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Sułkowski L, Rubinkiewicz M, Matyja A, Matyja M. Visual Impairment in Hemodialyzed Patients-An IVIS Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1106. [PMID: 37374311 DOI: 10.3390/medicina59061106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The growing and aging population of hemodialysis patients has become increasingly disabled, with more complex comorbidities, and are older upon initiating dialysis. Visual impairment can adversely affect their quality of life and life satisfaction. Treatment evaluation should not only consider remission of the disease, but also the improvement of quality of life and life satisfaction. This is a single-center cross-sectional study. It was designed to evaluate visual impairment in hemodialyzed patients, its correlation with quality of life and life satisfaction, and its relationship to clinical outcomes in hemodialyzed patients. Materials and Methods: Seventy patients with chronic kidney disease undergoing hemodialysis and aged 18 years or older were recruited from a single Dialysis Unit. The Impact of Visual Impairment Scale (IVIS), WHOQOL-BREF, and Cantril Ladder questionnaires were utilized to assess both sociodemographic and clinical variables. Results: It was found that, among all assessed variables (i.e., sex, marital status, level of education, months on hemodialysis, history of kidney transplantation, Kt/V, URR, and UF), only age and central venous catheter placement were positively correlated with IVIS scores, while arteriovenous fistula and willingness to become a kidney transplant recipient were negatively correlated. Furthermore, a comparison between patients with moderate and severe visual impairment yielded supplemental data indicating that individuals whose dialysis access was through a dialysis catheter and those ineligible or unwilling to undergo transplantation suffered more often from severe visual impairment. This finding may be attributed to age. Conclusions: Older patients were predominantly observed to experience visual impairment. Patients intending to receive a kidney transplant and whose dialysis access was through an arteriovenous fistula were less prone to visual impairment, compared to those who may be ineligible or unwilling to receive transplantation and those with hemodialysis catheters. This phenomenon can be attributed to age-related distinctions in patients' suitability for specific dialysis access and transplantation. Those reporting visual impairment gave lower ratings in all four domains of their quality of life (comprising physical health, psychological health, social relationships, and environment) and in both present and anticipated five-year life satisfaction. More severe visual impairment was related to an additional reduction in physical health, social relationship, and environment domains, and in life satisfaction.
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Affiliation(s)
- Leszek Sułkowski
- Department of General Surgery, Regional Specialist Hospital, 42-218 Częstochowa, Poland
| | - Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Andrzej Matyja
- 2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Maciej Matyja
- 2nd Department of General Surgery, Jagiellonian University Medical College, 30-688 Kraków, Poland
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Whitson HE, Hajduk AM, Song X, Geda M, Tsang S, Brush J, Chaudhry SI. Comorbid vision and cognitive impairments in older adults hospitalized for acute myocardial infarction. JOURNAL OF COMORBIDITY 2020; 10:2235042X20940493. [PMID: 32728552 PMCID: PMC7366400 DOI: 10.1177/2235042x20940493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
Older patients presenting with acute myocardial infarction (AMI) often have
comorbidities. Our objective was to examine how outcomes differ by cognitive and
vision status in older AMI patients. We use data from a prospective cohort study
conducted at 94 hospitals in the United States between January 2013 and October
2016 that enrolled men and women aged ≥75 years with AMI. Cognitive impairment
(CI) was defined as telephone interview for cognitive status (TICS) score
<27; vision impairment (VI) and activities of daily living (ADLs) were
assessed by questionnaire. Of 2988 senior AMI patients, 260 (8.7%) had CI but no
VI, 858 (28.7%) had VI but no CI, and 251 (8.4%) had both CI/VI. Patients in the
VI/CI group were most likely to exhibit geriatric syndromes. More severe VI was
associated with lower (worse) scores on the TICS (β −1.53, 95%
confidence interval (CI) −1.87 to −1.18). In adjusted models, compared to
participants with neither impairment, participants with VI/CI were more likely
to die (hazard ratio 1.61, 95% CI 1.10–2.37) and experience ADL decline (odds
ratio 2.11, 95% CI 1.39–3.21) at 180 days. Comorbid CIs and VIs were associated
with high rates of death and worsening disability after discharge among seniors
hospitalized for AMI. Future research should evaluate protocols to accommodate
these impairments during AMI presentations and optimize decision-making and
outcomes.
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Affiliation(s)
- Heather E Whitson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA.,Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA.,Geriatrics Research Education and Clinical Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Alexandra M Hajduk
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Xuemei Song
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Mary Geda
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | - Sui Tsang
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
| | | | - Sarwat I Chaudhry
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.,Yale University Program on Aging, New Haven, CT, USA
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Tetteh J, Fordjour G, Ekem-Ferguson G, Yawson AO, Boima V, Entsuah-Mensah K, Biritwum R, Essuman A, Mensah G, Yawson AE. Visual impairment and social isolation, depression and life satisfaction among older adults in Ghana: analysis of the WHO's Study on global AGEing and adult health (SAGE) Wave 2. BMJ Open Ophthalmol 2020; 5:e000492. [PMID: 32626826 PMCID: PMC7326267 DOI: 10.1136/bmjophth-2020-000492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 12/17/2022] Open
Abstract
AIM To estimate the prevalence of visual impairment (VI) and associated factors and further quantify its association with social isolation, depression and life satisfaction among older adults in Ghana. METHODS WHO Study on Global AGEing and Adult Health Ghana dataset for older adults 50 years and above was used for this study. Social isolation, depression and life satisfaction were our primary outcomes with VI being our secondary outcome. We employed negative binomial, Poisson and generalised negative binomial regression models individually modified with Coarsened Exact Matching method of analysis. All analysis was performed by adopting robust SE estimation using Stata V.15. RESULTS The prevalence of VI was 17.1% (95% CI14.3 to 20.2) and the factors associated include age groups, educational level, religion, region, where the participant was born, and difficulty in work/households activity (p<0.05). The inferential analysis shows that the significant log-likelihood score of social isolation and life satisfaction for older adults with VI was 0.25 more (95% CI 0.03 to 0.47) and 0.04 less (95% CI -0.08 to -0.01), respectively, compared with those without VI. The prevalence of depression among older adults with VI was significantly 90% higher compared with non-VI (adjusted prevalence ratio (95% CI) = 1.90 (1.17 to 3.09), p<0.001). CONCLUSION The prevalence of VI is associated with increasing age, educational level and self-rated health. VI was identified to be associated with social isolation, depression and diminishing life satisfaction. In order to achieve sustainable development goal #3, a national focus on geriatric care as part of the implementation of the National Ageing Policy will garner improvement in the quality of life of older adults with visual VI in Ghana. Eye health practitioners at all levels of the health systems should consider the psychosocial consequences of VI for the optimum care of the older adult client.
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Affiliation(s)
- John Tetteh
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Gladys Fordjour
- Ophthalmology Unit, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - George Ekem-Ferguson
- Psychiatry Unit, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | | | - Vincent Boima
- Medicine and Therapeutics, School of Medicine, University of Ghana College of Health Sciences, Accra, Greater Accra, Ghana
| | - Kow Entsuah-Mensah
- National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Richard Biritwum
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Akye Essuman
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - George Mensah
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Edwin Yawson
- Community Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
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Modification of the Association between Visual Impairment and Mortality by Physical Activity: A Cohort Study among the Korean National Health Examinees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224386. [PMID: 31717624 PMCID: PMC6888179 DOI: 10.3390/ijerph16224386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/11/2022]
Abstract
The association between visual impairment and higher mortality remains unclear. In addition, evidence is lacking on the interaction between visual function and physical activity on mortality. We used data of individuals with no disability or with visual impairment among those who participated in the National Health Screening Program in Korea in 2009 or 2010. We constructed Cox proportional hazard models adjusted for potential confounders to evaluate the independent association between visual impairment and mortality. More severe visual impairment was associated with higher all-cause mortality (p-value for trend = 0.03) and mortality due to cardiovascular diseases (p-value for trend = 0.02) and that due to other diseases (p-value for trend = 0.01). We found an interaction on an additive scale between visual impairment and no physical activity on all-cause mortality (relative excess risk due to interaction = 1.34, 95% confidence interval: 0.37, 2.30, p-value = 0.01). When we stratified the study population by physical activity, the association between visual impairment and mortality was only found among individuals who did not engage in regular physical activity (p-value for trend = 0.01). We found an independent association between visual impairment and mortality and modification of this association by physical activity.
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Ng SK, Kahawita S, Andrew NH, Henderson T, Craig JE, Landers J. Association of Visual Impairment and All-Cause 10-Year Mortality Among Indigenous Australian Individuals Within Central Australia: The Central Australian Ocular Health Study. JAMA Ophthalmol 2019; 136:534-537. [PMID: 29566110 DOI: 10.1001/jamaophthalmol.2017.6787] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance It is well established from different population-based studies that visual impairment is associated with increased mortality rate. However, to our knowledge, the association of visual impairment with increased mortality rate has not been reported among indigenous Australian individuals. Objective To assess the association between visual impairment and 10-year mortality risk among the remote indigenous Australian population. Design, Setting, and Participants Prospective cohort study recruiting indigenous Australian individuals from 30 remote communities located within the central Australian statistical local area over a 36-month period between July 2005 and June 2008. The data were analyzed in January 2017. Exposures Visual acuity, slitlamp biomicroscopy, and fundus examination were performed on all patients at recruitment. Visual impairment was defined as a visual acuity of less than 6/12 in the better eye. Main Outcomes and Measures Mortality rate and mortality cause were obtained at 10 years, and statistical analyses were performed. Hazard ratios for 10-year mortality with 95% confidence intervals are presented. Results One thousand three hundred forty-seven patients were recruited from a total target population number of 2014. The mean (SD) age was 56 (11) years, and 62% were women. The total all-cause mortality was found to be 29.3% at 10 years. This varied from 21.1% among those without visual impairment to 48.5% among those with visual impairment. After adjustment for age, sex, and the presence of diabetes and hypertension, those with visual impairment were 40% more likely to die (hazard ratio, 1.40; 95% CI, 1.16-1.70; P = .001) during the 10-year follow-up period compared with those with normal vision. Conclusions and Relevance Bilateral visual impairment among remote indigenous Australian individuals was associated with 40% higher 10-year mortality risk compared with those who were not visually impaired. Resource allocation toward improving visual acuity may therefore aid in closing the gap in mortality outcomes between indigenous and nonindigenous Australian individuals.
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Affiliation(s)
- Soo Khai Ng
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia
| | - Shyalle Kahawita
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia
| | | | - Tim Henderson
- Department of Ophthalmology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Jamie Evan Craig
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia
| | - John Landers
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia
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Nusinovici S, Sabanayagam C, Teo BW, Tan GSW, Wong TY. Vision Impairment in CKD Patients: Epidemiology, Mechanisms, Differential Diagnoses, and Prevention. Am J Kidney Dis 2019; 73:846-857. [PMID: 30929852 DOI: 10.1053/j.ajkd.2018.12.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/31/2018] [Indexed: 11/11/2022]
Abstract
Eyes and kidneys have numerous structural, developmental, physiologic, and pathogenic pathways in common, suggesting that many kidney and eye diseases may be interlinked. Studies suggest that the prevalence of eye diseases and vision impairment are higher among persons with end-stage kidney disease and earlier stages of chronic kidney disease (CKD) than in those without. Ocular morbidity in persons with CKD and end-stage kidney disease may be due to the following risk factors: (1) underlying conditions and risk factors for CKD such as diabetes or hypertension, (2) metabolic disorders associated with CKD, (3) uremia and anemia, and (4) CKD treatment. Among the chief eye diseases, diabetic retinopathy and age-related macular degeneration are most consistently associated with CKD. Further research for eye diseases such as glaucoma and cataract is needed to determine their relationships with CKD. Despite the high prevalence and burden of vision impairment among persons with CKD, eye screening in patients with CKD is not currently recommended as standard practice. This review suggests that patients with CKD should be encouraged to undergo a complete eye examination. Furthermore, physicians should be aware that patients undergoing dialysis may develop acute eye problems such as acute glaucoma, and appropriate referral to ophthalmologists should be considered in those with a history of glaucoma or recent ocular surgery. Interdisciplinary collaboration between nephrologists and ophthalmologists will ensure enhanced and appropriate management of patients with CKD.
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Affiliation(s)
- Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Boon Wee Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.
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