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Wu Y, Keel S, Carneiro VLA, Zhang S, Wang W, Liu C, Tang X, Han X, He M. Real-world application of a smartphone-based visual acuity test (WHOeyes) with automatic distance calibration. Br J Ophthalmol 2024:bjo-2023-324913. [PMID: 38514167 DOI: 10.1136/bjo-2023-324913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND To develop and assess the usability of a smartphone-based visual acuity (VA) test with an automatic distance calibration (ADC) function, the iOS version of WHOeyes. METHODS The WHOeyes was an upgraded version with a distinct feature of ADC of an existing validated VA testing app called V@home. Three groups of Chinese participants with different ages (≤20, 20-40, >40 years) were recruited for distance and near VA testing using both an Early Treatment Diabetic Retinopathy Study (ETDRS) chart and the WHOeyes. The ADC function would determine the testing distance. Infrared rangefinder was used to determine the testing distance for the ETDRS, and actual testing distance for the WHOeyes. A questionnaire-based interview was administered to assess the satisfaction. RESULTS The actual testing distance determined by the WHOeyes ADC showed an overall good agreement with the desired testing distance in all three age groups (p>0.50). Regarding the distance and near VA testing, the accuracy of WHOeyes was equivalent to ETDRS. The mean difference between the WHOeyes and ETDRS ranged from -0.084 to 0.012 logMAR, and the quadratic weighted kappa (QWK) values were >0.75 across all groups. The test-retest reliability of WHOeyes was high for both near and distance VA, with a mean difference ranging from -0.040 to 0.004 logMAR and QWK all >0.85. The questionnaire revealed an excellent user experience and acceptance of WHOeyes. CONCLUSIONS WHOeyes could provide accurate measurement of the testing distance as well as the distance and near VA when compared to the gold standard ETDRS chart.
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Affiliation(s)
- Yi Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Stuart Keel
- Department of Noncommunicable Diseases, Vision and eye care programme, World Health Organisation, Geneva, Switzerland
| | - Vera Lúcia Alves Carneiro
- Department of Noncommunicable Diseases, Vision and eye care programme, World Health Organisation, Geneva, Switzerland
| | - Shiran Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Chi Liu
- Faculty of Data Science, City University of Macau, Macao SAR, China
| | - Xuanzhang Tang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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2
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Rooth V, van der Aa H, Wisse RPL, Maarsingh OR, Koopmanschap M, Keunen JEE, Vermeulen H, Klaver CCW, Janssen G, van Rens GHMB, van Nispen RMA. Health economic evaluation of a nurse-assisted online eye screening in home healthcare to reduce avoidable vision impairment (iScreen): study protocol for a cluster randomized controlled trial. Trials 2024; 25:102. [PMID: 38308377 PMCID: PMC10835833 DOI: 10.1186/s13063-023-07882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/15/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Among older people undiagnosed and untreated vision impairment and blindness are common. The leading causes are uncorrected refractive errors and cataracts. Vision problems are associated with a lower quality of life, several health problems, and a higher chance of falling accidents and fractures. To eliminate avoidable vision impairment and blindness, targeted eye screening programs are recommended. Older patients, receiving home healthcare, have not yet been considered as a population at risk who could benefit from eye screening. METHODS A cluster-randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of online nurse-assisted eye screening in home healthcare, compared to care as usual, in reducing avoidable vision impairment. A healthcare and societal perspective will be used. The study will be performed in collaboration with several home healthcare organizations in the Netherlands. The online eye screening consists of near and distance visual acuity, followed by an Amsler grading test. Measurements in both groups will take place at baseline and after 6 and 12 months of follow-up. A total of 240 participants will be recruited. Older men and women (65 +), who receive home-based nursing and are cognitively able to participate, will be included. The primary outcome will be the change of two lines or more on the Colenbrander-1 M visual acuity chart between baseline and 12-month follow-up. DISCUSSION An eye screening for populations at risk contributes to the detection of undiagnosed and untreated vision impairment. This may reduce the health-related consequences of vision loss and the high economic burden associated with vision impairment. TRIAL REGISTRATION ClinicalTrials.gov NCT06058637. Registered on 27 September 2023.
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Affiliation(s)
- Vera Rooth
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands.
| | - Hilde van der Aa
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Robert P L Wisse
- Department of Ophthalmology, UMC Utrecht, Utrecht, The Netherlands
| | - Otto R Maarsingh
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
- General Practice, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marc Koopmanschap
- Erasmus School of Health Policy & Management, Health Technology Assessment (HTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jan E E Keunen
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Radboudumc, Nijmegen, The Netherlands
- Department of Ophthalmology, Erasmus MC, Rotterdam, The Netherlands
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | | | - Ger H M B van Rens
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Quality of Care, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, The Netherlands
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3
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Li X, Liu L, Luo N, Sun Y, Bai R, Xu X, Liu L. Association of changes in self-reported vision and hearing impairments with depressive symptoms in middle-aged and older adults: Evidence from a nationwide longitudinal study in China. Arch Gerontol Geriatr 2024; 116:105131. [PMID: 37552924 DOI: 10.1016/j.archger.2023.105131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This study assessed the longitudinal relationship between changes in self-reported vision impairment (VI) and hearing impairment (HI), and depressive symptoms in adults aged ≥45 years. METHODS Data from the China Health and Retirement Longitudinal Study for 2015 and 2018 were used, with a sample size of 10,050. VI and HI were self-reported. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D10) was used to assess depressive symptoms. Total scores and clinically significant depressive symptoms (CES-D10 scores ≥ 10) were used as outcomes and analyzed using generalized estimating equations with identity link and logit link functions. RESULTS Of all changes in HI with good vision, only persistent HI was associated with higher CES-D10 scores (OR 95% CI: 1.09-3.30). Both new-onset and persistent VI with good hearing were associated with CES-D10 scores (OR 95% CI, new-onset: 1.70-3.52; persistent: 1.58-2.78) and clinically significant depressive symptoms (OR 95% CI, new-onset: 1.41-2.56; persistent: 1.36-2.27). Persistent dual sensory impairment (DSI) was associated with the highest CES-D10 scores (OR 95% CI: 3.63-5.97) and the highest risk of clinically significant depressive symptoms (OR 95% CI: 1.78-2.85). Those who self-reported improvements in vision and hearing still had higher CES-D10 scores (OR 95% CI: 1.35-2.83) and a higher risk of clinically significant depressive symptoms (OR 95% CI: 1.03-2.02) than those maintaining good vision and hearing. CONCLUSION Self-reported VI and DSI are closely associated with depressive symptoms. Because VI and DSI are modifiable, interventions for them could also prevent depressive symptoms.
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Affiliation(s)
- Xueying Li
- Department of Social Medicine, School of Health Management, China Medical University, Shenyang 110004, China
| | - Libing Liu
- Department of Social Medicine, School of Health Management, China Medical University, Shenyang 110004, China
| | - Nansheng Luo
- Department of Social Medicine, School of Health Management, China Medical University, Shenyang 110004, China
| | - Yu Sun
- Department of Social Medicine, School of Health Management, China Medical University, Shenyang 110004, China
| | - Ru Bai
- Department of Social Medicine, School of Health Management, China Medical University, Shenyang 110004, China
| | - Xin Xu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110122, China.
| | - Li Liu
- Department of Social Medicine, School of Health Management, China Medical University, Shenyang 110004, China.
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Hughes AR, Elliott DB. Distance spectacle-wearing habits in older patients in England. Ophthalmic Physiol Opt 2023; 43:1040-1049. [PMID: 37272313 DOI: 10.1111/opo.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/04/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To report the proportion of older people in England who wear distance spectacles full time, part time and rarely, and to investigate factors that influence how much the distance vision (DV) correction is worn. METHODS A two-part questionnaire investigating the spectacle-wearing habits of older people was developed and completed by 322 participants (age 72 years ±7.7, range 60-94). A subcohort of 209 DV correction wearers with a mean spherical equivalent (MSE) of <±4.00DS was selected for a logistic regression to investigate which factors influence how much the DV correction is used. RESULTS In total, 43% of emmetropic, and 55% of pseudophakic, DV spectacle wearers wear their correction full time. Lens type, MSE and the age that participants first wore a DV correction significantly predicted DV correction wearing habit (adjusted R2 = 0.36), with lens type being the strongest predicting factor and progressive users wearing their spectacles 37% more than those using single vision lenses. CONCLUSIONS Many patients appear to consider convenience more important than being spectacle independent at distance, with lens type the most significant influencing factor of how much those with low/moderate refractive error wear their distance correction. Many emmetropes and pseudophakes choose to wear their progressive or bifocal spectacles full time, and the emmetropia provided by cataract surgery does not provide independence from full-time spectacle wear for many patients. The optometrist has a key role in discussing both choice of spectacle lens correction and the refractive outcome options of cataract surgery with patients.
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Affiliation(s)
- Amy R Hughes
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - David B Elliott
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
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5
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Zhao Y, Wang A. Development and validation of a risk prediction model for visual impairment in older adults. Int J Nurs Sci 2023; 10:383-390. [PMID: 37545769 PMCID: PMC10401343 DOI: 10.1016/j.ijnss.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives This study aimed to determine the risk factors that affect visual impairment in older adults for developing and evaluating a visual impairment risk prediction model. Methods In this hospital-based unmatched case-control design study, we enrolled 586 participants (411 in the training set and 175 in the internal test set) from the ophthalmology clinic and physical examination center of a teaching hospital in Liaoning Province, China, from June to December 2020. Visual impairment was defined as best-corrected visual acuity <6/18 (The WHO definition). Possible influencing factors of visual impairment were assessed, including demographic factors, socioeconomic factors, disease and medication factors, and lifestyle. A visual impairment risk prediction model was developed using binary logistic regression analysis. The area under the ROC curve (AUC) was used to evaluate the effectiveness of the proposed prediction model. Results Six independent influencing factors of visual impairment in older adults were identified: age, systolic blood pressure, physical activity scores, diabetes, self-reported ocular disease history, and education level. A visual impairment risk prediction model for older adults was developed, showing powerful predictive ability in the training set and internal test set with AUCs of 0.87 (95%CI 0.83-0.90) and 0.81 (95%CI 0.74-0.88), respectively. Conclusions The risk prediction model for visual impairment in older adults had high predictive power. Identifying older adults at risk for developing visual impairment can help healthcare workers to adopt appropriate targeted programs for early education and intervention to prevent or delay visual impairment and prevent injuries due to visual impairment in older adults.
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Marmamula S, Barrenkala NR, Kumbham TR, Modepalli SB, Yellapragada R, Khanna RC, Friedman DS. Impact of an intervention for avoidable vision loss on visual function in the elderly-The Hyderabad Ocular Morbidity in Elderly Study (HOMES). Eye (Lond) 2023; 37:1725-1731. [PMID: 36104520 PMCID: PMC10220055 DOI: 10.1038/s41433-022-02229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To report the impact of interventions for avoidable vision impairment (VI) on the visual function of elderly residents in 'homes for the aged' in India. METHODS Participants aged ≥60 years were recruited. A comprehensive eye examination was conducted by trained examiners and interventions were provided. Trained social investigators administered the Indian Vision Function questionnaire (INDVFQ) to assess visual function before and after the intervention (spectacles, cataract surgery or laser capsulotomy). Lower scores on IVFQ imply better visual function. VI was defined as presenting visual acuity worse than 6/18 in the better eye. VI due to cataract, uncorrected refractive errors, and posterior capsular opacification after cataract surgery were considered avoidable VI. RESULTS The mean age of the participants (n = 613) was 73.8 years (standard deviation: 8.1 years) and 378 (62.2%) were women. 64/103 (62.1%) participants who had avoidable VI at baseline were evaluated after the intervention. Significant gains were observed in all four domains of visual function. There was a 14.9% improvement in mobility scores (33.8 versus 28.8; p = 0.03), a 19.9% improvement in the activity limitations score (36.8 versus 29.5; p < 0.01), a 10.9% improvement in the psychosocial impact score (41.1 versus 36.6; p < 0.01) and a 13.6% improvement in the visual symptoms score (49.2 versus 42.5 p < 0.01). Overall, the mean IVFQ score improved by 16.4% (47.6 versus 39.8; p < 0.01). CONCLUSION Elderly individuals in residential care with avoidable VI had a significant improvement in visual function after relatively low-cost interventions such as spectacles and cataract surgery. Strategies are needed to provide these interventions for the elderly in 'homes for the aged' in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.
- Department of Biotechnology / Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, India.
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Harvard Medical School, Boston, MA, USA.
| | - Navya Rekha Barrenkala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Harvard Medical School, Boston, MA, USA
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Cao GY, Chen ZS, Yao SS, Wang K, Huang ZT, Su HX, Luo Y, De Fries CM, Hu YH, Xu B. The association between vision impairment and cognitive outcomes in older adults: a systematic review and meta-analysis. Aging Ment Health 2023; 27:350-356. [PMID: 35583075 DOI: 10.1080/13607863.2022.2077303] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To provide a quantitative synthesis of studies on the relationship between vision impairment (VI) and cognitive outcomes in older adults. METHOD A systematic search was undertaken of relevant databases for original articles published before April 2020. Random effect models were used to obtain pooled estimates of the associations between VI and cognitive outcomes (cognitive impairment and dementia) with subgroup analyses of VI measures, cross-sectional associations of VI with cognitive impairment, and longitudinal associations of baseline VI with incident cognitive impairment and dementia. Potential sources of heterogeneity were explored by meta-regression. Publication bias was evaluated with Egger's test. RESULTS Sixteen studies including 76,373 participants were included in this meta-analysis, with five cross-sectional studies and eleven longitudinal studies. There was a significantly increased risk of cognitive outcomes with VI identified by subjective measures (odds ratio (OR)=1.63; 95% confidence interval (CI): 1.26-1.99) and objective measures (OR = 1.59; 95% CI: 1.40-1.78). The odds of baseline cognitive impairment were 137% higher in older adults with VI compared with those without VI (OR = 2.37, 95% CI: 1.84-3.03) at baseline. Compared with older adults without VI at baseline, those with baseline VI had a higher relative risk (RR) of incident cognitive impairment (RR = 1.41; 95% CI: 1.31-1.51) and dementia (RR = 1.44, 95% CI: 1.19-1.75). CONCLUSIONS VI was associated with increased risks of cognitive impairment and dementia across cross-sectional and longitudinal studies. Additional research and randomized clinical trials are warranted to examine the implications of treatment for VI, such as wearing glasses and cataract surgery, to avoid cognitive impairment and dementia.
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Affiliation(s)
- Gui-Ying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zi-Shuo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Shan-Shan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Zi-Ting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - He-Xuan Su
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Carson M De Fries
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Yong-Hua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
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Luo Y, Zhang Q, Han L, Shen Z, Chen Y, Wang K, Huang Z, De Fries CM, Cao G, Su H, Xu H, Chen Z, Ren Z, Hu Y, Xu B. Trends in the prevalence of vision impairment among the oldest-old Chinese population from 1998 to 2018. J Glob Health 2022; 12:11006. [PMID: 35862489 DOI: 10.7189/jogh.12.11006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Vision impairment has become a prominent public health issue worldwide. However, little is known about vision impairment prevalence trends among the oldest-old adults in China. This study aimed to examine 20-year trends in the prevalence of vision impairment among the oldest-old Chinese adults and explore the contributions of sociodemographic variables, health behaviours, and chronic conditions to the trends. Methods This retrospective longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey during 1998-2018. A total of 45 849 participants aged ≥80 years at study entry were included. Vision impairment was assessed by an adapted Landolt-C chart at each wave. We examined unadjusted and adjusted nonlinear trends using generalized estimating equation models incorporating a natural cubic spline. We conducted linear regression models to estimate absolute annual prevalence changes and determine the contributions of sociodemographic variables, health behaviours, and chronic conditions to the trends. Results The fully adjusted prevalence doubled from 5.5% (95% confidence interval (CI) = 5.1%-6.0%) in 1998 to 10.7% (95% CI = 9.9%-11.5%) in 2011 and slightly increased to 11.1% (95% CI = 10.3%-12.0%) in 2018 among the oldest-old Chinese population. Glaucoma, cataracts, cognitive impairment, hearing impairment, and urban residence were significant contributors to changes in vision impairment prevalence during 1998-2018. Differences in vision impairment prevalence associated with glaucoma and cataracts narrowed since 2005. Disparities in the trends among cognitively impaired and unimpaired older adults remained unchanged over time. Similar results were observed in older people with and without hearing impairment. Conclusions Vision impairment prevalence among the oldest-old Chinese population increased from 1998 to 2011 and remained stable from 2011 to 2018. Future work is needed to improve the prevention and management of chronic diseases associated with vision impairment to reduce its prevalence.
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Affiliation(s)
- Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Qin Zhang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zhongchen Shen
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Yuming Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Ziting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Carson M De Fries
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hexuan Su
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Huiwen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zishuo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zeqin Ren
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, China
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9
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Bould J, Hepworth L, Howard C, Currie J, Rowe F. The Impact of Visual Impairment on Completion of Cognitive Screening Assessments: A Post-Hoc Analysis from the IVIS Study. BRITISH AND IRISH ORTHOPTIC JOURNAL 2022; 18:65-75. [PMID: 35855496 PMCID: PMC9248994 DOI: 10.22599/bioj.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
Aim: The aim of this study was to evaluate completed cognitive screens in stroke survivors with and without visual impairment to explore whether the presence of visual impairment impacts on completion of cognitive screening. Materials and methods: Cognitive screening assessment was undertaken using the Oxford Cognitive Screen (OCS). Data from visual function assessments (inclusive of visual acuity, visual fields, eye movements and visual perception evaluation) were analysed to determine whether presence and/or type of visual impairment impacted on cognitive screening scores achieved. Covariates, including glasses use, gender, age at stroke onset and stroke type, were used to assess confounding impacts on scores attained during cognitive screening. Results: 1500 stroke admissions were recruited. One hundred ninety-seven who completed the OCS, were identified from the IVIS study database. Those who reported visual symptoms performed worse statistically on all cognitive tasks except the recall recognition (p = 0.232) and executive tasks (p = 0.967). Visual symptoms did not prevent participants from completing every section of the OCS (p = 0.095). In certain tasks, those not wearing their required glasses performed worse, including the executive function (p = 0.012), broken hearts and sentence reading tasks. Conclusions: Many tasks within cognitive screening assessment are impacted by presence of visual deficits, and adjustments, where possible (e.g. good lighting, large print) should be used to facilitate completion of cognitive screening. It is important to ensure required reading correction is worn during screening.
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Sohail A, Du J, Nawaz Abbasi B, Taiwo AK. Prevalence, causes, and impact of self-reported vision impairment among older people in China: Findings from the China health and retirement longitudinal study. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2022. [DOI: 10.1177/02646196221099160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article investigated the prevalence, causes, and impact of self-reported vision impairment among older people in China. A total of 12,910 participants aged ⩾50 years were included in this study from China Health and Retirement Longitudinal Study (CHARLS) over the periods of 2011, 2013, and 2015. All data were reported by participants via a self-reported questionnaire. Distance vision was assessed by asking if they could see the face of a person on the other side of the street. Near vision was assessed by asking if they could read ordinary newspaper. Depressive symptoms were evaluated by 10-item Center for Epidemiological Studies Depression Scale. The analysis method included the χ2 – square distribution test and multiple regression analysis. This article first found that prevalence of self-reported vision impairment was much higher in rural than in urban areas; in urban areas, females had a greater chance of being affected than males, and for both sexes, it increases with increasing age. Second, some factors found are significantly associated with increased vision impairment rates, include increasing age, female gender, rural residents, elementary-level education, unmarried individuals, and non-agricultural occupations. Third, the leading cause of vision impairment was a refractive error and the most common causes of vision impairment include cataracts and glaucoma. Fourth, vision impairment was significantly associated with falls and depressive symptoms and has a negative effect on the quality of life of older Chinese. The article concluded that older people with self-reported vision impairment were relatively low and it is majorly caused by refractive error. Older people with distance vision impairment and near vision impairment were more likely to report falls and depressive symptoms in the future. In line with these findings, a couple of policy recommendations for further research were made.
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Affiliation(s)
- Ali Sohail
- Xian Jiaotong University, China; Shaanxi Normal University, China
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11
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Inoue A, Hiratsuka Y, Takesue A, Aida J, Kondo K, Murakami A. Association between visual status and the frequency of laughter in older Japanese individuals: the JAGES cross-sectional study. BMJ Open Ophthalmol 2022; 7:e000908. [PMID: 35415267 PMCID: PMC8948375 DOI: 10.1136/bmjophth-2021-000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/11/2022] [Indexed: 11/04/2022] Open
Abstract
Objective Although the beneficial effects of laughter are abundantly reported, the physical function that is required as a premise for laughter has not been studied. The aim of this study is to investigate the association between visual status and frequency of laughter in a population-based sample of older adults. Methods and analysis We analysed cross-sectional data of community-dwelling independent individuals aged ≥65 years (n=19 452) in Japan. The outcomes were frequency of laughter and number of opportunities to laugh. We used multivariable logistic regression analysis with multiple imputations to investigate the association between visual status and laughter. Results The number of participants who laughed almost every day was 8197 (42.1%). After adjusting for individual covariates in the multivariable logistic regression analysis with multiple imputations, visual status was found to be significantly associated with the frequency of laugher and the number of opportunities to laugh (p for trend <0.01). Compare to 'normal vision', while excellent/very good vision was associated with increased frequency and number of opportunities to laugh (ORs: 1.72 and 1.25, respectively), poor vision decreased the frequency and number of opportunities to laugh (ORs: 0.86 and 0.87, respectively). Conclusions There is a link between visual impairment and laughter, with poor vision having a negative impact while good vision has a positive effect. Improving vision may lead to laughter promotion.
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Affiliation(s)
- Akira Inoue
- Department of Ophthalmology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshimune Hiratsuka
- Department of Ophthalmology, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Atsuhide Takesue
- Department of Ophthalmology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan,Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu-city, Aichi, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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12
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Macnamara A, Schinazi VR, Chen C, Coussens S, Loetscher T. The effect of age-related macular degeneration on cognitive test performance. Sci Rep 2022; 12:4033. [PMID: 35260721 PMCID: PMC8904792 DOI: 10.1038/s41598-022-07924-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
The reliable assessment of cognitive functioning is critical to the study of brain-behaviour relationships. Yet conditions that are synchronous which ageing, including visual decline, are easily overlooked when interpreting cognitive test scores. The purpose of this study was to demonstrate the negative consequences of visual impairments on cognitive tests performance. Moderate to severe levels of age-related macular degeneration were simulated, with a set of goggles, in a sample of twenty-four normally sighted participants while they completed two cognitive tasks: a vision-dependent reaction time task and a vision-independent verbal fluency test. Performance on the reaction time task significantly decreased (p < 0.001) in the simulated age-related macular degeneration condition, by as much as 25 percentile ranks. In contrast, performance on the verbal fluency test were not statistically different between the simulated and normal vision conditions (p = 0.78). The findings highlight the importance of considering visual functioning when assessing cognitive function. When vision is not accounted for, low test scores may inaccurately indicate poor cognition. Such false attributions may have significant ramification for diagnosis and research on cognitive functioning.
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Affiliation(s)
- Anne Macnamara
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia.
| | - Victor R Schinazi
- Department of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Scott Coussens
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Tobias Loetscher
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
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13
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Association of Visual Impairment with Psychological Distress in Older Adults: A Survey of 105,092 Older People in Taiwan. J Clin Med 2022; 11:jcm11051458. [PMID: 35268549 PMCID: PMC8911337 DOI: 10.3390/jcm11051458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate the association between visual impairment (VI) and psychological distress (PD) among older adults in Taiwan. The present cohort study included participants aged >65 years who participated in a physical examination program. Participants were divided into two groups on the basis of whether they had PD at baseline. The association between PD and VI with other variables was compared using the two-sample t-test for continuous variables and chi-squared test for discrete variables. Cox regression analyses were used to calculate the hazard ratio (HR). Cumulative incidence of PD was analyzed using the Kaplan-Meier method, and differences among participants with different severities of VI were analyzed using the two-tailed log-rank test. Subgroup analyses were performed to calculate the HR for PD among participants with different severities of VI. The PD group showed a significantly high percentage of VI. In addition, participants with VI showed a significantly higher HR and seven-year cumulative incidence rate of PD than those without VI. VI was independently and significantly associated with a higher incidence of PD among older Asian people. Therefore, identifying and treating correctible VI is important to prevent PD and improve the overall quality of life.
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14
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Parmeggiani F. Are visual disturbances (excluding diabetic retinopathy) more common in geriatric DM patients? Are they risks factor for the progression of disability? JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Macnamara A, Schinazi VR, Chen C, Coussens S, Loetscher T. Vision impairments reduce cognitive test performance. NATURE AGING 2021; 1:975-976. [PMID: 37118337 DOI: 10.1038/s43587-021-00135-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Anne Macnamara
- Cognitive Ageing & Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Victor R Schinazi
- Department of Psychology, Faculty of Society & Design, Bond University, Gold Coast, Queensland, Australia
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Scott Coussens
- Cognitive Ageing & Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Tobias Loetscher
- Cognitive Ageing & Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia.
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16
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Cao G, Wang K, Han L, Zhang Q, Yao S, Chen Z, Huang Z, Luo Y, Hu Y, Xu B. Visual trajectories and risk of physical and cognitive impairment among older Chinese adults. J Am Geriatr Soc 2021; 69:2877-2887. [PMID: 34111310 DOI: 10.1111/jgs.17311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES To identify visual trajectories and examine their relationships with physical and cognitive function in older Chinese adults. DESIGN Population-based longitudinal study. SETTING The Chinese Longitudinal Healthy Longevity Survey. PARTICIPANTS A total of 16,151 participants aged ≥65 years. MEASUREMENTS Visual, physical (including activities of daily living [ADL] and instrumental ADL [IADL]), and cognitive function were assessed at baseline and subsequently every 3 years. ADI disability and IADL disability were defined as needing any help in any item of the Katz scale and a modified Lawton's scale, respectively. Cognitive impairment was defined as a Chinese version of the Mini-Mental State Examination score below 24. A group-based trajectory model was used to determine visual trajectories adjusted for age, sex, and education. Associations of visual trajectories with ADL disability, IADL disability, and cognitive impairment were evaluated using generalized estimating equation models adjusted for potential confounders. RESULTS This study identified three distinct visual trajectories, including no decline (32.4%), moderate decline (48.3%), and progressive decline (19.3%) during the follow-up period. Compared with the no decline trajectory, both the moderate decline (ADL disability: OR = 2.75, 95% CI: 2.30-3.28; IADL disability: OR = 3.01, 95% CI: 2.74-3.31; cognitive impairment: OR = 3.37, 95% CI: 3.02-3.76) and the progressive decline (ADL disability: OR = 8.50, 95% CI: 6.55-11.02; IADL disability: OR = 12.96, 95% CI: 9.95-16.87; cognitive impairment: OR = 10.84, 95% CI: 8.89-13.23) trajectories were significantly associated with an increased risk of functional impairment. Compared with the moderate decline trajectory, the progressive decline trajectory was significantly associated with an increased risk of ADL disability (OR = 3.09, 95% CI: 2.46-3.89), IADL disability (OR = 4.30, 95% CI: 3.29-5.61), and cognitive impairment (OR = 3.22, 95% CI:2.63-3.93). CONCLUSION Older Chinese adults exhibit three distinct visual trajectories and those with decline trajectories in vision have an increased risk of functional impairment than those with a trajectory of no decline in vision.
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Affiliation(s)
- Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Qin Zhang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China.,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Shanshan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zishuo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Ziting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, China
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17
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Littlejohn J, Bowen M, Constantinidou F, Dawes P, Dickinson C, Heyn P, Hooper E, Hopper T, Hubbard I, Langenbahn D, Nieman CL, Rajagopal M, Thodi C, Weinstein B, Wittich W, Leroi I. International Practice Recommendations for the Recognition and Management of Hearing and Vision Impairment in People with Dementia. Gerontology 2021; 68:121-135. [PMID: 34091448 PMCID: PMC10072340 DOI: 10.1159/000515892] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hearing, vision, and cognitive impairment commonly co-occur in older people. However, the rate of recognition and appropriate management of combined hearing and vision impairment in people with dementia impairment is low. The aim of this work was to codevelop internationally relevant, multidisciplinary practice recommendations for professionals involved in the diagnosis, care, and management of older people with these concurrent conditions. METHODS We applied consensus methods with professional and lay expert stakeholders, using an adapted version of the World Health Organization Handbook for Guideline Development. The development involved 4 phases and included: (1) collating existing evidence, (2) filling the gaps in evidence, (3) prioritising evidence, and (4) refining the final list of recommendations. Each phase encompassed various methodologies including a review of existing guidelines within the 3 clinical domains, systematic reviews, qualitative studies, a clinical professional consortium, surveys, and consensus meetings with interdisciplinary domain experts. RESULTS The task force evaluated an initial list of 26 recommendations, ranking them in the order of priority. A consensus was reached on 15 recommendations, which are classified into 6 domains of "awareness and knowledge," "recognition and detection," "evaluation," "management," "support," and "services and policies." Pragmatic options for implementation for each domain were then developed. CONCLUSION This is the first set of international, interdisciplinary practice recommendations that will guide the development of multidisciplinary services and policy to improve the lives of people with dementia and hearing and vision impairment.
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Affiliation(s)
- Jenna Littlejohn
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK
- Deafness Support Network, Cheshire, UK
| | - Michael Bowen
- Research Department, The College of Optometrists, London, UK
| | - Fofi Constantinidou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK
- The Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | - Christine Dickinson
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Patricia Heyn
- Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Emma Hooper
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Department of Occupational Therapy, Institute of Health, University of Cumbria, Lancaster, UK
| | - Tammy Hopper
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | - Isabel Hubbard
- Communication Sciences and Disorders, University of Kentucky, Lexington, KY, USA
| | - Donna Langenbahn
- Department of Rehabilitation, NYU School of Medicine, New York, NY, USA
| | - Carrie L. Nieman
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Chryssoula Thodi
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Barbara Weinstein
- Graduate Center, CUNY, NYU Langone Medical Center, New York, NY, USA
| | - Walter Wittich
- School of Optometry, Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Université de Montréal, Montreal, QC, Canada
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Republic of Ireland
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18
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Fung MM, Yap MK, Cheng KK. Correctable visual impairment among people with diabetes in Hong Kong. Clin Exp Optom 2021; 93:453-7. [DOI: 10.1111/j.1444-0938.2010.00539.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mavis My Fung
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
E‐mail:
| | - Maurice Kh Yap
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
E‐mail:
| | - Karen Ky Cheng
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
E‐mail:
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19
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Tiraset N, Poonyathalang A, Padungkiatsagul T, Deeyai M, Vichitkunakorn P, Vanikieti K. Comparison of Visual Acuity Measurement Using Three Methods: Standard ETDRS Chart, Near Chart and a Smartphone-Based Eye Chart Application. Clin Ophthalmol 2021; 15:859-869. [PMID: 33664563 PMCID: PMC7924116 DOI: 10.2147/opth.s304272] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To validate the Rosenbaum near vision card (Near Chart) and a smartphone-based visual acuity (VA) test (Eye Chart) against a standard retro-illuminated Early Treatment Diabetic Retinopathy Study (ETDRS) chart within participants. Materials and Methods A cross-sectional study of participants aged ≥18 years was conducted. VA was measured in all participants using the ETDRS chart, Near Chart and smartphone-based Eye Chart application, respectively. VA was converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Eyes with ETDRS VA worse than 1.0 logMAR (20/200) were excluded. The main outcome measures were levels of agreement between VA measured using the Near Chart or Eye Chart application vs the ETDRS chart. Results A total of 295 eyes of 151 participants were included. One hundred participants (66.2%) were female and the mean age was 64.3 ± 12.5 years. Educational level was high school or below for 49% of participants and at Bachelor's degree or above for 51%. The median logMAR VAs of all eyes tested using the ETDRS chart, Near Chart and Eye Chart application were 0.1, 0.0 and 0.1, respectively. The median VA difference between the Near Chart vs ETDRS chart and Eye Chart application vs ETDRS chart was 0.0 logMAR in both cases for both the right eye (OD) and left eye (OS). Intraclass correlation coefficient (ICC) demonstrated a strong positive correlation between VA tested with the Near Chart vs ETDRS chart (OD: ICC=0.85; p<0.001, OS: ICC=0.77; p<0.001) and Eye Chart application vs ETDRS chart (OD: ICC=0.88; p<0.001, OS: ICC=0.74; p<0.001). Conclusion VA measurements with the Near Chart and smartphone-based Eye Chart application corresponded well to the standard ETDRS chart, suggesting potential utility of alternative portable VA tests for in-office or remote vision monitoring, particularly during periods of physical distancing such as the Coronavirus disease 2019 (COVID-19) era.
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Affiliation(s)
- Nanida Tiraset
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anuchit Poonyathalang
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Montakarn Deeyai
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Polathep Vichitkunakorn
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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20
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MacLeod CA, Bu F, Rutherford AC, Phillips J, Woods R. Cognitive impairment negatively impacts allied health service uptake: Investigating the association between health and service use. SSM Popul Health 2020; 13:100720. [PMID: 33364299 PMCID: PMC7750552 DOI: 10.1016/j.ssmph.2020.100720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/13/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023] Open
Abstract
There is widespread concern about the potential impact on health and social care services of the ageing population and long-term health conditions, such as dementia. To effectively plan services it is important to understand current need and use and identify gaps in provision. Using data from the Cognitive Function and Ageing Study Wales (CFAS Wales), we used logistic regression to model the relationship between health (self-rated health, cognitive impairment, and activities of daily living), and the use of health and care services. CFAS Wales is a longitudinal cohort study of people aged 65 years and over, in two areas in Wales, UK, over-sampling those aged 75 years and over. Participants (n = 3593) answered a wide range of health and lifestyle questions and completed a variety of cognitive and physical health assessments. Data from 3153 people from wave 1 and 1968 people from wave 2 were analysed. As anticipated we found poorer health, on some indicators, predicted greater service use, including social care, hospital, general practitioner, and nursing services. However, cognitive impairment did not predict greater service use, except for social care. Controlling for age, sex, socio-economic status, social connection indices and area environment, conversely we found lower reported uptake of allied health services by people with cognitive impairment. Further analysis showed that people with a cognitive impairment were less likely to report having a sight-check or seeing a dentist in the previous year, a finding replicated in wave 2. These differences were not explained by transportation issues. In contrast, we did not find a significant difference in reported uptake of hearing checks or physiotherapist use, with mixed evidence of differences in chiropodist visits. Not accessing these preventative services may not only exacerbate existing conditions but have further downstream negative consequences for health and well-being in people who are cognitively impaired.
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Affiliation(s)
- Catherine A. MacLeod
- Dementia Services Development Centre Wales, School of Health Sciences, Bangor University, UK
- Corresponding author. DSDC Wales, School of Health Sciences, Ardudwy, Normal Site, Bangor University, Bangor, Gwynedd, LL57 2PZ, Wales, UK.
| | - Feifei Bu
- Department of Behavioural Science and Health, University College London, UK
| | | | | | - Robert Woods
- Dementia Services Development Centre Wales, School of Health Sciences, Bangor University, UK
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21
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Samanta A, Shetty A, Nelson PC. Better one or two? A systematic review of portable automated refractors. J Telemed Telecare 2020; 28:404-411. [PMID: 32778005 DOI: 10.1177/1357633x20940140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION More than 400 million people suffer from visual impairment globally, with more than half due to uncorrected refractive error. Autorefraction (AR) is the most common examination performed prior to prescribing glasses. As technology advances, so has the accuracy and number of portable autorefractors available. Portable technology has become acutely important with the coronavirus disease 2019 pandemic and the conversion of in-person clinical evaluations to remote telemedicine encounters. Patients and providers want to do as much as possible remotely. The aim of this study was to conduct a systematic literature review of the accuracy and effectiveness of available portable automated refractors compared to the current standard of care, subjective refraction (SR). METHODS A literature search of PubMED, Embase and ClinicalTrials.gov 97 unique publications in English on portable autorefractors. Twelve studies comparing a portable AR device to at least one form of SR were systematically included in this review. RESULTS There were four portable autorefractors (Netra, Quicksee, Retinomax and SVOne) studied against SR. There was high patient acceptance of glasses prescriptions by the Quicksee alone, with 87% subjects seeing the same or better than SR. Quicksee was more accurate than Netra and Retinomax. SVOne was preferred over Netra and outperformed Retinomax in multiple measures, despite Retinomax being the fastest test. DISCUSSION There are numerous portable autorefractors available, but few were compared against SR. Quicksee and SVOne are the most accurate and patient-preferred devices. Quicksee was the most accurate, and it performed clinically the same as SR in some reports.
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Affiliation(s)
- Anindya Samanta
- Department of Internal Medicine, Allegheny Health Network, USA
| | | | - Patricia C Nelson
- Ophthalmology, Department of Surgery Texas Tech University Health Sciences Center El Paso, USA
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22
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Marmamula S, Challa R, Khanna RC, Kunkunu E, Rao GN. Population-based Assessment of Vision Impairment in the Elderly Population in Telangana State in India - Policy Implications for Eye Health Programmes. Ophthalmic Epidemiol 2020; 28:144-151. [PMID: 32746673 DOI: 10.1080/09286586.2020.1797122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the prevalence, causes and risk factors for vision impairment (VI) among the elderly population in Telangana State, India. METHODS A population-based cross-sectional study were conducted in four districts. All participants had eye examinations including visual acuity assessment for distance and near, anterior segment examination and non-mydriatic fundus imaging by trained personnel. VI was defined as presenting visual acuity worse than 6/18 in the better eye. Individuals aged ≥60 years were considered as elderly. RESULTS In total, 11,238/12,150 (92.5%) individuals aged ≥40 years were examined. Of this, the dataset of 3,640 individuals (32.4%) elderly participants was used for analysis. Among the 3,640 participants, 53.1% were women and 78.1% had no education. The mean age of the participants was 67.8 years (standard deviation: 7 years; range: 60 to 102 years). The age and gender-adjusted prevalence of VI was 32.1% (95% CI: 29.5-34.8). On multivariable analysis, the odds of VI was significantly higher in older age groups, and among those with no education. Gender and district of residence were not associated with the prevalence of VI. Cataract (54.8%) was the leading cause of VI followed by uncorrected refractive errors (37.6%). CONCLUSIONS AND RELEVANCE VI was common and largely avoidable in the elderly population in Telangana state in India. Elderly centric eye care including screening for vision loss, provision of cataract surgery and spectacles can be used as strategies to address VI in the elderly.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.,Department of Biotechnology/Wellcome Trust India Alliance, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Eswararao Kunkunu
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Gullapalli N Rao
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
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Marmamula S, Barrenkala NR, Challa R, Kumbam TR, Modepalli SB, Yellapragada R, Bhakki M, Khanna RC, Friedman DS. Uncorrected refractive errors for distance among the residents in 'homes for the aged' in South India-The Hyderabad Ocular Morbidity in Elderly Study (HOMES). Ophthalmic Physiol Opt 2020; 40:343-349. [PMID: 32207179 PMCID: PMC7277039 DOI: 10.1111/opo.12684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the prevalence and risk factors of Uncorrected Refractive Errors (URE) for distance in elderly residents in 'homes for the aged' in Hyderabad, India. METHODS Individuals aged ≥60 years and residing in 'homes for the aged' in Hyderabad, India for a minimum of 1 month and providing consent for participation were recruited. All participants underwent visual acuity assessment, refraction, slit lamp biomicroscopy, intraocular pressure measurement, fundus examination, and retinal imaging. Monocular presenting visual acuity was recorded using a logMAR chart. Objective and subjective refraction were performed, and best-corrected visual acuity was recorded. URE was defined as presenting visual acuity worse than 6/12 but improving to 6/12 or better with refraction. Univariable and multivariable logistic regression analyses were used to assess the risk factors associated with URE. RESULTS In total, 1 513 elderly participants were enumerated from 41 homes of which 1 182 participants (78.1%) were examined. The mean age of participants was 75.0 years (standard deviation 8.8 years; range: 60-108 years). 35.4% of those examined were men and 20.3% had no formal education. The prevalence of URE was 13.5% (95% CI: 11.5-15.5; n = 159). On applying multiple logistic regression analysis, compared to those living in private homes, the odds of URE were significantly higher among the elderly living in the aided homes (OR: 1.65; 95% CI: 1.11-2.43) and free homes (OR: 1.67; 95% CI: 1.00-2.80). As compared to those who reported having an eye examination in the last 3 years, the odds of URE were higher among those who never had an eye examination in the last three years (OR: 1.51; 95% CI: 1.07-2.14). Similarly, those who had unilateral cataract surgery (OR: 1.80; 95% CI: 1.10-2.93) or bilateral cataract surgery (1.69; 95% CI: 1.10-2.56) had higher odds of URE compared to those elderly who were not operated for cataract. Gender, self-report of diabetes, and education were not associated with URE. CONCLUSIONS A large burden of URE was found among the residents in the 'homes for the aged' in Hyderabad, India which could be addressed with a pair of glasses. Over 40% of the residents never had an eye examination in the last three years, which indicates poor utilisation of eye care services by the elderly. Regular eye examinations and provision of spectacles are needed to address needless URE for distance among the elderly in residential care in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
- Wellcome Trust/Department of Biotechnology India AllianceL V Prasad Eye InstituteHyderabadIndia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
- Department of OphthalmologyMassachusetts Eye and EarHarvard Medical SchoolBostonUSA
| | - Navya Rekha Barrenkala
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Rajesh Challa
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Thirupathi Reddy Kumbam
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Madhuri Bhakki
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- Brien Holden Institute of Optometry and Vision ScienceL V Prasad Eye InstituteHyderabadIndia
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research CentreGullapalli Pratibha Rao International Centre for Advancement of Rural Eye careL V Prasad Eye InstituteHyderabadIndia
- School of Optometry and Vision ScienceUniversity of New South WalesSydneyAustralia
| | - David S Friedman
- Department of OphthalmologyMassachusetts Eye and EarHarvard Medical SchoolBostonUSA
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Yekta A, Hashemi H, Pakzad R, Aghamirsalim M, Ostadimoghaddam H, Doostdar A, Khoshhal F, Khabazkhoob M. Economic Inequality in Unmet Refractive Error Need in Deprived Rural Population of Iran. J Curr Ophthalmol 2020; 32:189-194. [PMID: 32671304 PMCID: PMC7337026 DOI: 10.4103/joco.joco_100_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose: To determine economic inequality in unmet refractive error (RE) need and its determinants in deprived rural population of Iran. Methods: In this population-based study, two villages were randomly selected from among underserved villages of Iran. After selecting the participants, optometric examinations, including uncorrected and corrected visual acuity and subjective and manifest refraction, were done for all the participants. Then, unmet need for glasses was determined. Concentration index (C) was used to assess inequality, and Oaxaca–Blinder decomposition method was applied to decompose the gap between the two groups based on the determinants. Results: Of 3851 samples, 3314 participated in the study (response rate = 86.05%). The data of 3255 participants were used for analysis. The value of C and 95% confidence interval (CI) was −0.088 (−0.157 to −0.020), indicating a pro-poor inequality in unmet need. The prevalence (95% CI) of unmet need was 11.74% (9.25–14.22) in the poor and 6.51% (4.96–8.06) in the rich, with a gap of about 5% in favor of the rich (P < 0.001). A marked percentage of the gap was due to the explained portion (b = 5.73; P = 0.031). In the explained portion, the variable of economic status (b = 3.48; P = 0.004) and myopia (b = 0.88; P = 0.031) caused inequality in favor of the rich and against the poor, respectively. In the unexplained portion (b = −0.51; P = 0.372), the variables of education (P = 0.002) and place (P = 0.001) had statistically significant effects on inequality. Conclusions: There is a significant pro-poor economic inequality in the prevalence of unmet need in rural areas of Iran. Although part of this inequality is related to variables such as education and myopia, a major portion (two thirds) of this inequality may be due to the direct effect of economic inequality.
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Affiliation(s)
- Abbasali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asgar Doostdar
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Khoshhal
- Department of Pediatrics, Dezful University of Medical Sciences, Dezful, Iran
| | - Mehdi Khabazkhoob
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Marmamula S, Barrenakala NR, Challa R, Kumbham TR, Modepalli SB, Yellapragada R, Bhakki M, Khanna RC, Friedman DS. Prevalence and risk factors for visual impairment among elderly residents in 'homes for the aged' in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES). Br J Ophthalmol 2020; 105:32-36. [PMID: 32217544 PMCID: PMC7116480 DOI: 10.1136/bjophthalmol-2019-315678] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/03/2020] [Accepted: 03/02/2020] [Indexed: 12/02/2022]
Abstract
Background/Aim To investigate the prevalence, causes and risk factors of visual impairment (VI) among the elderly in ‘home for the aged’ in Hyderabad, India. Methods Individuals aged ≥60 years were recruited from 41 ‘homes for the aged’. All participants had complete eye examinations including presenting visual acuity, refraction, slit-lamp examination, intraocular pressure measurement and fundus imaging by trained clinicians. VI was defined as presenting visual acuity worse than 6/18 in the better eye. Multivariate logistic regression was used to determine the risk factors associated with VI. Results 1512 elderly residents from 41 homes for the aged were enumerated, of whom 1182 (78.1%) were examined. The mean age of examined participants was 75.0 years (SD 8.8 years; range: 60–108 years); 35.4% of those examined were men. The prevalence of VI was 30.1% (95% CI 27.5 to 32.8). The leading cause of VI was cataract (46.3%, n=165), followed by uncorrected refractive error (27.0%, n=96), posterior capsular opacification (14.9%, n=53) and posterior segment disease (6.5%, n=23). Overall, 88.2% of the VI was either treatable or correctable. In multiple logistic regression, those aged 80 years and older (OR: 1.7, p<0.01), living in ‘free’ homes (OR: 1.5, p<0.01) and who were immobile/bedridden (OR: 3.02, p<0.01) had significantly higher odds of VI. Gender was not associated with VI. Conclusions VI was common and largely avoidable in residents of ‘homes for the aged’ in Hyderabad, India. Screening for vision loss in ‘homes for aged’ and the provision of appropriate services should become routine practice to achieve the goal of healthy ageing in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India .,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Wellcome Trust / Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India.,Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, US
| | - Navya Rekha Barrenakala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Thirupathi Reddy Kumbham
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Satya Brahmanandam Modepalli
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Ratnakar Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Madhuri Bhakki
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Medical School Department of Ophthalmology, Boston, US
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26
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Fidalgo BR, Dabasia P, Jindal A, Edgar DF, Ctori I, Peto T, Lawrenson JG. Role of advanced technology in the detection of sight-threatening eye disease in a UK community setting. BMJ Open Ophthalmol 2020; 4:e000347. [PMID: 31909190 PMCID: PMC6936448 DOI: 10.1136/bmjophth-2019-000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/23/2019] [Accepted: 10/31/2019] [Indexed: 11/05/2022] Open
Abstract
Background/aims To determine the performance of combinations of structural and functional screening tests in detecting sight-threatening eye disease in a cohort of elderly subjects recruited from primary care. Methods 505 subjects aged ≥60 years underwent frequency doubling technology (FDT) perimetry, iVue optical coherence tomography (iWellness and peripapillary retinal nerve fibre layer (RNFL) scans) and intraocular pressure with the Ocular Response Analyzer, all performed by an ophthalmic technician. The reference standard was a full ophthalmic examination by an experienced clinician who was masked to the index test results. Subjects were classified as presence or absence of sight-threatening eye disease (clinically significant cataract, primary open-angle glaucoma, intermediate or advanced age-related macular degeneration and significant diabetic retinopathy). Univariate and multivariate logistic regression analyses were used to determine the association between abnormal screening test results and the presence of sight-threatening eye disease. Results 171 subjects (33.8%) had one or more sight-threatening eye diseases. The multivariate analysis found significant associations with any of the target conditions for visual acuity of <6/12, an abnormal FDT and peripapillary RNFL thickness outside the 99% normal limit. The sensitivity of this optimised screening panel was 61.3% (95% CI 53.5 to 68.7), with a specificity of 78.8% (95% CI 74.0 to 83.1), a positive predictive value of 59.5% (95% CI 53.7 to 65.2) and an overall diagnostic accuracy of 72.9% (95% CI 68.8 to 76.8). Conclusions A subset of screening tests may provide an accurate and efficient means of population screening for significant eye disease in the elderly. This study provides useful preliminary data to inform the development of further larger, multicentre screening studies to validate this screening panel.
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Affiliation(s)
- Bruno R Fidalgo
- Applied Vision Research Centre, School of Health Sciences, City, University of London, London, UK
| | - Priya Dabasia
- Applied Vision Research Centre, School of Health Sciences, City, University of London, London, UK
| | - Anish Jindal
- Applied Vision Research Centre, School of Health Sciences, City, University of London, London, UK
| | - David F Edgar
- Applied Vision Research Centre, School of Health Sciences, City, University of London, London, UK
| | - Irene Ctori
- Applied Vision Research Centre, School of Health Sciences, City, University of London, London, UK
| | - Tunde Peto
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - John G Lawrenson
- Applied Vision Research Centre, School of Health Sciences, City, University of London, London, UK
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27
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Wolski L, Leroi I, Regan J, Dawes P, Charalambous AP, Thodi C, Prokopiou J, Villeneuve R, Helmer C, Yohannes AM, Himmelsbach I. The need for improved cognitive, hearing and vision assessments for older people with cognitive impairment: a qualitative study. BMC Geriatr 2019; 19:328. [PMID: 31791251 PMCID: PMC6889573 DOI: 10.1186/s12877-019-1336-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 10/31/2019] [Indexed: 12/01/2022] Open
Abstract
Background Hearing and vision (sensory) impairments are highly prevalent in people with dementia (PwD) and exacerbate the impact of living with dementia. Assessment of sensory or cognitive function may be difficult if people have concurrent dual or triple impairments. Most standard cognitive assessment tests are heavily dependent on having intact hearing and vision, and impairments in these domains may render the assessments unreliable or even invalid. Likewise, dementia may impede on the accurate reporting of symptoms that is required for most hearing and vision assessments. Thus, there is an urgent need for hearing, vision and cognitive assessment strategies to be adapted to ensure that appropriate management and support can be provided. Objective To explore the perspectives of PwD and the care partners regarding the need for accurate hearing, vision and cognitive assessments. Methods We conducted focus groups and semi-structured interviews regarding the clinical assessment for cognitive, hearing and visual impairment. Participants (n = 18) were older adults with mild to moderate dementia and a sensory impairment as well as their care partners (e.g. a family member) (n = 15) at three European sites. The qualitative material was analysed according to Mayring’s summative content analysis approach. Results Participants reported that hearing, vision and cognitive assessments were not appropriate to the complex needs of PwD and sensory comorbidity and that challenges in communication with professionals and conveying unmet needs and concerns by PwD were common in all three types of clinical assessments. They felt that information about and guidance regarding support for the condition was not adequate in the assessments and that information sharing among the professionals regarding the concurrent problems was limited. Professionals were reported as being concerned only with problems related to their own discipline and had limited regard for problems in other domains which might impact on their own assessments. Conclusions The optimal assessment and support for PwD with multiple impairments, more comprehensive, yet easy to understand, information regarding these linked to conditions and corrective device use is needed. Communication among health care professionals relevant to hearing, vision and cognition needs to be improved.
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Affiliation(s)
- Lucas Wolski
- Institute for Applied Sciences, Catholic University of Applied Sciences Freiburg, Freiburg im Breisgau, Germany.
| | - Iracema Leroi
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jemma Regan
- Devon Partnership NHS Trust, Wonford House, Exeter, UK
| | - Piers Dawes
- The Department of Linguistics, Macquarie University, Sydney, Australia.,Manchester Centre for Health Psychology, School of Psychological Sciences, Univesity of Manchester, Manchester, UK
| | | | - Chryssoula Thodi
- Department of Health Sciences, European University of Cyprus, Nicosia, Cyprus
| | | | | | | | | | - Ines Himmelsbach
- Institute for Applied Sciences, Catholic University of Applied Sciences Freiburg, Freiburg im Breisgau, Germany
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Bökberg C, Behm L, Ahlström G. Quality of life of older persons in nursing homes after the implementation of a knowledge-based palliative care intervention. Int J Older People Nurs 2019; 14:e12258. [PMID: 31298499 PMCID: PMC6900068 DOI: 10.1111/opn.12258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The goals of palliative care are to relieve suffering and promote quality of life. Palliative care for older persons has been less prioritised than palliative care for younger people with cancer, which may lead to unnecessary suffering and decreased quality of life at the final stage of life. AIM To evaluate whether a palliative care intervention had any influence on the perceived quality of life of older persons (≥65 years). METHODS This study was conducted as a complex intervention performed with an experimental crossover design. The intervention was implemented in 20 nursing homes, with a six-month intervention period in each nursing home. Twenty-three older persons (≥65 years) in the intervention group and 29 in the control group were interviewed using the WHOQOL-BREF and WHOQOL-OLD questionnaires at both baseline and follow-up. The collected data were analysed using the Wilcoxon signed-rank test to compare paired data between baseline and follow-up. RESULTS In the intervention group, no statistically significant increases in quality of life were found. This result contrasted with the control group, which revealed statistically significant declines in quality of life at both the dimension and item levels. Accordingly, this study showed a trend of decreased health after nine months in both the intervention and control groups. CONCLUSION It is reasonable to believe that quality of life decreases with age as part of the natural course of the ageing process. However, it seems that the palliative care approach of the intervention prevented unnecessary quality of life decline by supporting sensory abilities, autonomy and social participation among older persons in nursing homes. From the ageing perspective, it may not be realistic to strive for an increased quality of life in older people living in nursing homes; maybe the goal should be to delay or prevent reduced quality of life. Based on this perspective, the intervention prevented decline in quality of life in nursing home residents. IMPLICATIONS FOR PRACTICE The high number of deaths shows the importance to identify palliative care needs in older persons at an early stage to prevent or delay deterioration of quality of life.
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Affiliation(s)
- Christina Bökberg
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - Lina Behm
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
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29
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Marmamula S, Barrenkala NR, Challa R, Reddy K T, Yellapragada S, Brahmanandam M S, Friedman DS, Khanna RC. Hyderabad Ocular Morbidity in Elderly Study (HOMES) - Rationale, Study Design and Methodology. Ophthalmic Epidemiol 2019; 27:83-92. [PMID: 31658840 PMCID: PMC6961304 DOI: 10.1080/09286586.2019.1683867] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose: To describe the study design, interobserver variability of the questionnaires and clinical procedures of Hyderabad Ocular Morbidity in Elderly Study (HOMES) designed to, (a) to investigate the prevalence, causes and risk factors for visual impairment, and (b) to assess the impact of dispensing spectacles and cataract surgery on visual functions, fear of falls (FOF) and depression among the elderly in India.Methods: Individuals aged ≥60 years are considered elderly. The non-clinical protocol was administered by two trained investigators and included collection of personal, sociodemographic information, ocular and systemic history, Indian Visual Function Questionnaire (IND-VFQ33), Patient Health Questionnaire (PHQ9), Mini-Mental State Examination (MMSE) questionnaire, Hearing Handicap Inventory for the Elderly Screening (HHIE), Short Falls Efficacy Scale (SFES) questionnaire. The eye examination was conducted by a trained optometrist and vision technicians in clinics set-up in the homes and included visual acuity (VA) assessment for distance and near, anterior segment examination and fundus examination, and imaging. The reliability assessments were carried out among 138 participants.Result: The intraclass correlation (ICC) coefficients for MMSE, PHQ9, HHIE, SFES was 0.73 (95% CI: 0.62-0.81), 0.67 (95% CI: 0.54-0.77), 0.63 (95% CI: 0.48-0.74) and 0.70 (95% CI: 0.58-0.79) respectively. The ICC for INDVFQ domains ranged from 0.66 (95% CI: 0.55-0.74) for Psychosocial Impact to 0.88 (95% CI: 0.84-0.91) for activity limitation. The ICC for VA was 0.94 (95% CI: 0.92-0.96).Conclusion: All questionnaires demonstrated acceptable reliability and can be applied in the main study. HOMES is expected to provide data that will help plan strategies to contribute towards 'healthy aging' in India.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India,Wellcome Trust/Department of Biotechnology India Alliance, L V Prasad Eye Institute, Hyderabad, India,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia,CONTACT Srinivas Marmamula Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad 500034, India
| | - Navya Rekha Barrenkala
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Rajesh Challa
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Thirupathi Reddy K
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - Shashank Yellapragada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Satya Brahmanandam M
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
| | - David S. Friedman
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rohit C. Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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30
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Han X, Scheetz J, Keel S, Liao C, Liu C, Jiang Y, Müller A, Meng W, He M. Development and Validation of a Smartphone-Based Visual Acuity Test (Vision at Home). Transl Vis Sci Technol 2019; 8:27. [PMID: 31440424 PMCID: PMC6701871 DOI: 10.1167/tvst.8.4.27] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the development and validation of a smartphone-based visual acuity (VA) test called Vision at home (V@home). Methods Three study populations (elderly Chinese, adolescent Chinese, and Australian groups) underwent distance and near VA testing using standard Early Treatment Diabetic Retinopathy Study (ETDRS) charts and the V@home device; all VA tests used tumbling E optotypes. VA tests were repeated with one eye, selected randomly. Distance VA was measured monocularly at 2 m, and near VA was measured binocularly at 40 cm. Participants also completed a questionnaire about their satisfaction with the device. V@home VA (logMAR) was compared to VA for ETDRS charts at distance and near and test-retest reliability. Results The mean difference between V@home and ETDRS distance VA across all groups ranged from -0.010 to -0.100 logMAR. Tolerant weighted kappa (TWK) agreement ranged from substantial (0.742) in the Australian group to almost perfect (0.950) in the adolescent Chinese group. There was high agreement of V@home with near ETDRS VA across all groups, with a mean difference of -0.092 to -0.042 logMAR and a TWK of 0.736 to 0.837. Test-retest reliability was also high (difference: -0.018 to 0.026) for both distance and near VA tests (95% limits of agreement: -0.289 to 0.258 for distance and -0.235 to 0.199 for near). The majority of participants were satisfied with V@home. Conclusions V@home could accurately and reliably measure both distance and near VA and is well accepted by participants. Translational Relevance The V@home system could potentially serve as a useful tool to improve eye care accessibility, especially in underdeveloped areas with limited eye care personnel and resources.
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Affiliation(s)
- Xiaotong Han
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jane Scheetz
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Chimei Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yu Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Andreas Müller
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Wei Meng
- Guangzhou Healgoo Interactive Medical Technology Co. Ltd., Guangzhou, China
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
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Yu A, Liljas AEM. The relationship between self-reported sensory impairments and psychosocial health in older adults: a 4-year follow-up study using the English Longitudinal Study of Ageing. Public Health 2019; 169:140-148. [PMID: 30904768 DOI: 10.1016/j.puhe.2019.01.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/15/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To explore cross-sectional and longitudinal relationships between self-reported hearing and vision impairments and self-rated health, quality of life (QoL) and depressive symptoms at 4-year follow-up. STUDY DESIGN The study involved cross-sectional and longitudinal analyses with 4-year follow-up using data from the English Longitudinal Study of Ageing. METHODS Community-dwelling adults (n = 3931) aged ≥50 years from the English Longitudinal Study of Ageing participated in this study. Self-reported hearing and vision were defined as good or poor. Self-rated health was treated as a dichotomous variable (good and poor health). QoL was based on the 19-item Critical Appraisal Skills Programme and treated as a continuous variable (score 0-57). Depressive symptoms were assessed using the eight-item Center for Epidemiologic Studies Depression Scale (CES-D8) and defined as CES-D≥3. Relationships between sensory impairments and self-rated health and depressive symptoms were analysed using logistic regression. Linear regression was used to assess the relationships between sensory impairments and QoL. RESULTS In cross-sectional analyses, both self-reported hearing and vision impairment were positively associated with all outcomes assessed. In longitudinal analyses, self-reported poor hearing and vision were associated with increased risks of poor self-rated health (hearing: odds ratio [OR] 1.65, 95% confidence interval [CI] 1.32, 2.05; vision: OR 1.57, 95% CI 1.16, 2.12) and depressive symptoms (hearing: OR 1.35, 95% CI 1.07, 1.71; vision: OR 1.44, 95% CI 1.09, 1.90) after adjustment for sociodemographic and lifestyle factors, chronic illness, mobility limitations and cognition. Poor hearing and poor vision were not associated with reduced QoL after adjustment for covariates. CONCLUSIONS The findings stress the importance of identifying and addressing sensory impairments in older adults to improve their health and well-being.
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Affiliation(s)
- A Yu
- Research Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, United Kingdom
| | - A E M Liljas
- Research Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, NW3 2PF, United Kingdom.
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Ngo G, Trope G, Buys Y, Jin YP. Significant disparities in eyeglass insurance coverage in Canada. Can J Ophthalmol 2018; 53:260-265. [DOI: 10.1016/j.jcjo.2017.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Visual problems in older people are common and frequently under-reported. The effects of poor vision in older people are wide reaching and include falls, confusion and reduced quality of life. Much of the visual impairment in older ages can be treated (e.g. cataract surgery, correction of refractive error). Vision screening may therefore reduce the number of older people living with sight loss. OBJECTIVES The objective of this review was to assess the effects on vision of community vision screening of older people for visual impairment. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 10); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the ICTRP. The date of the search was 23 November 2017. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared vision screening alone or as part of a multi-component screening package as compared to no vision screening or standard care, on the vision of people aged 65 years or over in a community setting. We included trials that used self-reported visual problems or visual acuity testing as the screening tool. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. We graded the certainty of the evidence using GRADE. MAIN RESULTS Visual outcome data were available for 10,608 people in 10 trials. Four trials took place in the UK, two in Australia, two in the United States and two in the Netherlands. Length of follow-up ranged from one to five years. Three of these studies were cluster-randomised trials whereby general practitioners or family physicians were randomly allocated to undertake vision screening or no vision screening. All studies were funded by government agencies. Overall we judged the studies to be at low risk of bias and only downgraded the certainty of the evidence (GRADE) for imprecision.Seven trials compared vision screening as part of a multi-component screening versus no screening. Six of these studies used self-reported vision as both screening tool and outcome measure, but did not directly measure vision. One study used a combination of self-reported vision and visual acuity measurement: participants reporting vision problems at screening were treated by the attending doctor, referred to an eye care specialist or given information about resources that were available to assist with poor vision. There was a similar risk of "not seeing well" at follow-up in people screened compared with people not screened in meta-analysis of six studies (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.97 to 1.14, 4522 participants high-certainty evidence). One trial reported "improvement in vision" and this occurred slightly less frequently in the screened group (RR 0.85, 95% CI 0.52 to 1.40, 230 participants, moderate-certainty evidence).Two trials compared vision screening (visual acuity testing) alone with no vision screening. In one study, distance visual acuity was similar in the two groups at follow-up (mean difference (MD) 0.02 logMAR, 95% CI -0.02 to 0.05, 532 participants, high-certainty evidence). There was also little difference in near acuity (MD 0.02 logMAR, 95% CI -0.03 to 0.07, 532 participants, high-certainty evidence). There was no evidence of any important difference in quality of life (MD -0.06 National Eye Institute 25-item visual function questionnaire (VFQ-25) score adjusted for baseline VFQ-25 score, 95% CI -2.3 to 1.1, 532 participants, high-certainty evidence). The other study could not be included in the data analysis as the number of participants in each of the arms at follow-up could not be determined. However the authors stated that there was no significant difference in mean visual acuity in participants who had visual acuity assessed at baseline (39 letters) as compared to those who did not have their visual acuity assessed (35 letters, P = 0.25, 121 participants).One trial compared a detailed health assessment including measurement of visual acuity (intervention) with a brief health assessment including one question about vision (standard care). People given the detailed health assessment had a similar risk of visual impairment (visual acuity worse than 6/18 in either eye) at follow-up compared with people given the brief assessment (RR 1.07, 95% CI 0.84 to 1.36, 1807 participants, moderate-certainty evidence). The mean composite score of the VFQ-25 was 86.0 in the group that underwent visual acuity screening compared with 85.6 in the standard care group, a difference of 0.40 (95% CI -1.70 to 2.50, 1807 participants, high-certainty evidence). AUTHORS' CONCLUSIONS The evidence from RCTs undertaken to date does not support vision screening for older people living independently in a community setting, whether in isolation or as part of a multi-component screening package. This is true for screening programmes involving questions about visual problems, or direct measurements of visual acuity.The most likely reason for this negative review is that the populations within the trials often did not take up the offered intervention as a result of the vision screening and large proportions of those who did not have vision screening appeared to seek their own intervention. Also, trials that use questions about vision have a lower sensitivity and specificity than formal visual acuity testing. Given the importance of visual impairment among older people, further research into strategies to improve vision of older people is needed. The effectiveness of an optimised primary care-based screening intervention that overcomes possible factors contributing to the observed lack of benefit in trials to date warrants assessment; trials should consider including more dependent participants, rather than those living independently in the community.
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Affiliation(s)
- Emily L Clarke
- Leeds Teaching Hospitals NHS TrustLeedsUK
- University of LeedsLeedsUK
| | - Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Liam Smeeth
- London School of Hygiene & Tropical MedicineFaculty of Epidemiology and Population HealthKeppel StreetLondonUKWC1E 7HT
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Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: a scoping review. Int Psychogeriatr 2017; 29:1771-1784. [PMID: 28691649 DOI: 10.1017/s104161021700120x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive screening tests frequently rely on items being correctly heard or seen. We aimed to identify, describe, and evaluate the adaptation, validity, and availability of cognitive screening and assessment tools for dementia which have been developed or adapted for adults with acquired hearing and/or vision impairment. METHOD Electronic databases were searched using subject terms "hearing disorders" OR "vision disorders" AND "cognitive assessment," supplemented by exploring reference lists of included papers and via consultation with health professionals to identify additional literature. RESULTS 1,551 papers were identified, of which 13 met inclusion criteria. Four papers related to tests adapted for hearing impairment; 11 papers related to tests adapted for vision impairment. Frequently adapted tests were the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MOCA). Adaptations for hearing impairment involved deleting or creating written versions for hearing-dependent items. Adaptations for vision impairment involved deleting vision-dependent items or spoken/tactile versions of visual tasks. No study reported validity of the test in relation to detection of dementia in people with hearing/vision impairment. Item deletion had a negative impact on the psychometric properties of the test. CONCLUSIONS While attempts have been made to adapt cognitive tests for people with acquired hearing and/or vision impairment, the primary limitation of these adaptations is that their validity in accurately detecting dementia among those with acquired hearing or vision impairment is yet to be established. It is likely that the sensitivity and specificity of the adapted versions are poorer than the original, especially if the adaptation involved item deletion. One solution would involve item substitution in an alternative sensory modality followed by re-validation of the adapted test.
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Senjam SS, Vashist P, Gupta N, Malhotra S, Misra V, Bhardwaj A, Gupta V. Prevalence of visual impairment due to uncorrected refractive error: Results from Delhi-Rapid Assessment of Visual Impairment Study. Indian J Ophthalmol 2017; 64:387-90. [PMID: 27380979 PMCID: PMC4966377 DOI: 10.4103/0301-4738.185614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To estimate the prevalence of visual impairment (VI) due to uncorrected refractive error (URE) and to assess the barriers to utilization of services in the adult urban population of Delhi. MATERIALS AND METHODS A population-based rapid assessment of VI was conducted among people aged 40 years and above in 24 randomly selected clusters of East Delhi district. Presenting visual acuity (PVA) was assessed in each eye using Snellen's "E" chart. Pinhole examination was done if PVA was <20/60 in either eye and ocular examination to ascertain the cause of VI. Barriers to utilization of services for refractive error were recorded with questionnaires. RESULTS Of 2421 individuals enumerated, 2331 (96%) individuals were examined. Females were 50.7% among them. The mean age of all examined subjects was 51.32 ± 10.5 years (standard deviation). VI in either eye due to URE was present in 275 individuals (11.8%, 95% confidence interval [CI]: 10.5-13.1). URE was identified as the most common cause (53.4%) of VI. The overall prevalence of VI due to URE in the study population was 6.1% (95% CI: 5.1-7.0). The elder population as well as females were more likely to have VI due to URE (odds ratio [OR] = 12.3; P < 0.001 and OR = 1.5; P < 0.02). Lack of felt need was the most common reported barrier (31.5%). CONCLUSIONS The prevalence of VI due to URE among the urban adult population of Delhi is still high despite the availability of abundant eye care facilities. The majority of reported barriers are related to human behavior and attitude toward the refractive error. Understanding these aspects will help in planning appropriate strategies to eliminate VI due to URE.
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Affiliation(s)
- Suraj Singh Senjam
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Vashist
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Cornea Unit, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Malhotra
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vasundhara Misra
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Bhardwaj
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Gupta
- Department of Community Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Badcock JC, Dehon H, Larøi F. Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research. Front Psychol 2017; 8:1134. [PMID: 28736541 PMCID: PMC5500657 DOI: 10.3389/fpsyg.2017.01134] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/21/2017] [Indexed: 12/22/2022] Open
Abstract
KEY POINTS➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts. ➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond. ➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood. ➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions.
Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research.
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Affiliation(s)
- Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western AustraliaPerth, WA, Australia.,Australia and Perth Voices Clinic, Murdoch University Child and Adult Psychology Service, Murdoch UniversityMurdoch, WA, Australia
| | - Hedwige Dehon
- Psychology and Neuroscience of Cognition Research Unit, University of LiegeLiege, Belgium
| | - Frank Larøi
- Psychology and Neuroscience of Cognition Research Unit, University of LiegeLiege, Belgium.,Department of Biological and Medical Psychology, University of BergenBergen, Norway.,NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of OsloOslo, Norway
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Gomez-Salazar F, Campos-Romero A, Gomez-Campaña H, Cruz-Zamudio C, Chaidez-Felix M, Leon-Sicairos N, Velazquez-Roman J, Flores-Villaseñor H, Muro-Amador S, Guadron-Llanos AM, Martinez-Garcia JJ, Murillo-Llanes J, Sanchez-Cuen J, Llausas-Vargas A, Alapizco-Castro G, Irineo-Cabrales A, Graue-Hernandez E, Ramirez-Luquin T, Canizalez-Roman A. Refractive errors among children, adolescents and adults attending eye clinics in Mexico. Int J Ophthalmol 2017; 10:796-802. [PMID: 28546940 PMCID: PMC5437471 DOI: 10.18240/ijo.2017.05.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/13/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the proportion of refractive errors in the Mexican population that visited primary care optometry clinics in fourteen states of Mexico. METHODS Refractive data from 676 856 patients aged 6 to 90y were collected from optometry clinics in fourteen states of Mexico between 2014 and 2015. The refractive errors were classified by the spherical equivalent (SE), as follows: sphere+½ cylinder. Myopia (SE>-0.50 D), hyperopia (SE>+0.50 D), emmetropia (-0.50≤SE≤+0.50), and astigmatism alone (cylinder≥-0.25 D). A negative cylinder was selected as a notation. RESULTS The proportion (95% confidence interval) among all of the subjects was hyperopia 21.0% (20.9-21.0), emmetropia 40.7% (40.5-40.8), myopia 24.8% (24.7-24.9) and astigmatism alone 13.5% (13.4-13.5). Myopia was the most common refractive error and frequency seemed to increase among the young population (10 to 29 years old), however, hyperopia increased among the aging population (40 to 79 years old), and astigmatism alone showed a decreasing trend with age (6 to 90y; from 19.7% to 10.8%). There was a relationship between age and all refractive errors (approximately 60%, aged 50 and older). The proportion of any clinically important refractive error was higher in males (61.2%) than in females (58.3%; P<0.0001). From fourteen states that collected information, the proportion of refractive error showed variability in different geographical areas of Mexico. CONCLUSION Myopia is the most common refractive error in the population studied. This study provides the first data on refractive error in Mexico. Further programs and studies must be developed to address the refractive errors needs of the Mexican population.
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Affiliation(s)
| | | | | | | | | | - Nidia Leon-Sicairos
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
- Pediatric Hospital of Sinaloa, Culiacan Sinaloa 80200, Mexico
| | - Jorge Velazquez-Roman
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
| | | | - Secundino Muro-Amador
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
| | | | - Javier J. Martinez-Garcia
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
- Pediatric Hospital of Sinaloa, Culiacan Sinaloa 80200, Mexico
| | | | - Jaime Sanchez-Cuen
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
- Department of Gastroenterology, Regional Hospital, ISSSTE, Culiacán 80230, Sinaloa, Mexico
| | - Alejando Llausas-Vargas
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
| | - Gerardo Alapizco-Castro
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
- Education and Research Department, Regional general Hospital No. 1, IMSS, Culiacan Sinaloa 80220, Mexico
| | - Ana Irineo-Cabrales
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
- Department of Gastroenterology, Regional Hospital, ISSSTE, Culiacán 80230, Sinaloa, Mexico
| | - Enrique Graue-Hernandez
- Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City 06800, Mexico
| | - Tito Ramirez-Luquin
- Department of Cornea and Refractive Surgery, Institute of Ophthalmology “Conde de Valenciana”, Mexico City 06800, Mexico
| | - Adrian Canizalez-Roman
- CIASaP, School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80246, Mexico
- The Women's Hospital, Secretariat of Health, Culiacan Sinaloa 80127, Mexico
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Houston JR, Bennett IJ, Allen PA, Madden DJ. Visual Acuity does not Moderate Effect Sizes of Higher-Level Cognitive Tasks. Exp Aging Res 2017; 42:221-63. [PMID: 27070044 DOI: 10.1080/0361073x.2016.1156964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND/STUDY CONTEXT Declining visual capacities in older adults have been posited as a driving force behind adult age differences in higher-order cognitive functions (e.g., the "common cause" hypothesis of Lindenberger & Baltes, 1994, Psychology and Aging, 9, 339-355). McGowan, Patterson, and Jordan (2013, Experimental Aging Research, 39, 70-79) also found that a surprisingly large number of published cognitive aging studies failed to include adequate measures of visual acuity. However, a recent meta-analysis of three studies (La Fleur and Salthouse, 2014, Psychonomic Bulletin & Review, 21, 1202-1208) failed to find evidence that visual acuity moderated or mediated age differences in higher-level cognitive processes. In order to provide a more extensive test of whether visual acuity moderates age differences in higher-level cognitive processes, we conducted a more extensive meta-analysis of topic. METHODS Using results from 456 studies, we calculated effect sizes for the main effect of age across four cognitive domains (attention, executive function, memory, and perception/language) separately for five levels of visual acuity criteria (no criteria, undisclosed criteria, self-reported acuity, 20/80-20/31, and 20/30 or better). RESULTS As expected, age had a significant effect on each cognitive domain. However, these age effects did not further differ as a function of visual acuity criteria. CONCLUSION The current meta-analytic, cross-sectional results suggest that visual acuity is not significantly related to age group differences in higher-level cognitive performance-thereby replicating La Fleur and Salthouse (2014). Further efforts are needed to determine whether other measures of visual functioning (e.g., contrast sensitivity, luminance) affect age differences in cognitive functioning.
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Affiliation(s)
- James R Houston
- a Department of Psychology , The University of Akron , Akron , Ohio , USA
| | - Ilana J Bennett
- b Department of Neurobiology and Behavior , University of California , Irvine , Irvine California , USA
| | - Philip A Allen
- a Department of Psychology , The University of Akron , Akron , Ohio , USA
| | - David J Madden
- c Brain Imaging and Analysis Center , Duke University Medical Center , Durham , North Carolina , USA
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Matthews K, Nazroo J, Whillans J. The consequences of self-reported vision change in later-life: evidence from the English Longitudinal Study of Ageing. Public Health 2016; 142:7-14. [PMID: 28057201 DOI: 10.1016/j.puhe.2016.09.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/17/2016] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Using longitudinal data, we investigate whether deterioration and improvement in self-reported vision among people aged 50 years and older in England experience subsequent changes in various aspects of economic, psychological and social well-being. STUDY DESIGN Longitudinal random effects modelling. METHODS We used six waves of the biennial English Longitudinal Study of Ageing spanning 2002-2012. Self-reported vision change was classed as an increase or decrease in self-reported level of vision between each wave and effects on depression, satisfaction with life, quality of life, social engagement and equivalized income were examined. Models were adjusted for health, employment and wealth. RESULTS All well-being outcomes worsened among respondents experiencing deterioration in self-reported vision, and declined most among individuals with the poorest self-reported vision at baseline and follow-up. Results were significant in fully adjusted models for those deteriorating from optimal to suboptimal vision levels. Improvement in self-reported vision was associated with significantly better satisfaction with life, quality of life and social engagement when the improvement was from suboptimal to optimal vision levels. CONCLUSIONS Preventing deterioration in vision is the best means of ensuring well-being is not negatively affected by changes to sight. In addition, ensuring vision problems are corrected where possible may lead to improvements in well-being.
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Affiliation(s)
- K Matthews
- CMIST, University of Manchester, Humanities Bridgeford Street Building, Oxford Road, Manchester, M13 9PL, United Kingdom.
| | - J Nazroo
- CMIST, University of Manchester, Humanities Bridgeford Street Building, Oxford Road, Manchester, M13 9PL, United Kingdom.
| | - J Whillans
- CMIST, University of Manchester, Humanities Bridgeford Street Building, Oxford Road, Manchester, M13 9PL, United Kingdom.
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Stegemann S. Defining Patient Centric Drug Product Design and Its Impact on Improving Safety and Effectiveness. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-43099-7_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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The prevalence and risk factors of visual impairment among the elderly in Eastern Taiwan. Kaohsiung J Med Sci 2016; 32:475-81. [PMID: 27638408 DOI: 10.1016/j.kjms.2016.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/28/2016] [Accepted: 07/25/2016] [Indexed: 11/20/2022] Open
Abstract
Visual impairment is associated with disability and poor quality of life. This study aimed to investigate the prevalence and associated risk factors of visual impairment among the suburban elderly in Eastern Taiwan. The cross-sectional research was conducted from April 2012 to August 2012. The ocular condition examination took place in suburban areas of Hualien County. Medical records from local infirmaries and questionnaires were utilized to collect demographic data and systemic disease status. Logistic regression models were used for the simultaneous analysis of the association between the prevalence of visual impairment and risk factors. Six hundred and eighty-one residents participated in this project. The mean age of the participants was 71.4±7.3 years. The prevalence of vision impairment (better eye<6/18) was 11.0%. Refractive error and cataract were the main causes of vision impairment. Logistic regression analysis showed that people aged 65-75 years had a 3.8 times higher risk of developing visual impairment (p=0.021), while the odds ratio of people aged > 75 years was 10.0 (p<0.001). In addition, patients with diabetic retinopathy had a 3.7 times higher risk of developing visual impairment (p=0.002), while the odds ratio of refractive error was 0.36 (p<0.001). The prevalence of visual impairment was relatively high compared with previous studies. Diabetic retinopathy was an important risk factor of visual impairment; by contrast, refractive error was beneficial to resist visual impairment. Therefore, regular screening of ocular condition and early intervention might aid in the prevention of avoidable vision loss.
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Guymer C, Casson R, Howell C, Stocks N. The AgED Study. Age-related eye disease (AgED) in South Australian general practice: are we blind to early detection and intervention? Aust J Prim Health 2016; 23:75-79. [PMID: 27480940 DOI: 10.1071/py15189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/28/2016] [Indexed: 11/23/2022]
Abstract
The AgED Study aimed to evaluate the detection, awareness and management of age-related eye disease (AgED) in South Australian general practice. Three South Australian metropolitan general practices were recruited and all patients aged 75 years and older were invited to participate. A cross-sectional postal questionnaire and retrospective audit of consenting patients' medical records was performed. On average, patients had their last eye check 9 months ago; the majority (64.9%) performed by an optometrist. Only 7.6% had visited their GP for their last eye check, mostly (90.5%) for a mandatory 'Fitness to Drive' medical assessment. There were marked differences in GP recording v. self-reported AgED and a marked discrepancy in the prevalence rates of AgED, visual impairment and blindness in this study compared with Australian population-based prevalence surveys. Despite the lack of GP documentation of eye disease, the majority of patients engaged in timely eye checks with either an optometrist or ophthalmologist, and their overall visual function and vision-related quality of life (QoL) were satisfactory.
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Affiliation(s)
- Chelsea Guymer
- Discipline of General Practice, School of Medicine, University of Adelaide, Frome Road, Adelaide, SA 5000, Australia
| | - Robert Casson
- South Australian Institute of Ophthalmology, University of Adelaide, Frome Rd, Adelaide, SA 5000, Australia
| | - Cate Howell
- Adelaide to Outback General Practice Training Program, Lower Level, 183 Melbourne Street, North Adelaide, SA 5006, Australia
| | - Nigel Stocks
- Discipline of General Practice, School of Medicine, University of Adelaide, Frome Road, Adelaide, SA 5000, Australia
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Goodman-Deane J, Waller S, Latham K, Price H, Tenneti R, Clarkson PJ. Differences in vision performance in different scenarios and implications for design. APPLIED ERGONOMICS 2016; 55:149-155. [PMID: 26995045 DOI: 10.1016/j.apergo.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/09/2015] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Abstract
To design accessibly, designers need good, relevant population data on visual abilities. However, currently available data often focuses on clinical vision measures that are not entirely relevant to everyday product use. This paper presents data from a pilot survey of 362 participants in the UK, covering a range of vision measures of particular relevance to product design. The results from the different measures are compared, and recommendations are given for relative text sizes to use in different situations. The results indicate that text needs to be 17-18% larger for comfortable rather than perceived threshold viewing, and a further 20% larger when users are expected to wear their everyday vision setup rather than specific reading aids.
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Affiliation(s)
- Joy Goodman-Deane
- Engineering Design Centre, Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, Cambridgeshire, UK.
| | - Sam Waller
- Engineering Design Centre, Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, Cambridgeshire, UK
| | - Keziah Latham
- Department of Vision & Hearing Sciences and Vision and Eye Research Unit, Anglia Ruskin University, Cambridge CB1 1PT, Cambridgeshire, UK
| | - Holly Price
- Department of Vision & Hearing Sciences and Vision and Eye Research Unit, Anglia Ruskin University, Cambridge CB1 1PT, Cambridgeshire, UK
| | - Raji Tenneti
- General Practice, University of Western Australia, Crawley WA 6009, Western Australia, Australia
| | - P John Clarkson
- Engineering Design Centre, Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, Cambridgeshire, UK
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Bowen M, Edgar DF, Hancock B, Haque S, Shah R, Buchanan S, Iliffe S, Maskell S, Pickett J, Taylor JP, O’Leary N. The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04210] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BackgroundThe prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia.ObjectivesTo measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management.DesignStage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care.SettingStage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions.ParticipantsStage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants.InterventionsStage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behaviour were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers).Main outcome measures.VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction.ResultsStage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA < 6/12) and 47% (VA < 6/18) were correctable with new spectacles. Almost 50% of remaining uncorrectable VI (VA < 6/12) was associated with cataract, and was, therefore, potentially remediable, and one-third was associated with macular degeneration. Uncorrected/undercorrected VI prevalence (VA < 6/12) was significantly higher in participants in care homes (odds ratio 2.19, 95% CI 1.30 to 3.73;p < 0.01) when adjusted for age, sex and sMMSE score. VA could not be measured in 2.6% of group 1 and 34.2% of group 2 participants (p < 0.01). The main eye examination elements (excluding visual fields) could be performed in > 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis.LimitationsSampling bias is possible owing to quota-sampling and response bias.ConclusionsThe prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Michael Bowen
- Research Department, College of Optometrists, London, UK
| | - David F Edgar
- Division of Optometry and Visual Science, City University London, London, UK
| | | | - Sayeed Haque
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rakhee Shah
- Research Department, College of Optometrists, London, UK
- The Outside Clinic, Swindon, UK
| | - Sarah Buchanan
- Research Department, Thomas Pocklington Trust, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Susan Maskell
- Public and participant involvement representative, Alzheimer’s Society Research Network, London, UK
| | - James Pickett
- Research Department, Alzheimer’s Society, London, UK
| | - John-Paul Taylor
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil O’Leary
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Republic of Ireland
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Fisher DE, Shrager S, Shea SJ, Burke GL, Klein R, Wong TY, Klein BE, Cotch MF. Visual Impairment in White, Chinese, Black, and Hispanic Participants from the Multi-Ethnic Study of Atherosclerosis Cohort. Ophthalmic Epidemiol 2016; 22:321-32. [PMID: 26395659 DOI: 10.3109/09286586.2015.1066395] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the prevalence of visual impairment and examine its association with demographic, socioeconomic, and health characteristics in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. METHODS Visual acuity data were obtained from 6134 participants, aged 46-87 years at time of examination between 2002 and 2004 (mean age 64 years, 47.6% male), from six communities in the United States. Visual impairment was defined as presenting visual acuity 20/50 or worse in the better-seeing eye. Risk factors were included in multivariable logistic regression models to determine their impact on visual impairment for men and women in each racial/ethnic group. RESULTS Among all participants, 6.6% (n = 421) had visual impairment, including 5.6% of men (n = 178) and 7.5% of women (n = 243). Prevalence of impairment ranged from 4.2% (n = 52) and 6.0% (n = 77) in white men and women, respectively, to 7.6% (n = 37) and 11.6% (n = 44) in Chinese men and women, respectively. Older age was significantly associated with visual impairment in both men and women, particularly in those with lower socioeconomic status, but the effects of increasing age were more pronounced in men. Two-thirds of participants already wore distance correction, and not unexpectedly, a lower prevalence of visual impairment was seen in this group; however, 2.4% of men and 3.5% of women with current distance correction had correctable visual impairment, most notably among seniors. CONCLUSION Even in the U.S. where prevalence of refractive correction is high, both visual impairment and uncorrected refractive error represent current public health challenges.
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Affiliation(s)
- Diana E Fisher
- a Division of Epidemiology and Clinical Applications , Intramural Research Program, National Eye Institute (NEI), National Institutes of Health (NIH) , Bethesda , MD , USA
| | - Sandi Shrager
- b Department of Biostatistics , University of Washington , Seattle , WA , USA
| | - Steven J Shea
- c Departments of Medicine and Epidemiology , Columbia University , New York , NY , USA
| | - Gregory L Burke
- d Division of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Ronald Klein
- e Department of Ophthalmology and Visual Sciences , University of Wisconsin--Madison , Madison , WI , USA
| | - Tien Y Wong
- f Department of Ophthalmology , Yong Loo Lin School of Medicine, National University of Singapore , Singapore , and.,g Singapore Eye Research Institute, Singapore National Eye Centre , Singapore
| | - Barbara E Klein
- e Department of Ophthalmology and Visual Sciences , University of Wisconsin--Madison , Madison , WI , USA
| | - Mary Frances Cotch
- a Division of Epidemiology and Clinical Applications , Intramural Research Program, National Eye Institute (NEI), National Institutes of Health (NIH) , Bethesda , MD , USA
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Ramessur R, Williams KM, Hammond CJ. Risk factors for myopia in a discordant monozygotic twin study. Ophthalmic Physiol Opt 2015; 35:643-51. [PMID: 26376775 PMCID: PMC4832275 DOI: 10.1111/opo.12246] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 08/03/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Monozygotic (MZ) twin pairs discordant for disease allow careful examination of environmental factors whilst controlling for genetic variation. The purpose of this study was to examine differences in environmental risk factors in MZ twins discordant for myopia. METHODS Sixty four MZ twin pairs discordant for refractive error were interviewed. Discordant twins were selected from 1326 MZ twin pairs from the TwinsUK adult twin registry with non-cycloplegic autorefraction. Discordancy was defined as ≥ 2 Dioptres (D) difference in spherical equivalent (SphE) and discordant for class of refractive error. In a 35-item telephone questionnaire twins were separately asked (and scored) about the risk factors urban/rural residence, occupational status and highest educational level. They responded with more (1), less (-1) or the same (0) as their twin on time spent outside, playing outdoor sport, and on close work aged <16 and 16-25 years. The lower SphE twin's score was subtracted from the higher SphE twin's score, and mean values of the difference calculated for each variable. RESULTS Sixty four twin pairs were included (mean age 56, range 30-79 years; mean difference in refraction 3.35 D, S.D. 1.55 D, median difference 2.78 D). Within discordant MZ twin pairs, the more myopic twin was associated with having a higher occupational status (mean score between 16 and 25 years -0.11; 95% CI -0.19 to -0.04; mean score aged >25 years -0.23, 95% CI -0.28 to -0.17), being resident in urban area (mean score -0.26; 95% CI -0.33 to -0.18) and performing more close work (mean score <16 years -0.11; 95% CI -0.18 to -0.05; mean score aged 16-25 years -0.17, 95% CI -0.24 to -0.10) than their twin. The twins who spent more time outdoors (mean score <16 years 0.09; 95% CI 0.03-0.15; mean score aged 16-25 years 0.28, 95% CI 0.15-0.41) or performed more outdoors sports (mean score <16 years 0.13; 95% CI 0.04-0.21; mean score aged 16-25 years 0.23, 95% CI 0.10-0.36) were less likely to be myopic than their twin. CONCLUSIONS This study has confirmed known environmental risk factors for myopia. These data will allow selection of discordant twins for epigenetic analysis to advance knowledge of mechanisms of refractive error development.
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Affiliation(s)
- Rishi Ramessur
- Department of Twin Research, Kings College London, London, UK.,Department of Medicine, University of Oxford, Oxford, UK
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Elliott DB, Foster RJ, Whitaker D, Scally AJ, Buckley JG. Analysis of lower limb movement to determine the effect of manipulating the appearance of stairs to improve safety: a linked series of laboratory-based, repeated measures studies. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundFalls on stairs are a common and dangerous problem for older people. This series of studies evaluated whether or not selected changes to the appearance of stairs could make them safer for older people to negotiate.ObjectivesTo determine the effect of (1) a step edge highlighter and its position and (2) an optimised horizontal–vertical (H–V) visual illusion placed on a step riser on gait safety during stair descent and ascent.DesignA series of studies using a repeated measures, laboratory-based design, investigating gait control and safety in independently mobile older people.SettingThe University of Bradford Vision and Mobility Laboratory.ParticipantsFit and healthy older people aged 60 years of age or more, independently mobile, reasonably active and with normal healthy eyes and corrected vision.InterventionsA step edge highlighter in a variety of offsets from the stair edge and an optimised H–V visual illusion placed on the stair riser. The H–V illusion was provided on a staircase by horizontal step edge highlighters on the tread edges and vertical stripes on the step risers.Main outcome measuresGait parameters that are important for safe stepping in ascent and descent, particularly toe clearance during stair ascent and heel clearance during stair descent.ResultsThe step edge highlighter increased the precision of heel clearance during stepping and its positioning relative to the tread edge determined the extent of heel clearance over the tread edge. Positioning the highlighter away from the tread edge, as is not uncommonly provided by friction strips, decreased heel clearance significantly and led to greater heel scuffs. Although psychophysics experiments suggested that higher spatial frequencies of the H–V illusion might provide greater toe clearance on stair ascent, gait trials showed similar increased toe clearances for all spatial frequencies. When a 12 cycle per step spatial frequency H–V illusion was used, toe clearance increases of approximately 1 cm (17.5%) occurred without any accompanying changes in other important gait parameters or stability measures.ConclusionsHigh-contrast tread edge highlighters present on steps and stairs and positioned flush with the edge of the tread or as near to this as possible should improve stair descent safety in older people. A H–V illusion positioned on the riser of a raised surface/walkway (e.g. kerbs) and/or the top and/or bottom of a stairway is likely to increase foot clearance over the associated step/stair edge, and appears not to lead to any decrement in postural stability. Thus, their use is likely to reduce trip risk and hence improve stair ascent safety. The effect of the step and stair modifications should be assessed in older people with visual impairment. The only other remaining assessment that could be made would be to assess fall prevalence on steps and stairs, perhaps in public buildings, with and without these modifications.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- David B Elliott
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Richard J Foster
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - David Whitaker
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Andrew J Scally
- School of Allied Health Professions and Sport, Faculty of Health Studies, University of Bradford, Bradford, UK
| | - John G Buckley
- Division of Medical Engineering, School of Engineering, University of Bradford, Bradford, UK
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Rees G, Xie J, Chiang PP, Larizza MF, Marella M, Hassell JB, Keeffe JE, Lamoureux EL. A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services. PATIENT EDUCATION AND COUNSELING 2015; 98:174-181. [PMID: 25481576 DOI: 10.1016/j.pec.2014.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 10/28/2014] [Accepted: 11/11/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the effectiveness of a low vision self-management programme (LVSMP) in older adults. METHODS Participants (n=153) were existing clients of a national low vision rehabilitation organisation randomly allocated to usual services (n=60) or usual services plus LVSMP (n=93). The LVSMP was an 8-week group programme facilitated by low vision counsellors. The primary outcome was vision-specific quality of life (QoL) measured using the Impact of Vision Impairment (IVI) questionnaire. Secondary outcomes emotional well-being, self-efficacy and adaptation to vision loss were measured using the depression, anxiety, stress scale (DASS), general self-efficacy scale (GSES), and short form adaptation to age-related vision loss scale (AVL12). RESULTS At one and six month follow-up assessments, no significant between-group differences were found for vision-specific QoL, emotional well-being, adaptation to vision loss or self-efficacy (p>0.05). Univariate and multivariate analyses revealed no impact of the intervention on outcome measures. CONCLUSIONS In contrast to previous work, our study found limited benefit of a LVSM programme on QoL for older adults accessing low vision services. PRACTICE IMPLICATIONS When implementing self-management programmes in low vision rehabilitation settings, issues of client interest, divergence of need, programme accessibility and fidelity of intervention delivery need to be addressed.
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Affiliation(s)
- Gwyneth Rees
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - Jing Xie
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Peggy P Chiang
- Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore
| | - Melanie F Larizza
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Manjula Marella
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Jennifer B Hassell
- Office for Research Ethics and Integrity, University of Melbourne, Melbourne, Australia
| | - Jill E Keeffe
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Prasad Eye Institute, Hyderabad, India
| | - Ecosse L Lamoureux
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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Shickle D, Todkill D, Chisholm C, Rughani S, Griffin M, Cassels-Brown A, May H, Slade SV, Davey CJ. Addressing inequalities in eye health with subsidies and increased fees for General Ophthalmic Services in socio-economically deprived communities: a sensitivity analysis. Public Health 2014; 129:131-7. [PMID: 25443104 DOI: 10.1016/j.puhe.2014.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/30/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Poor knowledge of eye health, concerns about the cost of spectacles, mistrust of optometrists and limited geographical access in socio-economically deprived areas are barriers to accessing regular eye examinations and result in low uptake and subsequent late presentation to ophthalmology clinics. Personal Medical Services (PMS) were introduced in the late 1990 s to provide locally negotiated solutions to problems associated with inequalities in access to primary care. An equivalent approach to delivery of optometric services could address inequalities in the uptake of eye examinations. STUDY DESIGN One-way and multiway sensitivity analyses. METHODS Variations in assumptions were included in the models for equipment and accommodation costs, uptake and length of appointments. The sensitivity analyses thresholds were cost-per-person tested below the GOS1 fee paid by the NHS and achieving break-even between income and expenditure, assuming no cross-subsidy from profits from sales of optical appliances. RESULTS Cost per test ranged from £ 24.01 to £ 64.80 and subsidy required varied from £ 14,490 to £ 108,046. Unused capacity utilised for local enhanced service schemes such as glaucoma referral refinement reduced the subsidy needed. CONCLUSIONS In order to support the financial viability of primary eye care in socio-economically deprived communities, income is required from additional subsidies or from sources other than eye examinations, such as ophthalmic or other optometric community services. This would require a significant shift of activity from secondary to primary care locations. The subsidy required could also be justified by the utility gain from earlier detection of preventable sight loss.
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Affiliation(s)
| | | | | | | | | | | | - Helen May
- Royal National Institute of Blind People, UK
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50
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Heuristics in primary care for recognition of unreported vision loss in older people: a technology development study. Prim Health Care Res Dev 2014; 16:429-35. [PMID: 25348032 DOI: 10.1017/s1463423614000425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To evaluate heuristics (rules of thumb) for recognition of undetected vision loss in older patients in primary care. BACKGROUND Vision loss is associated with ageing, and its prevalence is increasing. Visual impairment has a broad impact on health, functioning and well-being. Unrecognised vision loss remains common, and screening interventions have yet to reduce its prevalence. An alternative approach is to enhance practitioners' skills in recognising undetected vision loss, by having a more detailed picture of those who are likely not to act on vision changes, report symptoms or have eye tests. This paper describes a qualitative technology development study to evaluate heuristics for recognition of undetected vision loss in older patients in primary care. METHOD Using a previous modelling study, two heuristics in the form of mnemonics were developed to aid pattern recognition and allow general practitioners to identify potential cases of unreported vision loss. These heuristics were then analysed with experts. Findings It was concluded that their implementation in modern general practice was unsuitable and an alternative solution should be sort.
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