Visual Impairment among Older Adults in a Rural Community in Eastern China

The Burden of Managing Medicines for Older People With Sensory Impairment: An Ethnographic-Informed Study

Background: Older age is associated with increased prevalence of sensory impairment and use of medicines. Objectives: To explore the daily "medicine journey" of older people with sensory impairment. Methods: The study used ethnographic-informed methods (using audio-, photo- and video-recordings, diary notes and semi-structured interviews with researchers) and involved community-dwelling adults (aged > 65) in Scotland, with visual and/or hearing impairment and using >4 medicines. Data analysis used the constant comparative method. Results: Fourteen older people with sensory impairment participated and used a mean of 11.0 (SD 5.0) medicines (range 5-22). Participants reported difficulties with medicine ordering, obtaining, storage, administration and disposal. They used elaborate strategies to manage their medicines including bespoke storage systems, fixed routines, simple aids, communication, and assistive technologies. Conclusion: Older people with sensory impairment experience substantial burden, challenges and risk with medicines management. Tailored medicine regimens and assistive technologies could provide greater support to older people with sensory impairment.

Development and validation of a risk prediction model for visual impairment in older adults

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.

Common causes of visual impairment in the elderly

Background

Aging is not a disease; rather, it is a process. As people age, visual impairment (VI) becomes more common. In 2010, the overall prevalence rate of vision impairment in all races was 25.66% in individuals aged ≥ 80 years, according to the estimate of the National Eye Institute at the National Institutes of Health. This review aimed to address the common causes of VI in the elderly.

Methods

In this narrative review, an electronic search of the PubMed/MEDLINE database was conducted using "visual impairment" and "elderly" for the period between January 2010 and April 2021, to include randomized clinical trials and observational studies concerning VI in the elderly. The selected time period was chosen to provide an updated review.

Results

The search yielded 2955 articles published over the period of more than 11 years. The relevant randomized clinical trials or observational studies were included and reviewed. Cataracts, refractive errors, open-angle glaucoma, age-related macular degeneration, and diabetic retinopathy were the most common age-related ocular disorders leading to VI if untreated in the elderly. The loss of visual acuity can adversely affect quality of life in the elderly. Difficulty with activities of daily living related to VI can lead to social isolation, depression, and anxiety. Loss of vision in the elderly is linked to an increased risk of falls, hip fracture, depression, and poor quality of life.

Conclusions

The most common causes of VI in the elderly are cataracts and refractive errors. VI in most ocular diseases is more prevalent in women than in men due to longer lifespan. The overall prevalence of the main causes of VI in the elderly is expected to increase; therefore, health policymakers should consider this when planning for the health-enhancement program of the population.

Corneal Blindness in Asia: A Systematic Review and Meta-Analysis to Identify Challenges and Opportunities

PURPOSE

To describe the causes and prevalence of moderate-to-severe visual impairment (MSVI) and blindness from corneal diseases, as well as corneal transplantation across Asia.

METHODS

A meta-analysis of the published literature to identify population-based surveys conducted from 2008 to 2019 in 22 Asian countries regarding the prevalence and causes of MSVI and blindness from corneal disease, and a review of national corneal transplant data and eye bank statistics.

RESULTS

A total of 5307 records were screened to identify 57 reports that were used to estimate a prevalence of MSVI and blindness caused by corneal diseases in Asia of 0.38% (95% confidence interval, 0.29%-0.48%). The most frequent corneal diseases were infectious keratitis, trauma, and pseudophakic bullous keratopathy. As expected, these represented the most common indications for corneal transplantation, although the percentages in each country differed based on the level of economic development, with pseudophakic bullous keratopathy being the most common indication in countries with higher gross national income per capita. Despite this, endothelial keratoplasty is not the most commonly performed form of corneal transplantation in any Asian country and represents only a small percentage of keratoplasty procedures performed in most countries.

CONCLUSIONS

The prevalence of MSVI and blindness from corneal disease in Asia is approximately 0.4%, with a nearly 20-fold difference in the national prevalence across the region. The indications for keratoplasty, reflective of the causes of corneal dysfunction, also vary, more so according to the gross national income than to geographic location, and only a few Asian countries have rates of corneal transplantation above international means.

Prevalence of visual impairment among older Chinese population: A systematic review and meta-analysis

Background

To evaluate the prevalence of visual impairment (VI) among elderly Chinese population.

Methods

All population-based studies on VI prevalence among elderly Chinese populations were searched and only studies with clear definitions of diagnosis were selected. Meta-analysis methods were used to estimate the pooled prevalence and its 95% confidence interval (95%CI) of moderate and severe visual impairment (MSVI) and blindness both by presenting visual acuity (PVA) and best corrected visual acuity (BCVA). Subgroup analysis of gender, district, geographical location, age, education level and examined year were also conducted.

Results

72 studies with 465 039 individuals were included and analyzed. Using PVA, the pooled prevalence of MSVI is 10.9% (95% CI = 9.4%-12.6%) and blindness is 2.2% (95% CI = 1.8%-2.8%), while prevalence of MSVI and blindness by BCVA was 5.4% (95% CI = 4.6%-6.2%) and 2.2% (95% CI = 1.9%-2.5%), respectively. Females, rural residents, older age and lower educational level were risk factors for MSVI and blindness.

Conclusions

VI causes a great health burden among Chinese populations, particularly affecting female subjects, subjects dwelling in rural area, older subjects and subjects with lower educational level.

Sociodemographic, behavioral, and medical risk factors associated with visual impairment among older adults: a community-based pilot survey in Southern District of Hong Kong

Background

The last visual survey of older adults in Hong Kong was a district-level study in 2002, with no assessment of behavioral and medical risk factors for visual impairment (VI). Our objectives were to determine the latest VI prevalence among older adults, significance of any spatial and temporal differences on the prevalence, and any associations of sociodemographic, behavioral and medical risk factors with VI from a multi-perspective analysis.

Methods

Community-based pilot survey of residents from a suburb of Hong Kong, aged ≥50, using a standardized questionnaire, was conducted in 2016.

Results

Of the 222 subjects, crude rates of bilateral and unilateral VI were 9.46 and 32.88%, respectively, or corresponding age-and-gender-adjusted rates of 6.89 and 30.5%. Older age and lower educational were associated with higher risk for unilateral VI, while older age, temporary housing, obesity and hyperlipidemia were associated with higher risk for bilateral VI. Smoking and alcohol-drinking status were not associated with unilateral or bilateral VI. Relative changes in ORs of hypertension or educational level on unilateral or bilateral VI were >  10% after adjusting for age. Interaction term between hyperlipidemia and gender or obesity was significant for unilateral VI. Gender, hypertension and cataract were not associated with unilateral or bilateral VI in general population of pooled analysis but were identified as risk factors in specific subgroups of stratified analysis. Refractive error (myopia or hyperopia) was significantly associated with VI in the eye-level analysis after adjusting the inter-eye correlation.

Conclusions

Sociodemographic and medical risk factors contributed to VI, but behavioral risk factors did not. Sociodemographic disparities of visual health existed. Age was the confounders of the VI-hypertension or VI-educational level relationships. Gender and obesity were more likely to have multiplicative effect on unilateral VI when combined with hyperlipidemia. Stratified analysis should be conducted to provide further insight into the risk factors for VI in specific populations. Uncorrected refractive error remains a significant cause of impaired vision. The spatial and temporal differences in bilateral VI prevalence from the previous local study indicates a territory-wide survey is needed to assess regional differences and overall prevalence of VI in Hong Kong.

Proportion and Associated Factors of Low Vision among Adult Patients Attending at University of Gondar Tertiary Eye Care and Training Center, Gondar Town, Ethiopia

Introduction

Low vision is a worldwide health problem in both developing and developed countries. A national survey of low vision and blindness in Ethiopia showed that the prevalence of low vision was 3.7% and that of blindness was 1.6%, whereas there is no evidence in the study area.

Purpose

The study was aimed to assess the proportion and associated factors of low vision at the University of Gondar tertiary eye care and training center.

Methods

A hospital-based cross-sectional study was conducted on 727 study participants with a systematic random sampling technique from April 18 to May 16, 2019. Data were collected through the use of a structural questionnaire and physical eye examination. Data were entered into Epi Info version 7, and analysis was performed by using statistical package for social science (SPSS) version 20. The binary logistic regression model was fitted to identify factors associated with low vision, and variables with a P value of <0.05 in a multivariable binary logistic regression were considered as statistically significant.

Results

A total of 715 study participants have participated in this study with a mean age of 49.39 ± 19.93 years. The prevalence of low vision was 35.7% (95% CI: 32.3, 39.3). Being female (AOR = 1.58; 95% CI: 1.10, 2.28), no formal educational level (AOR = 2.24; 95% CI: 1.25, 4.02), history of cataract surgery (AOR = 2.58; 95% CI: 1.53, 4.36), and age ≥ 70 years (AOR: 3.96; 95% CI: 2.21, 7.10) were significantly associated with low vision. Conclusion and Recommendation. The prevalence of low vision found in this study was high as compared with the national and global magnitude. Older age, being female, previous history of cataract surgery, and no formal education were independently and significantly associated with low vision. Cataract and uncorrected refractive errors were identified as the main causes of low vision. Therefore, it requires a plan to provide an eye care education to the community, increasing the quality of cataract surgery and refractive service for the community in the catchment area.

Serum metabolic signatures of high myopia among older Chinese adults

PURPOSE

High myopia is associated with blinding ocular morbidities. Identifying novel biomarkers may provide clues on pathogenic pathways that are currently unknown. We aimed to identify serum metabolic biomarkers and investigate the metabolic alterations in relation to high myopia.

METHODS

Forty adults with high myopia and 40 with low myopia aged 60 years or older from the Weitang Geriatric Diseases study were included in the case-control study. Refractive error was determined by autorefraction followed by subjective refraction. We performed the metabolomic analysis of serum samples from patients with high myopia and age- and sex- matched controls with low myopia, using a nontargeted gas chromatography coupled to time-of-flight mass spectrometer. The area under the receiver operating characteristic curve (AUC) was computed to assess the discrimination capacities of each metabolite marker. Databases including KEGG and MetaboAnalyst were utilized to search for the potential pathways of metabolites.

RESULTS

Serum metabolomic profiles could well distinguish high myopia from low myopia. Twenty metabolic biomarkers were identified as potential serum biomarkers for high myopia, yielding AUC values of 0.59-0.71. Metabolic pathways in relation to high myopia, mainly characterized by increased energy metabolism, increased oxidative stress, abnormal amino acid metabolism, and altered biotin metabolism, provide a foundation to support myopia progression.

CONCLUSIONS

This study identified valuable metabolic biomarkers and pathways that may facilitate an improved understanding of the disease pathogenesis. The finding holds translational value in the development of new therapeutic measures for high myopia-related complications.

A qualitative exploration of the experiences of community dwelling older adults with sensory impairment/s receiving polypharmacy on their pharmaceutical care journey

BACKGROUND

Most developed countries have increasing numbers of community dwelling older people with both multi-morbidity and sensory impairment that includes visual, hearing or dual impairment. Older people with sensory impairment are more likely to have chronic health conditions and to be in receipt of polypharmacy (>4 medicines). It is important to understand their experience of pharmaceutical care provision to facilitate a safe, appropriate and person centred approach.

AIM

this study explored the pharmaceutical care experiences and perspectives of older people with sensory impairment receiving polypharmacy.

DESIGN AND SETTING

exploratory qualitative study with semi-structured telephone or face-to-face interviews with community dwelling older adults with sensory impairment receiving polypharmacy in Scotland in 2016.

METHODS

in total, 23 interviews were conducted with older people from seven of the 14 Scottish Health Board areas.

SUBJECTS

over half the participants (n = 12) had dual sensory impairment, six had visual impairment and five had hearing impairment.

RESULTS

three overarching themes were identified reflecting different stages of participants' pharmaceutical care journey: ordering and collection of prescriptions; medicine storage; and administration. At each stage of their journey, participants identified barriers and facilitators associated with their pharmaceutical care.

CONCLUSIONS

this is the first comprehensive, in-depth exploration of the pharmaceutical care journey needs of older people with sensory impairment. As the number of community dwelling older people with sensory impairment and polypharmacy increases there is a requirement to identify challenges experienced by this population and offer solutions for safe and effective pharmaceutical care provision.