and visual function in patients with intermediate uveitis

AIMS

To assess visual function, vision related quality of life (VR-QOL), and general health related quality of life (HR-QOL) in intermediate uveitis (IU).

METHODS

VR-QOL and HR-QOL were evaluated in 42 patients with IU using the VCM1 and SF-36 questionnaires, respectively. LogMAR visual acuity (VA), Pelli-Robson contrast sensitivity (CS), Farnsworth-Munsell 100 hue colour vision (CV), and Estermann visual field (VF) were recorded monocularly and binocularly.

RESULTS

Median (interquartile range) visual acuity (VA) and CS of 72 affected eyes were 0.1 (0.015-0.3) and 1.55 (1.35-1.65), respectively. 9.5% of patients had a VCM1 score of more than 2.0, indicating "more than a little" concern over vision. Worse eye VA (p=0.045) and CS (p=0.042) were predictive of a VCM1 score of more than 2.0 independently of age, sex, uveitis duration, laterality and activity, systemic uveitis therapy, and medical co-morbidity. The physical and mental component summary scores of the SF-36 were significantly worse in those who reported significant impairment of vision on the VCM1 than those who did not.

CONCLUSIONS

The majority of patients with IU maintain good visual function and quality of life. VR-QOL impairment in IU correlates with vision in the worse eye and is associated with impaired HR-QOL.

Socioeconomic status and clinical features of patients undergoing photodynamic therapy or transpupillary thermotherapy for subfoveal choroidal neovascularization due to age-related macular degeneration

BACKGROUND

The purpose of this study was to compare baseline clinical and socioeconomic features of patients undergoing self-funded photodynamic therapy (PDT) or government-funded subthreshold transpupillary thermotherapy (TTT) with a diode laser for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD).

METHODS

Between July 2000 and August 2001, 115 patients with subfoveal choroidal neovascularization secondary to AMD were offered PDT as an initial intervention. If individuals believed that they could not afford or did not want PDT, then TTT was offered. In masked fashion, leakage pattern and lesion size were determined retrospectively from pretreatment angiograms. Baseline visual acuity was determined with autorefraction and subsequent Snellen testing. The mean income of each treatment group was estimated from the average sex-specific income for each subject's postal code, based on the 1996 Canadian census data. The average education level for each subject's postal code was also determined.

RESULTS

The patients who were not willing to pay for PDT had significantly worse macular disease before treatment (larger lesions and poorer visual acuity) and a significantly lower mean income than the patients who were willing to pay for PDT.

INTERPRETATION

The severity of exudative choroidal neovascularization appears to be associated with lower socioeconomic status.

Quality of Life in Patients With Age-related Macular Degeneration: Impact of the Condition and Benefits of Treatment

Age-related macular degeneration (AMD) is a chronic, progressive, degenerative disease of the macula and is the leading cause of central vision loss among elderly people in the western world. Traditionally, clinical studies of AMD have described the impact of AMD, and treatments for AMD, in terms of the patient's visual acuity. However, visual acuity alone does not provide information about a patient's perception of his or her quality of life. Researchers have used a variety of instruments to measure quality of life. Several studies have shown that AMD can severely impair quality of life and that increasing vision loss is associated with increasing impairment of quality of life and frequently causes depression. Interestingly, patients with only one eye affected may become more depressed than those with both eyes affected, possibly because of uncertainty surrounding future vision loss in patients with one eye affected and a greater acceptance of the condition in those with both eyes affected. Studies also have provided some information on the possible quality of life benefits of therapy for AMD. By incorporating measurements of quality of life into the design of future prospective studies, clinical researchers may be able to obtain more comprehensive data on the impact of AMD on patients and the relative benefits of different therapies.

Correctable visual impairment in older people: a major unmet need

This review seeks to determine the prevalence of correctable visual impairment (VI) in older people in the UK, to discover what proportion of these cases are undetected, to suggest reasons for the poor detection and to make recommendations for improving the detection. To establish the context of these issues, the review will also touch on the general prevalence and causes of VI in older people in developed countries and on the impact of VI in older people. Typically, studies suggest that VI affects about 10% of people aged 65-75, and 20% of those aged 75 or older. There is a strong relationship between impaired vision in older people and both reduced quality of life and increased risk of accidents, particularly falls. The literature suggests that those with low vision are about two times more likely to have falls than fully sighted people, and the annual UK cost of treating falls directly attributable to VI is pound 128 million. The literature on the prevalence of undetected reduced vision in older people reveals that between 20 and 50% of older people have undetected reduced vision. The majority of these people have correctable visual problems (refractive errors or cataract). It is particularly startling that, in 'developed countries', between 7 and 34% of older people have VI that could simply be cured by appropriate spectacles. The reasons why so many cases of treatable VI remain untreated are discussed, and suggestions are made for improving the detection of these cases. We conclude that there should be better publicity encouraging older people to attend for regular optometric eye examinations. A complementary approach is annual visual screening of the elderly, possibly as part of GPs annual health check on people aged 75 years and older. Recommendations are made for evaluating new approaches to screening and for improving the management of cases detected by screening.

Impact of graphical user interface screen features on computer task accuracy and speed in a cohort of patients with age-related macular degeneration

PURPOSE

To investigate the impact of graphical user interface screen features on computer task performance in patients with age-related macular degeneration (AMD).

DESIGN

Interventional case series.

METHODS

Eighteen patients with visual impairment due to AMD were recruited from the Bascom Palmer Eye Institute Low Vision Clinic. Each patient underwent evaluation of visual acuity using the Early Treatment Diabetic Retinopathy Study protocol, contrast sensitivity using a Pelli-Robson chart, binocular simultaneous visual field using the Esterman program on an automated perimeter, and color vision using Farnsworth D-15. Each subject then completed computer icon identification tasks while the following screen features of the graphical user interface were varied: size of icons displayed, icon set size (number of icons displayed), and background color. Each patient performed all 125 computer tasks with each of five icon sizes (9.2 mm, 14.6 mm, 23.2 mm, 36.8 mm, 58.3 mm), each of five icon set sizes (2, 3, 4, 5, 6), and each of five different background colors (black, white, red, green, blue) in a randomly ordered fashion. Relationships between computer task performance (accuracy and speed) and graphical user interface screen features were studied.

RESULTS

Icon size and icon set size are significantly associated with computer task accuracy (P <.001), whereas background color is not a significant predictor of task accuracy (P =.63). The impact of icon size on accuracy is nonlinear, with the data indicating that no additional improvement in accuracy is associated with increasing the icon size beyond 23.2 mm. The impact of icon set size on accuracy is linear, with a smaller icon set size significantly associated with greater computer accuracy. A larger icon size is significantly associated with a shorter time to task completion (P =.001); this relationship is largely linearly related to icon size. There was no significant impact of background color (P =.11) or set size (P =.37) on time to task completion.

CONCLUSIONS

Modifications of graphical user interface design may permit improved computer task performance among patients with visual impairment due to AMD.

The population requirement for cataract extraction: a cross-sectional study

PURPOSE

To examine the distribution in the population of indications for cataract extraction in order to relate demand for this procedure to the capacity for satisfying it.

METHODS

An age-stratified random population sample of 2783 individuals aged 55 years and over was taken from inner-city, urban and rural areas of Avon and Somerset. The requirement for cataract extraction was estimated on the basis of measures of vision-related quality of life, refracted visual acuity, and application of the Oxford Clinical Cataract Classification and Grading System. Data were also collected concerning suitability for surgery, including relative contraindications to surgery and whether participants considered their eyesight bad enough to merit surgery. Three sets of composite indications were defined.

RESULTS

Estimated prevalent requirements for cataract extraction for the three sets of composite criteria were: 29 per 1000 aged over 55 years (95% CI 20-41) for the most inclusive criterion; 17 per thousand (95% CI 10-27) for the intermediate criterion; and 7 per thousand (95% CI 3-14) for the most stringent criterion. These rates are equivalent to a national prevalent requirement for England of 384,000 for the most inclusive criterion. If the approximately 15% of individuals whose desire or fitness for surgery was questionable are removed from this estimate, the prevalent requirement, including the backlog from previous unsatisfied demand, becomes 325,000 individuals.

CONCLUSIONS

The findings suggest only a modest imbalance between supply and demand for cataract surgery. In particular there was a very small prevalence of untreated severe cataract, less than the annual health service surgical capacity, suggesting that the current National Health Service surgical capacity is adequate for cases of severe cataract.