Depression and disability associated with impaired vision: the MoVies Project

Essential Occupational Therapy Competencies for Low Vision and Blindness

Background. The prevalence of low vision and blindness in persons across the lifespan means that occupational therapists will encounter these conditions across all areas of practice. Practitioners must be equipped with competencies necessary to recognize and respond to vision loss-related concerns. Purpose. This study sought to identify essential occupational therapy competencies when providing services to people with low vision and blindness. Method. The study employed a three-phase modified Delphi methodology administered through online surveys and focus group. Respondents included people with low vision or blindness, professionals with special expertise in low vision/blindness, and occupational therapists in other practice areas. Data were analyzed using an iterative, consensus-generating strategy involving quantitative analysis of competencies, qualitative input, and expert panel review. Findings. The process yielded a 51-item competency framework organized into six domains. Implications. The framework provides the foundation for a common curriculum for Canadian occupational therapy programs and for the creation of educational resources.

Young adults with vision impairment in India: Loneliness and social networks

PURPOSE

To examine the prevalence of loneliness and associated factors in young adults with vision impairment (VI), including quality of life (QoL) in India.

METHODS

Two hundred and three VI young adults (18-35 years) and 219 age-matched non-VI (controls) adults completed the loneliness scale, WHOQOL-BREF, Social Network Index (SNI) (network diversity, people in network size and number of embedded network subscales) and questions regarding sociodemographic characteristics and independent mobility. Rasch analysis was used to validate the questionnaires and interval-level scores were generated. Generalised linear models were used to estimate independent associations of sociodemographic factors, VI characteristics, social networks and QoL with loneliness.

RESULTS

The prevalence of moderate and severe loneliness in the VI group was 10% (95% CI: 6.5, 15.4) and 4.4% (95% CI: 2.0, 8.2), respectively, and higher than that of controls. The VI group had a worse loneliness score than controls (-1.66 ± 2.25 vs. -2.13 ± 1.85 logits; p = 0.03). Those with ≤12 years and >12 years of education had loneliness scores of -1.58 ± 2.45 and -1.82 ± 1.99 logits, respectively (p = 0.01). Compared with controls, the VI group reported fewer extended family members, neighbours and friends leading to significantly smaller networks and network diversity (all p < 0.001). Loneliness scores demonstrated a significant correlation with only two SNI subscales for both groups: people in network size (r = -0.28 for VI; r = -0.30 for non-VI; p < 0.001 for both) and number of embedded networks (r = -0.22 for VI; r = -0.21 for non-VI; p = 0.002 for both). Both education (β = 0.45; p = 0.04) and QoL (β = -0.27, p = 0.02) were predictors of loneliness.

CONCLUSIONS

Loneliness was commonly experienced by young VI adults and was higher among those with lower levels of education. Loneliness decreased with the presence of a larger number of people in network, suggesting that interventions to increase social activity and participation may be valuable in young VI adults.

The association between cataract surgery and mental health in older adults: a review

BACKGROUND

Although cataract surgery has been proposed as a potentially modifiable protective factor for enhancing emotional well-being in cataract patients, studies examining the relationship between anxiety or depression and cataract surgery have yielded inconsistent findings. This review summarizes existing evidence to establish whether cataract surgery is associated with depression and anxiety in older adults.

METHODS

A literature search was conducted across PubMed, Medline, Web of Science, and Embase databases. An initial screening by abstracts and titles was performed, followed by a review and assessment of the methodological quality of the relevant full papers, and final inclusion of 44 studies were deemed eligible for inclusion in this review.

RESULTS

Among 44 included studies, 36 studies (81.8%) were observational studies concerning the association of cataract surgery or cataracts with anxiety or depression, four studies (9.1%) were interventional studies, and four studies (9.1%) were reviews. Cataract surgery notably enhances the mental health of individuals with impaired vision. However, the multifaceted nature of psychological well-being, influenced by various factors, suggests that cataract surgery may not address all aspects comprehensively. Additionally, preoperative anxiety and depression significantly impact cataract surgery outcomes.

CONCLUSION

Vision impairment in older adults is closely associated with increased symptoms of depression and anxiety. While surgical intervention for cataracts improves these symptoms, it might be less effective for mental disorders with multifactorial causes. Notably, anxiety or depression poses challenges to successful preoperative and intraoperative cataract surgeries.

Blindness and visual impairment: quality of life and accessibility in the city of Turin

Purpose

Despite the increase in socio-health conditions and, in general, the focus on health worldwide, many diseases still adversely affect the quality of life (QoL), including those causing vision loss. The main purpose of this study was to evaluate the QoL of people with visual impairments through a questionnaire and identify issues concerning everyday life in the urban and extra-urban areas of Turin.

Patients and methods

A personalized questionnaire including 25 questions was distributed to 100 enrolled patients. It was designed by integrating the most widely used questionnaires related to the QoL of people with visual impairment with questions concerning the city of Turin. The inclusion criteria were any degree of visual impairment (from mild defect to complete blindness), according to Law n. 138/2001 classification. The exclusion criteria were mental disability and residence in care homes. Finally, statistical analysis was performed. Pearson's Chi-Square test was used to evaluate the strength of the association between two qualitative variables in different sections of the questionnaire. The results were classified as statistically significant with a p-value of ≤0.05 or borderline (0.05 < p-value<0.10).

Results

Based on responses to question 7 (Q7), 67% of selected patients stated that sight markedly influences their QoL. Moreover, 49% of patients responding to question 12 considered themselves almost completely dependent on other people regarding mobility and movement in and around Turin. In total, 57% used public transport (Q13); however, 50% of them found it challenging to access (Q14). Personal aids (e.g., white cane and magnifying glasses) were adopted only by 51% (Q15), and 63% of patients responding to question 18 suggested a refinement of urban aids (e.g., road signs). Of the 53 patients, 30 patients (56.6%) considered Turin a livable city for visually impaired people (Q19); however, 44 patients (84.6%) reported no significant improvements in Turin's urban logistics during the last 5 years and highlighted the urgent need to improve urban aids (Q21). Furthermore, the statistical associations studied showed that the loss of vision plays a significant role in influencing the perception of one's QoL (association of questions 7 and 8, X2 = 112.119, Cramer's V = 0.548, p-value <0.001). In addition, it is more difficult for visually impaired patients living outside the city to move outdoors (Chi-Square = 10.637, Cramer's V = 0.326, p - 245 value = 0.031) and to cross the street (Chi-Square = 14.102, Cramer's V = 0.376, p-250 value = 0.007). Finally, those who feel independent perceive their lives to be more fulfilling (Chi-Square = 268, X2 = 37.433; Cramer's V = 0.306, p value = 0.002).

Conclusion

Our study showed how vision loss plays a remarkable role in influencing the perception of one's QoL. Furthermore, it highlighted how the implementation of mobility and the use of personal aids for living in a city, such as Turin, were associated with a better perception of QoL by visually impaired patients. However, it is necessary to improve urban technological development according to the needs of people with visual disability.

R., Janana Priya G.. Association of Visual Impairment with Suicidal Ideation and Suicide Attempts: A Systematic Review and Meta-Analysis

Background

Worldwide, there is an increase in the incidence of suicide each year. Suicide attempts are estimated to be more frequent than actual suicide mortality. One potential contributor to suicide risk is the presence of sensory impairments (visual or hearing impairments). The present review aimed to assess the direction and strength of the association between visual impairment (VI) and the risk of suicidal behavior.

Methods

A systematic search was carried out on the literature published up to July 2021 in PubMed, Embase, Cochrane Library, and clinicaltrials.gov. The association between VI and suicidal ideation/attempt was summarized by pooled odds ratio with 95% CI.

Results

Six studies with a sample size of 1,64,752 were included in the final quantitative synthesis. The pooled odds ratios (95% CI) for suicidal ideation and attempt among persons with VI were 1.53 (1.30-1.79) and 4.55 (2.39-8.67), respectively. On subgroup analysis, the odds of suicidal ideation were higher in persons with additional sensory impairment, 2.07 (1.21-3.53), than in the group with VI only, 1.63 (95% 1.34-1.98).

Conclusion

This study found a significant association between suicidal behavior and VI, more so in persons with dual impairment. Structured assessment for psychological health and appropriate management should be an integral part of managing people with visual and other sensory impairments, to prevent this serious adverse consequence.

Association between Visual Impairment and Nutritional Risk among Older Adults with Diabetes: A Population-Based Cross-Sectional Study

PURPOSE

Despite the high prevalence of visual impairment caused by diabetic retinopathy and nutritional problems among older adults with diabetes, evidence regarding factors related to nutritional risk in this population is limited. Therefore, this study aimed to identify the correlates of nutritional risk among older adults with diabetes, focusing on visual impairment.

METHODS

This study was a secondary data analysis of the 2020 National Survey of Older Koreans aged 65 years and above. The sample comprised 2,376 older adults with diabetes, and complex sample ANOVA and Rao-Scott chi-square tests were used to compare the groups according to visual impairment. Complex-sample logistic regression analyses were conducted to verify the association between visual impairment and nutritional risk.

RESULTS

Older adults with diabetes, who also have severe visual impairment, are more likely to have nutritional risk status than those without impairment after controlling for covariates (odds ratio [OR] = 2.44, 95% confidence interval [CI] 1.16~5.13). Among the covariates, depression (OR = 3.58, 95% CI 2.60~4.94), dependent activities of daily living status (OR = 2.79, 95% CI 1.60~4.86), and experience of hospitalization during the past year (OR = 2.51, 95% CI 1.57~4.03) were strongly associated with nutritional risk.

CONCLUSION

Severe visual impairment increases the nutritional risk among older adults with diabetes. Therefore, it is essential to prevent visual impairment due to exacerbation of diabetes through appropriate management. Additionally, tailored nutritional interventions for visually impaired older adults with diabetes that consider visual characteristics are required.

The Association between Vision Impairment and Depression: A Systematic Review of Population-Based Studies

We conducted a systematic review and meta-analysis to investigate whether depression is associated with vision impairment (VI) in population-based studies in adults. MEDLINE and EMBASE were searched, from inception to June 2020. Studies were included if they provided two-by-two data for calculating the OR of association between VI and depression, or crude and/or an adjusted odds ratio (OR) with a corresponding 95% confidence interval (CI) were reported. The proportion of VI and depression was also extracted. ORs were pooled using random-effect models, proportions were pooled using random intercepts logistic regression models. Overall, 29 articles (31 studies) were included: of those, 18 studies used survey data (622,312 participants), 10 used clinical examination data (69,178 participants), and 3 used administrative databases (48,162,290 participants). The proportion of depression (95%CI) was 0.17 (0.13-0.22) overall and 0.27 (0.21-0.33) in VI subjects. The proportion of VI was 0.10 (0.07-0.16) overall and 0.20 (0.13-0.29) in depressed subjects. The association between VI and depression was direct: crude ORs were 1.89 (1.51-2.37) for survey data, 2.17 (1.76-2.67) for clinical examination data, and 3.34 (1.01-11.11) for administrative databases; adjusted ORs were 1.75 (1.34-2.30), 1.59 (1.22-1.96), and 2.47 (0.97-6.33), respectively. In conclusion, VI and depression are prevalent morbidities and should be actively sought when either is identified, especially in older adults.

Telemedicine Readiness Across Medical Conditions in a US National Representative Sample of Older Adults

Telemedicine has provided older adults the ability to seek care remotely during the coronavirus disease (COVID-19) pandemic. However, it is unclear how diverse medical conditions play a role in telemedicine uptake. A total of 3379 participants (≥65 years) were interviewed in 2018 as part of the National Health and Aging Trends Study. We assessed telemedicine readiness across multiple medical conditions. Most chronic medical conditions and mood symptoms were significantly associated with telemedicine unreadiness, for physical or technical reasons or both, while cancer, hypertension, and arthritis were significantly associated with telemedicine readiness. Our findings suggest that multiple medical conditions play a substantial role in telemedicine uptake among older adults in the US. Therefore, comorbidities should be taken into consideration when promoting and adopting telemedicine technologies among older adults.

Barriers to Low Vision Services Among Optometrists in Saudi Arabia

Introduction:

This study identifies the barriers and challenges to the provision of low vision services among practicing optometrists in Saudi Arabia.

Methods:

In this study, a self-administered online structured survey for practicing optometrists was used. Responses were collected to understand the number and percentage of low vision service providers, level of awareness, and barriers to the provision of low vision services.

Results:

This study included 154 (79 females and 75 males) practicing optometrists. They were from the five regions of Saudi Arabia (23 cities). The age of the practitioners ranged from 22 to 54 years. They had Bachelor’s, Master’s, and Doctor of Philosophy degrees. Forty-four participants (30%) provided low vision services. The major barriers reported were lack of training (87%), lack of awareness about low vision services (76%), lack of availability of low vision devices (70%), lack of motivation (65%), low vision services being time-consuming (55%), being busy in providing general optometry (65%), and lack of financial sources (31%).

Conclusion:

Building an efficient model for low vision rehabilitation in Saudi Arabia is needed. Moreover, encouraging more optometrists to be involved in low vision rehabilitation is necessary. There is also a need for more low vision education, national health coverage of patients with low vision, and better collaboration between low vision service providers.

Cardiovascular care of older adults

Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient's aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their care givers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient's function and quality of life at a time in life when these often become foremost therapeutic priorities.

Impact of sensory interventions on the quality of life of long-term care residents: a scoping review

INTRODUCTION AND PURPOSE

Residents in long-term care exhibit diminishing senses (hearing, sight, taste, smell or touch). The purpose of this study was to examine the available literature on the impact of sensory interventions on the quality of life of residents living in long-term care settings.

METHODS

We conducted a mixed-methods scoping review using Arksey and O'Malley's framework. Seven databases (Medline (Ovid), PubMed (non-Medline-Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials until 1 December 2020) were searched. Two reviewers independently screened the studies for sensory interventions using a two-step process. Eligible studies underwent data extraction and results were synthesised descriptively.

RESULTS

We screened 5551 titles and abstracts. A total of 52 articles met our inclusion criteria. Some interventions involved only one sense: hearing (n=3), sight (n=12), smell (n=4) and touch (n=15). Other interventions involved multiple senses (n=18). We grouped the interventions into 16 categories (music programmes, environmental white noise, bright light interventions, visual stimulations, olfactory stimulations, massages, therapeutic touch, tactile stimulations, physical activity plus night-time programmes, pet therapies, various stimuli interventions, Snoezelen rooms, motor and multisensory based strategies, Namaste care, environmental modifications and expressive touch activities).

CONCLUSION

This preliminary review summarised some of the available sensory interventions that will help inform a series of future systematic reviews on each of the specific interventions. The evidence-based knowledge for sensory interventions will also inform a future audit programme for assessing the presence of sensory interventions in long-term care.

The Prevalence and Determinant Factors of Self-Reported Depressive Symptoms Among Elderly People with Visual Impairment Attending an Outpatient Clinic in Ethiopia

BACKGROUND

Depression among older adults with visual impairment is the commonest psychiatric problem and causes a range of effects in on disability and progression of visual health outcomes that may even end in death. In Ethiopia, there are gaps in the detection of the comorbidity of mental health problems especially depressive symptoms among those older people. This study aimed to assess the prevalence of self-reported depressive symptoms and determinant factors among the elderly people with visual impairment attending the ophthalmologic outpatient clinic.

METHODS

A group of 423 elderly people with visual impairment invited by systematic random sampling technique to took part in the interview for this cross-sectional study at Menelik II referral hospital, Addis Ababa, Ethiopia from January to June 2019. Descriptive statistics like frequency, percentage, mean and standard deviation were used to summarize the distribution of the data. Binary logistic regression analysis was employed to examine the associated factors. An adjusted odds ratio with a 95% confidence interval was used for reporting the result, and a p-value of <0.05 was considered as statistically significant.

RESULTS

The prevalence of self-reported depressive symptoms among elderly people with visual impairment was 26.7% with a 95% confidence interval (22.6-30.8). Widowhood, single and/divorced [Adjusted Odds Ratio (AOR)= 3.17, 95% CI: 1.71, 5.91]; [AOR=2.70, 95% CI: 1.35, 5.38], respectively, poor social support [AOR=4.34, 95% CI: 1.84, 10.24], severe level [AOR=2.63, 95% CI: 1.73, 6.63] and longer duration (>5 years) of the illness [AOR=3.15, 95% CI: 1.60, 6.19] were the factors significantly associated with higher odds of depressive symptoms.

CONCLUSION

The Prevalence of self-reported depressive symptoms among elderly people with visual impairment in Ethiopia was high. Public health interventions targeting risky individuals with high depressive symptoms are needed to reduce depressive symptoms and to prevent disability and poor medical illnesses outcomes related to depressive symptoms.

Association between sensory impairment and suicidal ideation and attempt: a cross-sectional analysis of nationally representative English household data

OBJECTIVES

Sensory impairments are associated with worse mental health and poorer quality of life, but few studies have investigated whether sensory impairment is associated with suicidal behaviour in a population sample. We investigated whether visual and hearing impairments were associated with suicidal ideation and attempt.

DESIGN

National cross-sectional study.

SETTING

Households in England.

PARTICIPANTS

We analysed data for 7546 household residents in England, aged 16 and over from the 2014 Adult Psychiatric Morbidity Survey.

EXPOSURES

Sensory impairment (either visual or hearing), Dual sensory impairment (visual and hearing), visual impairment, hearing impairment.

PRIMARY OUTCOME

Suicidal ideation and suicide attempt in the past year.

RESULTS

People with visual or hearing sensory impairments had twice the odds of past-year suicidal ideation (OR 2.06; 95% CI 1.17 to 2.73; p<0.001), and over three times the odds of reporting past-year suicide attempt (OR 3.12; 95% CI 1.57 to 6.20; p=0.001) compared with people without these impairments. Similar results were found for hearing and visual impairments separately and co-occurring.

CONCLUSIONS

We found evidence that individuals with sensory impairments are more likely to have thought about or attempted suicide in the past year than individuals without.

Differential and spatial expression meta-analysis of genes identified in genome-wide association studies of depression

Major depressive disorder (MDD) is the most prevalent psychiatric disorder worldwide and affects individuals of all ages. It causes significant psychosocial impairments and is a major cause of disability. A recent consortium study identified 102 genetic variants and 269 genes associated with depression. To provide targets for future depression research, we prioritized these recently identified genes using expression data. We examined the differential expression of these genes in three studies that profiled gene expression of MDD cases and controls across multiple brain regions. In addition, we integrated anatomical expression information to determine which brain regions and transcriptomic cell types highly express the candidate genes. We highlight 12 of the 269 genes with the most consistent differential expression: MANEA, UBE2M, CKB, ITPR3, SPRY2, SAMD5, TMEM106B, ZC3H7B, LST1, ASXL3, ZNF184 and HSPA1A. The majority of these top genes were found to have sex-specific differential expression. We place greater emphasis on ZNF184 as it is the top gene in a more conservative analysis of the 269. Specifically, the differential expression of ZNF184 was strongest in subcortical regions in males and females. Anatomically, our results suggest the importance of the dorsal lateral geniculate nucleus, cholinergic, monoaminergic and enteric neurons. These findings provide a guide for targeted experiments to advance our understanding of the genetic underpinnings of depression.

Self-reported vision impairment, vision correction, and depressive symptoms among middle-aged and older Chinese: Findings from the China health and retirement longitudinal study

OBJECTIVE

To investigate associations between vision impairment (VI), vision correction (VC) and depressive symptoms among middle-aged and older Chinese.

METHODS

22 203 participants aged ≥45 years from China Health and Retirement Longitudinal Study 2011 to 2015 were divided into four self-reported VI categories: no VI, distance VI (DVI) only, near VI (NVI) only, and both distance and near VI (DNVI); and four self-reported VI/VC subgroups: VI(+)/VC(-), VI(+)/VC(+), VI(-)/VC(-) and VI(-)/VC(+). Depressive symptoms were evaluated by 10-item Center for Epidemiological Studies Depression Scale (CESD-10).

RESULTS

Compared with no VI, DVI only (OR = 2.12, 95% CI: 1.95, 2.31), NVI only (OR = 1.51, 95% CI: 1.39, 1.63) and DNVI (OR = 2.75, 95% CI: 2.47, 3.07) were associated with higher odds of depressive symptoms. Compared with VI(+)/VC(-), VI(+)/VC(+) (OR = 0.91, 95% CI: 0.83, 0.98), VI (-)/VC(-) (OR = 0.50, 95% CI: 0.48, 0.53) and VI(-)/VC(+) (OR = 0.49, 95% CI: 0.47, 0.54) were associated with lower odds of depressive symptoms. Compared with no VI at baseline, baseline DNVI was significantly associated with higher odds of depressive symptoms after two (OR = 1.48, 95% CI: 1.16, 1.88) and four (OR = 1.32, 95% CI: 1.04, 1.68) years. Baseline depressive symptoms were significantly associated with higher odds of VI after two (OR = 1.53, 95% CI: 1.34, 1.74) and four (OR = 1.54, 95% CI: 1.34, 1.76) years.

CONCLUSION

Adults with DNVI were more likely to report depressive symptoms in the future and those with depressive symptoms were more likely to report VI in the future. VC might be a protective factor for preventing depressive symptoms among adults with VI.

Demographic and Socioeconomic Differences in Outpatient Ophthalmology Utilization in the United States

PURPOSE

The purpose was to assess differences in outpatient ophthalmologic usage based on patient characteristics such as race/ethnicity, income, insurance type, geographical region, and educational attainment.

DESIGN

Retrospective cross-sectional study.

METHODS

The Medical Expenditure Panel Survey (MEPS) is a nationally representative data set for the noninstitutionalized population cosponsored by the Agency for Healthcare Research. This study involved 183,054 MEPS respondents from 2007 to 2015. Primary outcome measure was patient utilization of outpatient ophthalmologic care. Secondary outcome measure was annual health care use and costs by patients in outpatient, inpatient, and the emergency department settings based on race.

RESULTS

Overall, 21,673 participants self-reported an ophthalmologic condition, and 12,462 had at least 1 outpatient ophthalmologic visit. Hispanic (adjusted odds ratio [aOR] 0.72; P < .001) and black patients (aOR 0.74; P < .001) had fewer outpatient visits than their non-Hispanic white counterparts. Uninsured (aOR 0.41; P = .009) and Medicare/Medicaid (aOR 0.92; P < .001) patients had less outpatient care than their privately insured counterparts. Increasing income and education was associated with higher outpatient ophthalmologic care utilization. In the emergency department, non-Hispanic white patients had the least encounters (1.1 per 100 patients) and highest costs ($25,314.05) when compared to non-Hispanic black patients (3.2 encounters per 100 patients and $10,780.22 respectively) and Hispanic patients (2.2 encounters per 100 patients and $9,837.03 respectively).

CONCLUSIONS

This study's findings demonstrate differences in outpatient ophthalmologic utilization based on demographic and socioeconomic characteristics. Concurrently, minority Americans had more ophthalmic emergency department visits but lower cost per visit. There is a need to further characterize these differences to predict future ophthalmologic care needs.

Screening for Vision Impairments in Individuals with Dementia Living in Long-Term Care: A Scoping Review

Vision impairments are prevalent, but underdiagnosed in individuals with dementia living in long-term care (LTC). Effective screening tools could identify remediable vision problems. This scoping review was conducted to identify vision screening tests used with individuals with dementia and assesses their suitability for administration by nurses in LTC. A literature search using the Arksey and O’Malley (2005) method included research articles, conference proceedings, and dissertations. Data were included from participants over 65 years of age with a diagnosis of probable dementia. A panel of vision experts evaluated the suitability of the candidate vision tests. The search yielded 179 publications that met the inclusion criteria. Of 134 vision tests that were identified, 19 were deemed suitable for screening by nurses in LTC. Tests screened for acuity (12), visual field (1), anatomy (2), color vision (2), and general visual abilities (2). Tests were excluded because of complexity of interpretation (90), need for specialized training (83), use in research only (57), need for specialized equipment (54), not assessing visual function (44), long test duration (21), uncommonness (13), and needing an act reserved for specialists (7). Psychometric properties were not often reported for tests. Few of the tests identified had been validated for use with individuals with dementia. Based on our review, few tests were deemed suitable for use by nurses to assess this population in LTC. Identifying appropriate tools to screen vision in individuals with dementia is a necessary first step to interventions that could potentially improve functioning and quality of life.

Veterans Affairs Low-vision Intervention Trial II: One-year Follow-up

SIGNIFICANCE

One-year follow-up is recommended for patients with macular diseases to assess functional changes associated with disease progression and to modify low-vision (LV) treatment plans, if indicated.

PURPOSE

The purpose of this study was to observe 255 patients with macular diseases who received LV rehabilitation (rehabilitation with a therapist) or basic LV services (LV devices dispensed without therapy) during Veterans Affairs Low-vision Intervention Trial II after the trial ended at 4 months until 1-year follow-up.

METHODS

The primary outcome measure was visual ability measured with the 48-item Veterans Affairs Low-vision Visual Functioning Questionnaire. Mean visual ability scores for the treatment groups were compared from baseline to 4 months, 4 months to 1 year, and baseline to 1 year. Changes from baseline to 1 year were compared between the two groups. Predictors of changes in visual ability from 4 months to 1 year were assessed using linear regression.

RESULTS

Both groups experienced significant improvement in all measures of visual ability from baseline to 1 year but lost visual reading ability during the observation period (LV rehabilitation group, -0.64 [1.2] logit; 95% confidence interval [CI], -0.84 to -0.44 logit; basic LV group, -0.63 [1.4] logit; 95% CI, -0.88 to -0.38 logit), and overall visual ability was lost in the LV rehabilitation group (-0.20 [0.8] logit; 95% CI, -0.34 to -0.06 logit). Loss of visual reading ability in both groups from 4 months to 1 year was predicted by reading ability scores at 4 months, loss of near visual acuity from 4 months to 1 year, and lower EuroQol-5D utility index scores; loss of overall visual ability in the LV rehabilitation group during the same time period was predicted by lower overall ability scores at 4 months.

CONCLUSIONS

Visual ability significantly improved in all groups from baseline to 1 year. However, the loss of visual reading ability experienced by both groups from 4 months to 1 year reduced the benefit of the services provided.

Large-scale assessment of needs in low vision individuals using the Aira assistive technology

PURPOSE

To systematically evaluate the needs of low vision individuals through call data obtained through the Aira assistive technology system.

PATIENTS AND METHODS

Aira (Aira Tech Corporation, La Jolla, CA, USA) is an on-demand assistive wearable technology designed for individuals with low vision. The user wears glasses with an integrated front-facing video camera that connects with a remote human agent who assists the user with the specified task. Call types, temporal characteristics, and duration of call were compared by gender and vision status (low vision, light perception, and blind). Chi-square tests, t-tests, ANOVA, linear regression and Poisson regression analyses were performed.

RESULTS

878 subscribers placed 10,022 total calls (4759 female, 5263 male) over 3 months. The most common categories were reading (35%), navigation (33%), and home management (16%). The distribution of categories (χ2=49.3, p<0.001), duration (t=-7.59, p<0.0001) and time of call (χ2=37.4, p<0.001) differed by gender. The distribution of categories (χ2=61, p<0.001), duration (F=13.7, p<0.0001), and time of call (χ2=36.9, p<0.001) differed by vision status. Blind [adjusted IRR=1.68 (95% CI: 1.56-1.79)] and light perception users [adjusted IRR=1.43 (95% CI: 1.32-1.53)] had increased usage compared to low vision users. Women had higher usage than men [adjusted IRR=1.09 (95% CI: 1.04-1.13)].

CONCLUSION

To our knowledge, this is the first large-scale needs assessment of 878 low vision individuals over 10,022 calls. The most common categories were reading, navigation, and home management. Distribution of call types, duration, and time of call differed significantly by gender and vision status. Blind and light perception users had higher usage rates than those with low vision. Women had higher usage rates than men. This large-scale needs analysis of low vision individuals provides insight into utilization patterns across varying levels of vision loss and gender, which will guide future evolutions of assistive technology by tailoring future hardware and software upgrades.

Patient-Reported Outcomes Reveal Impairments Not Explained by Psychophysical Testing in Patients With Regressed PDR

Purpose

We evaluated the correlations between visual deficits and patient-reported symptoms in patients with regressed proliferative diabetic retinopathy (PDR) to determine whether there is a psychophysical basis for vision-related impairments.

Methods

Visual acuity, reading acuity, contrast sensitivity, frequency doubling perimetry (FDP), Humphrey field analyzer (HFA), and dark adaptation assessed visual function. The National Eye Institute Vision Function Questionnaire-25 (NEI VFQ-25) and Low Luminance Questionnaire (LLQ) assessed quality of life.

Results

We recruited 30 adults who received panretinal photocoagulation (PRP) for PDR and 15 control subjects; 22 diabetic and 11 control participants completed a second evaluation 5 years later. Visual acuity of the worse-seeing eyes tended to correlate better with NEI VFQ-25 and LLQ than did the acuity of the better-seeing eyes. Other vision measures were generally not associated with either questionnaire, especially responses related to driving ability and mental health. Visual acuity only detected subnormal performance in 43% to 45% of patients, while FDP 24-2, HFA 60-4, and LLQ detected abnormal performance in >80% of patients.

Conclusions

Poor visual acuity may explain some vision-related impairments in daily function. However, many patients with regressed PDR have normal acuity but reduced visual field and poor quality of life. In these patients, their reported symptoms were not fully explained by visual acuity or any psychophysical tests alone.

Translational Relevance

Visual acuity is a poor indicator of overall visual function in people with regressed PDR. In clinical settings, visual field tests and patient-reported outcomes may provide more comprehensive assessments of their functional deficits than visual acuity.

Health Conditions, Activity Limitations, and Participation Restrictions among Older People with Visual Impairments

Data from the Second Supplement on Aging (1994) were analyzed to evaluate the presence of selected medical conditions, performance of basic and instrumental activities of daily living, and participation in life situations in two groups of visually impaired elders (persons aged 70–74 and persons aged 85 years or older) and two other groups of elders in the same age groups who are not visually impaired. Results indicated that, for both age groups, visual impairment is a significant risk factor for additional medical conditions, activity limitations, and participation restrictions.

Functional Outcomes Reported by Consumers of the Independent Living Program for Older Individuals who are Blind

This study surveyed 940 elders regarding their perceptions of the services they received under the Independent Living Program for Older Individuals Who Are Blind (Title VII, Chapter 2 of the Rehabilitation Act, 1973, as amended). Significant differences were found in perceived outcomes based on the elders’ gender, age, living arrangements, and age at onset of visual impairment. The results have programmatic and service delivery implications for staff who conduct program evaluation.

Impact of a Vision Intervention on the Functional Status of Nursing Home Residents

This study examined the outcomes associated with an intervention for residents of two nursing homes who had low vision and cognitive impairments that included diagnosis, optical correction, ensuring that the participants wore their eyeglasses, and staff training in recognizing vision problems. It found that a significantly decreased decline in function was associated with the provision of both eyeglasses and Croakies to the residents and staff training to recognize vision problems and provide reinforcement techniques, rather than only the provision of eyeglasses and Croakies.

Effects of self-reported hearing or vision impairment on depressive symptoms: a population-based longitudinal study

AIMS

The aims of this study were to investigate the effects of either hearing, vision or dual sensory impairment on depressive symptoms and to identify subgroups that are vulnerable and significantly affected.

METHODS

Data from the 2006-2014 Korean Longitudinal Study of Aging (KLoSA) were used and a total of 5832 individuals were included in this study. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D10) scale. Sensory impairment was assessed according to the levels of self-reported hearing or vision, which were categorised as either good (excellent, very good or good) or poor (fair or poor). The changes in hearing or vision from records of previous survey were investigated. Changes from good to poor, which indicates new onset, were defined as hearing impairment or vision impairment. Interactions of changes in hearing and vision were considered in the analysis. Dual sensory impairment was indicated when hearing impairment and vision impairment both developed at the same time. Demographic, socioeconomic and health-related factors were considered as potential confounders and were adjusted for in the generalised estimating equation model.

RESULTS

Individuals with hearing impairment demonstrated significantly more severe depressive symptoms [β = 0.434, standard errors (s.e.) = 0.097, p &lt; 0.001] than those who had good hearing. Those with vision impairment also showed significantly elevated depressive symptoms (β = 0.253, s.e. = 0.058, p &lt; 0.001) than those with good vision. When the interactions between hearing and vision were considered, participants with dual sensory impairment showed significantly more severe depressive symptoms (β = 0.768, s.e. = 0.197, p &lt; 0.001) than those with good hearing and vision. The effect of a single and dual sensory impairment on depressive symptoms was significant in both sexes and across age groups, except for vision impairment in male participants.

CONCLUSIONS

Hearing, vision and dual sensory impairment are significantly associated with depressive symptoms. Our results suggest that treatment or rehabilitation of either hearing or vision impairment would help prevent depression.

Effectiveness of the "living successfully with low vision" self-management program: Results from a randomized controlled trial in Singaporeans with low vision

OBJECTIVE

To determine the effectiveness of the "Living Successfully with Low Vision" (LSLV) self-management program to improve patient-reported outcomes in Singaporeans.

METHODS

In this randomized controlled trial, 165 participants with low vision (LV) were recruited and assigned to usual care (LV aid training only; N = 82) or LSLV program (N = 83). The LSLV program focuses on problem solving, coping mechanism and anticipation/preparation for future needs. The primary outcome was vision-related quality of life (VRQoL; measured using the Impact of Vision Impairment [IVI] questionnaire), while secondary outcomes included health-related quality of life; mental health; and self-efficacy, assessed at baseline, 2-weeks and 6-months post-intervention. Within- and between-group comparisons were conducted using paired t-tests and repeated measures analysis of covariance, respectively.

RESULTS

A total of 128 individuals (77.6%) completed all assessments. At 2 weeks, LSLV participants alone experienced a significant within-group improvement in the mean IVI Emotional score (P = 0.05) but not at 6 months. No other within- or between-group effects were observed.

CONCLUSION

While SM programs have shown promising results in the management of many chronic diseases, our findings suggest that the LVSM program was not an effective approach for LV rehabilitation in Singapore.

PRACTICE IMPLICATION

Other evidence-based strategies to improve QoL in patients with LV may be warranted.

Double Jeopardy: The Effects of Comorbid Conditions among Older People with Vision Loss

This retrospective study used national survey data to examine multiple effects of nine comorbid conditions—breathing problems, depression risk, diabetes, heart problems, hearing impairment, hypertension, joint problems, low back pain, and stroke—on physical functioning, participation, and health status among older adults with visual impairments. Bivariate and multivariate procedures were used to compare older adults who had neither visual impairment nor these conditions with adults of similar age who had one of the nine conditions only, visual impairment only, or both visual impairment and the condition. Findings indicate that older adults with visual impairment frequently experience comorbid conditions, and that these conditions are associated with difficulties in walking and climbing steps, shopping, and socializing, and with significantly more self-reports of declining health. Results suggest that interventions by health care and mental health providers, as well as enhanced rehabilitation services, have the potential to reduce or prevent the deleterious effects of comorbid conditions.

Comparing iStent versus CyPass with or without phacoemulsification in patients with glaucoma: a meta-analysis

Bacground

The aim of this study was to conduct a meta-analysis to compare the overall intraocular pressure (IOP)-lowering effect of iStent or CyPass as isolated procedures or in combination with cataract extraction.

Materials and methods

Cochrane review manager 5.3 software (RevMan^® 5.3) was used for a meta-analysis of IOPs and the number of antiglaucoma medications in six groups according to the type and number of stents and whether the procedure was isolated or in combination with cataract extraction.

Main results

A total of 33 out of 446 publications retrieved have been enrolled. The mean changes in IOP in the groups with one iStent and more than two iStents with concurrent cataract extraction were -3.78 ± 0.53 mmHg and -3.89 ± 0.73 mmHg, respectively. The mean differences in IOP in the groups with one iStent and more than two iStents without concurrent cataract extraction were -3.96 ± 0.25 mmHg and -7.48 ± 0.55 mmHg, respectively. The mean changes in IOP in the groups with CyPass implantation with and without concurrent cataract extraction were -4.97 ± 1.38 mmHg and -8.96 ± 0.16 mmHg, respectively.

Conclusions

Both iStent and CyPass either in combination with cataract extraction or as isolated procedures effectively decrease IOP. This effect is greatest with isolated implantation of CyPass followed by multiple iStents and then single iStent implantation and lasts up to 2 years.

Depression in Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is a major cause of disability in the elderly, substantially degrades the quality of their lives, and is a risk factor for depression. Rates of depression in AMD are substantially greater than those found in the general population of older people, and are on par with those of other chronic and disabling diseases. This article discusses the effect of depression on vision-related disability in patients with AMD, suggests methods for screening for depression, and summarizes interventions for preventing depression in this high-risk group.

What is the impact of sensory practices on the quality of life of long-term care residents? A mixed-methods systematic review protocol

BACKGROUND

With age, the acuity of the five senses (i.e., hearing, sight, taste, smell, touch) is reduced. These types of sensory changes can affect day-to-day activities, making it more difficult for individuals to communicate and to interact with the world around them. The five senses allow us to receive information from the environment in the form of sound, light, smell, taste, and touch. As an older person's senses decline, they need more stimulation to be aware of these sensations. In long-term care settings, appropriate sensory practices are needed to address the diminishing senses of older adults. The objective of this mixed-methods systematic review is to examine the relationship between the sensory practices and the quality of life of residents living in long-term care settings and to develop an aggregated synthesis of mixed-methods studies to derive recommendations for policy, practice, and research.

METHODS

We will conduct a mixed-methods systematic review in accordance with the Cochrane Handbook. A search strategy has been developed with an expert health sciences librarian and peer reviewed using Peer Review for Electronic Search Strategies (PRESS). Seven databases: MEDLINE (Ovid), PubMed (non-MEDLINE-Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid), and Cochrane Central Register of Controlled Trials (CENTRAL) will be searched for studies that meet the inclusion criteria. Two reviewers will independently screen the results of the literature search using a two-step process. Eligible studies will undergo a quality assessment and data extraction. Disagreements will be resolved through consultation with a third reviewer. We will assess the quality of individual studies using the Mixed Methods Appraisal Tool (MMAT). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) will be used to summarize the strength of the quantitative evidence, and the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool to assess confidence in the qualitative syntheses.

DISCUSSION

This systematic review will summarize evidence-based knowledge for sensory practices, identify gaps in the literature, and inform an audit program for assessing the presence of sensory practices in the long-term care setting. The results will be relevant to policy makers, decision-makers, clinicians, and residents/families in long-term care settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration # CRD42017032330 .

Low vision rehabilitation: An update

This article provides information concerning issues related to the care of individuals who are visually impaired. Issues reviewed include determining who should be referred for vision rehabilitation services, Charles Bonnet syndrome, visual acuity, contrast sensitivity and visual field testing along with Useful Field of View testing. This article also discusses technology advances that can enhance the visual functioning of individuals who are visually impaired, including how these advances can help drivers with visual impairments to continue to safely operate motor vehicles, at least on a limited basis. Finally, resources that are available to both encourage and motivate patients to take advantages of vision rehabilitation services are reviewed.

Visual impairment and risk of depression: A longitudinal follow-up study using a national sample cohort

The association of visual impairment and depression has been investigated in several studies based on a cross-sectional design, which cannot delineate temporal relationships. In the present study, we evaluated the influence of visual impairment on depression in all age groups using a longitudinal database of a national sample cohort from 2002 to 2013 provided by the Korean National Health Insurance Service. Of a total of 1,025,340 subjects, 5,846 participants who were registered as visually impaired persons without a previous diagnosis of depression were enrolled at a 1:4 ratio with 23,384 control participants matched for age, sex, income, and region of residence. The crude and adjusted (age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia) hazard ratios (HRs) for the development of depression between the visually impaired and control groups were analyzed using a Cox proportional hazards model. Visual impairment increased the risk of depression after adjusting for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia (adjusted HR = 1.19, P = 0.002). The risk of depression increased significantly in both the non-blindness visual impairment (adjusted HR = 1.15, P = 0.036) and blindness subgroups (adjusted HR = 1.31, P = 0.016), with a higher HR in the blindness subgroup.

The impact of age-related cataract on measures of frailty in an aging global population

PURPOSE OF REVIEW

To review the associations among age-related cataract, frailty, and frailty outcomes (e.g., disabilities).

RECENT FINDINGS

It is predicted that the proportion of the population aged 65 and older, in developed and developing nations alike, will rise until at least 2050. The proportion of patients suffering from cataracts and frailty is expected to increase, as are age-related diseases. Although there are many papers reporting on the association between frailty outcomes, cataract, and visual impairment, there is a relative paucity of papers describing associations between frailty markers, cataract, and visual impairment.

SUMMARY

Reports regarding the relationship between frailty, visual impairment, cataract, and cataract surgery are limited, but gradually increasing. Further research is expected to clarify the mechanism of visual function or the impact of restored vision on frailty. Evidence for the effect of cataract on frailty and frailty outcomes after restoring vision by cataract surgery remains limited.

Seeing through their eyes: lived experiences of people with retinitis pigmentosa

PurposeRetinitis pigmentosa (RP) is the most common retinal degeneration causing blindness. Although their clinical problems are amenable for the clinical diagnosis, their day-to-day problems for having to live with the disease are mostly unexplored. This study aims to explore and understand the issues and impact of people with RP on quality of life (QoL).MethodsA qualitative research methodology to facilitate the understanding of the experiences of people with RP was carried out. Data were collected through audio-recorded semi-structured interviews. Thematic analysis occurred through the process of line-by-line coding, aggregation, and theme development using the NVivo-10 software.ResultsTwenty-three interviews were conducted (mean age=56 years; females, 14). We identified five major QoL themes: (1) struggle to perform important day-to-day tasks; (2) concerns about disease progression, disease outcome and personal safety; (3) facing a lot of emotional and psychological challenges; (4) experiencing a myriad of visual symptoms; and (5) adopting different strategies to cope and manage stressful circumstances. Difficulty in performing important day-to-day tasks was the most prominent QoL issue among these people. Their major concerns were going blind and uncertainties about their future. They face a lot of emotional and psychological challenges to adapt to the physiological stress associated with the progressive vision loss. However, they adopt several coping strategies to manage the stressful circumstances.ConclusionsPeople with RP experience a myriad of QoL issues. Despite all the hardship, they remain optimistic and learn to accept their eye condition and move on in life.

Does Visual Impairment Affect Social Ties in Late Life? Findings of a Multicenter Prospective Cohort Study in Germany

OBJECTIVE

To investigate how visual impairment affects social ties in late life longitudinally.

DESIGN

Population-based prospective cohort study.

SETTING

Individuals in old age were recruited via general practitioners' offices (at six study centers) in Germany. They were interviewed every 18 months.

PARTICIPANTS

Individuals aged 75 years and above at baseline. Follow-up wave 2 (36 months after baseline, n=2,443) and wave 4 (72 months after baseline, n=1,618) were used for the analyses presented here.

MEASUREMENTS

Social ties were assessed using the 14-item form of the questionnaire for social support (F-SozU K-14). Visual impairment was self-rated on a three level Likert scale (no impairment, mild visual impairment, or severe/profound visual impairment).

RESULTS

Adjusting for sociodemographic factors, hearing impairment and comorbidity, fixed effects regressions revealed that the onset of mild visual impairment decreased the social support score, in particular the emotional support score. Additionally, the onset of mild hearing impairment decreased the social support score in men. Moreover, increasing age decreased the social support score in the total sample and in both sexes. Loss of spouse and increasing comorbidity did not affect the social support score.

CONCLUSION

Our results highlight the importance of visual impairment for social ties in late life. Consequently, appropriate strategies in order to delay visual impairment might help to maintain social ties in old age.

Targeted Vision Function Goals and Use of Vision Resources in Ophthalmology Patients with Age-Related Macular Degeneration and Comorbid Depressive Symptoms

Introduction

This study characterizes self-reported functional vision goals and the use of low vision resources (for example, services and devices) in ophthalmology clinic patients with age-related macular degeneration (AMD) and comorbid depressive symptoms.

Methods

From July 2009 to February 2013, we assessed 188 consecutive patients (age 65 +; mean 84.0 years; 70.2% female) with AMD (best corrected distance acuity 20/70 or worse) enrolled in a 12-month randomized clinical trial to test the efficacy of a multi-component intervention that combined low vision optometry and home-based occupational therapy to prevent depression (Low Vision Depression Prevention Trial [VITAL]). A geriatric nurse conducted in-home assessments to measure visual acuity and contrast sensitivity, self-reported functional vision, functional vision goals that were personally important yet difficult to achieve (targeted vision function goals), and the use of low vision resources (defined as services, devices and strategies utilized by low vision patients to compensate for visual deficits). This study reports on baseline data collected prior to randomization.

Results

Only 9.6% of the sample had received formal low vision services. The five most common goals were newspaper reading, leisure and entertainment, computer use, personal communication, and correspondence. Participants engaged in targeted vision function goals less frequently since being diagnosed with AMD, despite using low vision resources and reporting low to moderate difficulty in using them.

Discussion

Few patients with AMD seen in ophthalmology clinics received low vision rehabilitation. Patients who utilized resources engaged in goals less frequently since being diagnosed with AMD.

Implications for practitioners

Patients with AMD are underutilizing low vision rehabilitation resources. Strategies for increasing low vision referrals are suggested.

The Role of Vision and Hearing in Physical, Social, and Emotional Functioning Among Older Adults

The present study examined the comparative roles of vision and hearing in differentaspects of older individuals' lives. The significance of vision and hearing on physical, social, and emotional functioning (disability, social activity, and depressive symptoms) was assessed along with the role of personality traits and social resources, using a stratified sample of 425 community-dwelling older individuals ( M age = 72.2). Vision was a significant factor for disability, while hearing was significantly associated with social activity, implying the unique contribution of vision and hearing. The association between sensory performance and depressive symptoms became nonsignificant in multivariate analysis. After adjusting for vision and hearing, psychosocial factors increased the amount of explained variance in physical, social, and emotional outcomes. The findings demonstrate the important roles of personality and social resources along with vision and hearing and suggest a need to consider them when planning interventions.

Effect of rehabilitation worker input on visual function outcomes in individuals with low vision: study protocol for a randomised controlled trial

Background

Visual Rehabilitation Officers help people with a visual impairment maintain their independence. This intervention adopts a flexible, goal-centred approach, which may include training in mobility, use of optical and non-optical aids, and performance of activities of daily living. Although Visual Rehabilitation Officers are an integral part of the low vision service in the United Kingdom, evidence that they are effective is lacking. The purpose of this exploratory trial is to estimate the impact of a Visual Rehabilitation Officer on self-reported visual function, psychosocial and quality-of-life outcomes in individuals with low vision.

Methods/design

In this exploratory, assessor-masked, parallel group, randomised controlled trial, participants will be allocated either to receive home visits from a Visual Rehabilitation Officer (n = 30) or to a waiting list control group (n = 30) in a 1:1 ratio. Adult volunteers with a visual impairment, who have been identified as needing rehabilitation officer input by a social worker, will take part. Those with an urgent need for a Visual Rehabilitation Officer or who have a cognitive impairment will be excluded. The primary outcome measure will be self-reported visual function (48-item Veterans Affairs Low Vision Visual Functioning Questionnaire). Secondary outcome measures will include psychological and quality-of-life metrics: the Patient Health Questionnaire (PHQ-9), the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Adjustment to Age-related Visual Loss Scale (AVL-12), the Standardised Health-related Quality of Life Questionnaire (EQ-5D) and the UCLA Loneliness Scale. The interviewer collecting the outcomes will be masked to the group allocations. The analysis will be undertaken on a complete case and intention-to-treat basis. Analysis of covariance (ANCOVA) will be applied to follow-up questionnaire scores, with the baseline score as a covariate.

Discussion

This trial is expected to provide robust effect size estimates of the intervention effect. The data will be used to design a large-scale randomised controlled trial to evaluate fully the Visual Rehabilitation Officer intervention. A rigorous evaluation of Rehabilitation Officer input is vital to direct a future low vision rehabilitation strategy and to help direct government resources.

Trial registration

The trial was registered with (ISRCTN44807874) on 9 March 2015.

Global Sensory Impairment in Older Adults in the United States

OBJECTIVES

To determine whether there may be a common mechanism resulting in global sensory impairment of the five classical senses (vision, smell, hearing, touch, and taste) in older adults.

DESIGN

Representative, population-based study.

SETTING

National Social Life, Health, and Aging Project.

PARTICIPANTS

Community-dwelling U.S. adults aged 57 to 85.

MEASUREMENTS

The frequency with which impairment co-occurred across the five senses was estimated as an integrated measure of sensory aging. It was hypothesized that multisensory deficits would be common and reflect global sensory impairment that would largely explain the effects of age, sex, and race on sensory dysfunction.

RESULTS

Two-thirds of subjects had two or more sensory deficits, 27% had just one, and 6% had none. Seventy-four percent had impairment in taste, 70% in touch, 22% in smell, 20% in corrected vision, and 18% in corrected hearing. Older adults, men, African Americans, and Hispanics had greater multisensory impairment (all P < .01). Global sensory impairment largely accounted for the effects of age, sex, and race on the likelihood of impairment in each of the five senses.

CONCLUSION

Multisensory impairment is prevalent in older U.S. adults. These data support the concept of a common process that underlies sensory aging across the five senses. Clinicians assessing individuals with a sensory deficit should consider further evaluation for additional co-occurring sensory deficits.

Anxiety and depression in patients with advanced macular degeneration: current perspectives

Age-related macular degeneration (AMD) - despite advances in prevention and medical treatment options - remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD.

Emotional Health of People with Visual Impairment Caused by Retinitis Pigmentosa

Purpose

To understand the emotional difficulties associated with living with the ocular condition Retinitis Pigmentosa, and to examine the functioning of a self-report instrument used to assess this construct.

Methods

The difficulty of goals and tasks in the emotional health domain of the Dutch ICF Activity Inventory were rated by 166 people with Retinitis Pigmentosa in a cross-sectional study. Demographic factors were also assessed.

Results

Responses to the 23 emotional health tasks were Rasch analysed and could be used to form either one 20 item overview scale with some multidimensionality, or three unidimensional subscales addressing feelings (4 items), communicating visual loss (5 items) and fatigue (7 items). The most difficult individual tasks related to communicating visual loss to other people, and dealing with feelings such as frustration, anxiety and stress. The use of mobility aids and female gender were associated with increased difficulty with emotional health, explaining 19% of the variance in the overview scale.

Conclusions

The emotional health domain of the Dutch ICF Activity Inventory is a valid tool to assess emotional difficulties arising from visual loss. Interventions to aid people with Retinitis Pigmentosa deal with emotional difficulties should particularly address communicating vision loss effectively to others and coping with negative feelings.

Screening for sensory impairment in older adults: Training and practice of occupational therapists in Quebec

BACKGROUND

The goal of occupational therapy education is to train generalists who can refine their knowledge after graduation according to the requirements of the professional environment. However, it is currently unclear to what extent sensory screening should be included in the educational curricula.

PURPOSE

The purpose of this study was to examine the sensory screening education for and practice by occupational therapists working with older adults.

METHOD

A cross-sectional survey was used to collect data from members of the Quebec Order of Occupational Therapists. Descriptive statistics were used in the analysis.

FINDINGS

Data from 102 respondents indicated that training on sensory impairment-related topics was minimal and in stark contrast to the proportion who reported serving clients with a visual (92%), hearing (84%), or combined impairment (53%).

IMPLICATIONS

Occupational therapy considers numerous aspects of physical, cognitive, and emotional well-being. The question remains as to what extent vision and hearing health should take their place among these priorities.

Low-vision service provision by optometrists: a Canadian nationwide survey

PURPOSE

To document the degree to which Canadian optometrists are involved in the provision of low-vision (LV) care and their referral patterns. To investigate the barriers to providing optometric low-vision services (LVS).

METHODS

Practicing optometrists across Canada were randomly sampled and invited to participate in a questionnaire that included questions on personal profile, primary practice profile, levels of LV care offered, patterns of referral, and barriers to provision of LV care. Questions included a combination of multiple choice and open-ended formats, and included hypothetical cases.

RESULTS

A total of 459 optometrists responded (response rate, 24.8%). Optometrists estimated that 1% (range, 0 to 100%) of their patients were LV patients yet also estimated that 10% of their patients had acuity equal to or worse than 20/40. Thirty-five percent of respondents indicated that their primary practice offered LV care, 75.6% would manage a patient with minimum disability and simple goals themselves, whereas 10.7% would manage a patient with more than minimal visual disability who needed more specialized LV devices (e.g., telescopes, electronic aids, and custom-designed microscopes); 84.3% of optometrists would assess for basic magnification and lighting in a hypothetical patient with early age-related macular degeneration, whereas 15% would undertake full LV rehabilitation in advanced age-related macular degeneration. Optometrists commonly referred to CNIB (formerly the Canadian National Institute for the Blind), yet only 10.7% of respondents almost always received a written report after referral. Those who would not undertake LV assessment stated that they lacked the knowledge, equipment, or experience; that LV assessment is too time consuming; and that the cost is too prohibitive.

CONCLUSIONS

This is the first comprehensive study of LVS provision by optometrists in Canada. In order for optometrists to become more involved in LVS, there is a need for more LV education, provincial health coverage of optometric LVS, and better collaboration communication between LV providers.

Association of Ophthalmologic Disorders and Depression in the Elderly: A Review of the Literature

OBJECTIVE

To review the prevalence of depression in common ophthalmologic disorders in the elderly and provide insight into treatment.

DATA SOURCES

PubMed, Google Scholar, and DynaMed were searched using the terms depression and ophthalmology in combination with depression, mood disorders, cataracts, vision loss, age-related macular degeneration, primary open-angle glaucoma, and Fuchs corneal dystrophy. Articles were limited to those published in the English language between 1993 and 2013.

STUDY SELECTION AND DATA EXTRACTION

Twenty-eight articles that studied the prevalence of depression in ophthalmologic disorders were screened and summarized.

RESULTS

The strongest association between ophthalmologic disorders and psychiatry is depression. In the future, primary care physicians and psychiatrists should play a significant role in the assessment and treatment of depression in visually impaired patients.

CONCLUSION

Greater recognition and treatment of depression in individuals with impaired vision is warranted.