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Ekemiri K, Ekemiri C, Ezinne N, Virginia V, Okoendo O, Seemongal-Dass R, Van Staden D, Abraham C. Global burden of fall and associated factors among individual with low vision: A systematic-review and meta-analysis. PLoS One 2024; 19:e0302428. [PMID: 39047020 PMCID: PMC11268632 DOI: 10.1371/journal.pone.0302428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/04/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Low vision has a significant global health problem that impacts the personal, economical, psychological, and social life of an individual. Each year around 684 000 individuals die from falls, 80% of these deaths occur are in low- and middle-income countries. The risk of falling significantly increases with visual impairment. This review aimed to determine the global pooled prevalence of fall and associated factors among individuals with low vision. METHODS AND MATERIALS Systematic search of published studies done on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL and, Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to report the findings. Quality of studies was assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using a random-effects method using the STATA™ Version 14 software. RESULT Thirty-five (35) studies from different regions involving 175,297 participants included in this meta-analysis. The overall pooled global prevalence fall among individual with low vision was17.7% (95% CI: 16.4-18.9) whereas the highest prevalence was 35.5%; (95% CI: 28.4-42.5) in Australia and the lowest was 19.7%; (95% CI: 7.6-31.8) seen in South America. Fear of falling (OR: 0.16(95%CI 0.09-0.30), and severity of visual impairment (OR: 0.27(95%CI (0.18-0.39) increases the odds of falling. CONCLUSION As one cause of accidental death, the prevalence of falls among individuals with low vision is high. Fear of falling and severity of falling increases the odds of falling. Different stakeholders should give due attention and plan effective strategies to reduce the fall among this population.
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Affiliation(s)
- Kingsley Ekemiri
- Department of Optometry, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Tunapuna, Trinidad and Tobago
| | - Chioma Ekemiri
- Department of Health Promotion, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Tunapuna, Trinidad and Tobago
| | - Ngozika Ezinne
- Department of Optometry, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Tunapuna, Trinidad and Tobago
| | - Victor Virginia
- School of Nursing, Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Tunapuna, Trinidad and Tobago
| | - Osaze Okoendo
- Department of Optometry, Courts Optical, Couva, Trinidad and Tobago
| | - Robin Seemongal-Dass
- Ophthalmology Unit, Faculty of Medical Sciences, The University of the West Indies, Tunapuna, Trinidad and Tobago
| | - Diane Van Staden
- Faculty of Health Sciences and Social Development, University of British Columbia, Tunapuna, South Africa
| | - Carl Abraham
- Department of Optometry and Vision Sciences, University of the Cape Coast, Coast, Ghana
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Stolwijk ML, van Nispen RMA, van der Pas SL, van Rens GHMB. A retrospective big data study using healthcare insurance claims to investigate the role of comorbidities in receiving low vision services. FRONTIERS IN HEALTH SERVICES 2024; 4:1264838. [PMID: 38500632 PMCID: PMC10944930 DOI: 10.3389/frhs.2024.1264838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
Introduction The aim was to examine the association between physical and mental comorbidity with receiving low vision services (LVS). Methods A retrospective study based on Dutch claims data of health insurers was performed. We retrieved data (2015-2018) of patients (≥18 years) with eye diseases causing severe vision loss who received LVS at Dutch rehabilitation organizations in 2018 (target group) and patients who did not receive LVS, but who received ophthalmic medical specialist care for glaucoma, macular, diabetic retinal and/or retinal diseases in 2018 (reference group). For examining the association between the patients' comorbidities and receiving LVS, multivariable logistic regression was used. The relative quality of five different models was assessed with the Akaike Information Criterion (AIC). Results The study population consisted of 574,262 patients, of which 8,766 in the target group and 565,496 in the reference group. Physical comorbidity was found in 83% and 14% had mental comorbidity. After adjustment for all assumed confounders, both physical and mental comorbidity remained significantly associated with receiving LVS. In the adjusted model, which also included both comorbidity variables, the best relative quality was found to describe the association between mental and physical comorbidity and receiving LVS. Conclusions Mental comorbidity seemed to be independently associated with receiving LVS, implying that the odds for receiving a LVS referral are higher in patients who are vulnerable to mental comorbidity. Physical comorbidity was independently associated, however, the association with receiving LVS might not be that meaningful in terms of policy implications. Providing mental healthcare interventions for people with VI seems warranted.
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Affiliation(s)
- M. L. Stolwijk
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, Netherlands
| | - R. M. A. van Nispen
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, Netherlands
| | - S. L. van der Pas
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Methodology, Amsterdam Public Health, Amsterdam, Netherlands
| | - G. H. M. B. van Rens
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, Netherlands
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Bittner AK, Kaminski JE, Yoshinaga PD, Shepherd JD, Chan TL, Malkin AG, Deemer A, Gobeille M, Thoene SJ, Rossi A, Ross NC. Outcomes of Telerehabilitation Versus In-Office Training With Magnification Devices for Low Vision: A Randomized Controlled Trial. Transl Vis Sci Technol 2024; 13:6. [PMID: 38214688 PMCID: PMC10790671 DOI: 10.1167/tvst.13.1.6] [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: 10/18/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024] Open
Abstract
Purpose An evidence basis is lacking but needed to compare reading ability outcomes after magnification device training remotely via telerehabilitation versus in office. Methods A multicenter randomized controlled trial at academic centers and vision rehabilitation private practices randomized 61 visually impaired adults to telerehabilitation or in-office training 1 to 4 months after dispensing new portable electronic, hand-held, or stand optical magnifiers. Telerehabilitation included loaner equipment for Zoom videoconferencing with remote control access software. Using a multilevel regression model, changes in Activity Inventory responses using Rasch analysis estimated reading ability in dimensionless log odds units (logits) (0.14-logit change corresponds with ability change expected from a one-line change in visual acuity). Results Across 47 participants who completed the trial, reading ability with new magnifiers improved significantly by 0.61 logits on average (95% confidence interval [CI], 0.36-0.86; P < 0.001) from baseline to 1 month, and by an additional 0.44 logits on average (95% CI, 0.19-0.69; P < 0.001) from 1 to 4months (i.e., after magnifier training), with very similar significant findings for both telerehabilitation (n = 29; mean improvement = 0.44 logits; 95% CI, 0.08-0.80; P = 0.018) and in-office training (n = 18; mean improvement = 0.43 logits; 95% CI, 0.15-0.71; P = .003), and no significant difference between randomized groups across both follow-ups (95% CI, -0.43 to 0.61; P = .73). Vision, demographics, and health factors were nonsignificantly related to reading ability changes from 1 to 4 months. Conclusions Reading ability improved after the provision of newly dispensed magnifiers, with further improvements following additional magnifier training via either telerehabilitation or in-office usual care. Translational Relevance These findings provide support for the use of telerehabilitation to enhance reading ability with newly prescribed magnifiers as an alternative modality of care delivery.
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Affiliation(s)
- Ava K Bittner
- University of California, Los Angeles, Department of Ophthalmology, Stein Eye Institute, Los Angeles, CA, USA
| | | | - Patrick D Yoshinaga
- Marshall B. Ketchum University, Southern California College of Optometry, Fullerton, CA, USA
| | - John D Shepherd
- University of Nebraska Medical Center, Department of Ophthalmology, Truhlsen Eye Institute, Weigel Williamson Center for Visual Rehabilitation, Omaha, NE, USA
| | - Tiffany L Chan
- Chan Family Optometry, Grass Valley, CA, USA
- Frank Stein & Paul S. May Center for Low Vision Rehabilitation, San Francisco, CA, USA
| | | | - Ashley Deemer
- Marshall B. Ketchum University, Southern California College of Optometry, Fullerton, CA, USA
| | | | - Stacy J Thoene
- University of Nebraska Medical Center, Department of Ophthalmology, Truhlsen Eye Institute, Weigel Williamson Center for Visual Rehabilitation, Omaha, NE, USA
| | - Annemarie Rossi
- Frank Stein & Paul S. May Center for Low Vision Rehabilitation, San Francisco, CA, USA
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Pundlik S, Shivshanker P, Luo G. Impact of Apps as Assistive Devices for Visually Impaired Persons. Annu Rev Vis Sci 2023; 9:111-130. [PMID: 37127283 DOI: 10.1146/annurev-vision-111022-123837] [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] [Indexed: 05/03/2023]
Abstract
The pervasiveness of mobile devices and other associated technologies has affected all aspects of our daily lives. People with visual impairments are no exception, as they increasingly tend to rely on mobile apps for assistance with various visual tasks in daily life. Compared to dedicated visual aids, mobile apps offer advantages such as affordability, versatility, portability, and ubiquity. We have surveyed hundreds of mobile apps of potential interest to people with vision impairments, either released as special assistive apps claiming to help in tasks such as text or object recognition (n = 68), digital accessibility (n = 84), navigation (n = 44), and remote sighted service (n = 4), among others, or marketed as general camera magnification apps that can be used for visual assistance (n = 77). While assistive apps as a whole received positive feedback from visually impaired users, as reported in various studies, evaluations of the usability of every app were typically limited to user reviews, which are often not scientifically informative. Rigorous evaluation studies on the effect of vision assistance apps on daily task performance and quality of life are relatively rare. Moreover, evaluation criteria are difficult to establish, given the heterogeneity of the visual tasks and visual needs of the users. In addition to surveying literature on vision assistance apps, this review discusses the feasibility and necessity of conducting scientific research to understand visual needs and methods to evaluate real-world benefits.
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Affiliation(s)
- Shrinivas Pundlik
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA;
| | - Prerana Shivshanker
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA;
| | - Gang Luo
- Schepens Eye Research Institute of Mass Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA;
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Saito T, Imahashi K. Barriers and enablers of utilization of low-vision rehabilitation services among people 50 years or older in East and Southeast Asia: a scoping review protocol. JBI Evid Synth 2023; 21:1687-1696. [PMID: 36974445 DOI: 10.11124/jbies-22-00429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVES This scoping review aims to explore and describe the barriers and enablers of low-vision rehabilitation service utilization among people 50 years or older in East and Southeast Asia. INTRODUCTION Vision impairment is strongly associated with aging. East and Southeast Asia are experiencing a rapidly growing aging population and the associated eye-related health burdens. Despite the benefits of low-vision rehabilitation services, they are underutilized in these regions. Identifying the barriers and enablers of service utilization could be a crucial first step in making the services more accessible and, ultimately, easing the burden of this health issue. INCLUSION CRITERIA This review will include published quantitative, qualitative, or mixed methods studies and reviews that examine the barriers and/or enablers of low-vision rehabilitation service utilization among people aged 50 years or older living in East and Southeast Asia. Low-vision rehabilitation services are defined as any kind of intervention that aims to mitigate the impact of disability induced by eye-related health conditions. METHODS A literature search of 4 databases (MEDLINE, Web of Science, Academic Search Ultimate, and Ichushi-Web), as well as a manual search of the reference lists of included articles, will be conducted to identify eligible articles. Two independent reviewers will assess the articles for inclusion. Data extraction will focus on general information of the study, demographic or descriptive information about the study population, the eye condition being studied, means of low-vision rehabilitation, and the barriers and/or enablers of service utilization. The information will be tabulated to depict the categories of barriers and enablers that influence access to services. REVIEW REGISTRATION Open Science Framework https://osf.io/8y2wp.
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Affiliation(s)
- Takashi Saito
- Department of Social Rehabilitation, Research Institute of National Rehabilitation Center for Persons with Disability, Tokorozawa, Saitama, Japan
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Vision rehabilitation in glaucoma patients. Curr Opin Ophthalmol 2023; 34:109-115. [PMID: 36718681 DOI: 10.1097/icu.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Vision rehabilitation services are important but underutilized resources for patients with glaucoma. Glaucoma and its impact on vision can affect patients' abilities to read and drive, two activities of daily living that are associated with quality of life and functional independence. In this review, we provide an overview of low vision, discuss barriers to vision rehabilitation, and outline various strategies and interventions to optimize visual function and quality of life in patients with glaucoma. RECENT FINDINGS Studies have shown that glaucoma negatively impacts reading, driving and overall quality of life. Decreased visual acuity, visual field loss and reduced contrast sensitivity play a role. Low vision services and interventions can help patients maximize visual function and improve their quality of life. Barriers to receiving these services exist at multiple levels and an increased awareness and integration into routine ophthalmic care are needed to deliver comprehensive care. SUMMARY Glaucoma is one of the leading causes of low vision. Ophthalmologists who treat glaucoma often tend to focus on objective measures to monitor progression and disease severity, but the functional impact of glaucoma should also be addressed. Low vision services can benefit patients, particularly for reading and driving, and should be considered as an essential component of patient care.
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Guo X, Boland MV, Swenor BK, Goldstein JE. Low Vision Rehabilitation Service Utilization Before and After Implementation of a Clinical Decision Support System in Ophthalmology. JAMA Netw Open 2023; 6:e2254006. [PMID: 36735257 PMCID: PMC9898817 DOI: 10.1001/jamanetworkopen.2022.54006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE Electronic clinical decision support systems apply clinical guidelines in real time and offer a new approach to improve referral and utilization of low vision rehabilitation (LVR) care. OBJECTIVE To characterize patients and factors associated with LVR service utilization with and without the use of an electronic health record (EHR) clinical decision support system (CDSS) alert. DESIGN, SETTING, AND PARTICIPANTS Quality improvement study using EHR data to compare patients who did and did not utilize LVR service after referral between November 6, 2017, and October 5, 2019, (primary) and to assess overall service utilization rate from September 1, 2016, to April 2, 2021, regardless of referral status (secondary). Participants in the primary analysis were patients at a large ophthalmology department in an academic medical center in the US who received an LVR referral recommendation from their ophthalmologist according to the CDSS alert. The secondary analysis included patients with best documented visual acuity (BDVA) worse than 20/40 before, during, and after the CDSS implementation. Data were analyzed from August 2021 to April 2022. EXPOSURES Number and locations of referral recommendations for LVR service according to the CDSS alert in the primary analysis; active CDSS implementation in the secondary analysis. MAIN OUTCOMES AND MEASURES LVR service utilization rate was defined as the number of patients who accessed service among those who were referred (primary) and among those with BDVA worse than 20/40 (secondary). EHR data on patient demographics (age, sex, race, ethnicity) and ophthalmology encounter characteristics (numbers of referral recommendations, encounter location, and BDVA) were extracted. RESULTS Of the 429 patients (median [IQR] age, 71 [53 to 83] years; 233 female [54%]) who received a CDSS-based referral recommendation, 184 (42.9%) utilized LVR service. Compared with nonusers of LVR, users were more likely to have received at least 2 referral recommendations (12.5% vs 6.1%; χ21 = 5.29; P = .02) and at an ophthalmology location with onsite LVR service (87.5% vs 78.0%; χ21 = 6.50; P = .01). Onsite LVR service (odds ratio, 2.06; 95% CI, 1.18-3.61) persisted as the only statistically significant factor after adjusting for patient demographics and other referral characteristics. Among patients whose BDVA was worse than 20/40 before, during, and after the CDSS implementation regardless of referral status, the LVR service utilization rate was 6.1%, 13.8%, and 7.5%, respectively. CONCLUSIONS AND RELEVANCE In this quality improvement study, ophthalmologist referral recommendations and onsite LVR services at the location where patients receive other ophthalmic care were significantly associated with service utilization. Ophthalmology CDSSs are promising tools to apply clinical guidelines in real time to improve connection to care.
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Affiliation(s)
- Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael V. Boland
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston
| | - Bonnie K. Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Judith E. Goldstein
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bittner AK, Yoshinaga PD, Shepherd JD, Kaminski JE, Malkin AG, Chun MW, Chan TL, Deemer AD, Ross NC. Acceptability of Telerehabilitation for Magnification Devices for the Visually Impaired Using Various Approaches to Facilitate Accessibility. Transl Vis Sci Technol 2022; 11:4. [PMID: 35917136 PMCID: PMC9358294 DOI: 10.1167/tvst.11.8.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We examined different methods to reduce the burden of accessing technology for videoconferencing during telerehabilitation for magnification devices for the visually impaired. Methods During telerehabilitation studies over the past 5 years, vision rehabilitation providers assessed and gave training to visually impaired participants with newly dispensed magnification devices at home who connected to Zoom videoconferencing via loaner tablets or smartphones with assistance from (phase 1; n = 10) investigators by phone, (phase 2; n = 11) local Lions Club volunteers in participants’ homes, or (phase 3; n = 24) remote access control software in a randomized controlled trial with 13 usual care controls who received in-office training. All participants completed the same post-telerehabilitation phone survey. Results A significantly greater proportion of phase 3 subjects indicated they strongly or mostly agreed that the technology did not interfere with the session (96%) compared to phase 1 (60%; 95% confidence interval [CI], 1.2–12.5; P = 0.03) or phase 2 (55%; 95% CI, 1.8–188; P = 0.01). The majority indicated telerehabilitation was as accurate as in person (68%), they were comfortable with telerehabilitation (91%) and interested in a future session (83%), and their magnifier use improved (79%), with no significant differences in these responses between phases (all P > 0.10), including comparisons of participants randomized to telerehabilitation or in-office training in phase 3 who reported similar overall satisfaction levels (P = 0.84). Conclusions Participants across all phases reported high levels of acceptance for telerehabilitation, with least interference from technology using remote access control in phase 3. Translational Relevance With accommodations for accessibility to videoconferencing technology, telerehabilitation for magnification devices can be a feasible, acceptable, and valuable option in countries with resources to support the technology.
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Affiliation(s)
- Ava K Bittner
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA.,College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Patrick D Yoshinaga
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA, USA
| | - John D Shepherd
- Department of Ophthalmology, Truhlsen Eye Institute, Weigel Williamson Center for Visual Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Melissa W Chun
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tiffany L Chan
- Frank Stein & Paul S. May Center for Low Vision Rehabilitation, San Francisco, CA, USA
| | - Ashley D Deemer
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA, USA
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