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Stalin A, Narayan A, Labreche T, Khan S, Stanberry A, Christian LWT, Leat SJ. Status of Vision and Eye Care Among Patients in Rehabilitation Hospital Units: A Cross-Sectional Study. J Am Med Dir Assoc 2024; 25:361-367.e1. [PMID: 38052415 DOI: 10.1016/j.jamda.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES The prevalence of vision disorders is high among geriatric and hospital inpatient populations, yet they often go undetected, resulting in consequences such as falls or prolonged recovery time. A needs assessment study was conducted to investigate levels of vision and the potential prevalence of unmanaged/undiagnosed ocular disorders among adult inpatients in a hospital-based rehabilitation unit. DESIGN Cross-sectional study. SETTING & PARTICIPANTS Inpatient rehabilitation units of an acute care hospital system in Ontario, Canada. Adults (n = 112) in a hospital inpatient rehabilitation unit participated from October 2018 to February 2019. METHODS Participants were surveyed regarding their demographic, ocular, and medical data and spectacle wear. Visual acuity, contrast sensitivity, visual fields, and stereoacuity plus the spectacle condition were directly assessed. RESULTS The majority (75%) were found to have reduced habitual vision while in hospital. Nearly 60% of participants reported at least some difficulty reading a newspaper or distinguishing a face or were "not happy with their vision." This was despite 80% of participants reporting that they had an eye care practitioner and 70% that they had an eye examination within the last 2 years. More than half (51.8%) of the participants received the recommendation to follow up with their eye care practitioner on discharge from the hospital. CONCLUSIONS AND IMPLICATIONS Reduced vision and vision disorders has a high prevalence among hospital patients in rehabilitation units and should be evaluated at or soon after hospital intake. By incorporating vision screening tools, necessary precautions may be taken to avoid possible falls and promote recovery.
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Affiliation(s)
- Amritha Stalin
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada.
| | | | - Tammy Labreche
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Shamrozé Khan
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Andre Stanberry
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Lisa W T Christian
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Leat
- School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Davinelli S, Ali S, Scapagnini G, Costagliola C. Effects of Flavonoid Supplementation on Common Eye Disorders: A Systematic Review and Meta-Analysis of Clinical Trials. Front Nutr 2021; 8:651441. [PMID: 34124119 PMCID: PMC8189261 DOI: 10.3389/fnut.2021.651441] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Emerging studies show that certain plant compounds may reduce the severity of most prevalent ocular abnormalities. The aim of this systematic review and meta-analysis was to assess the effect of dietary flavonoids on major eye disorders. Methods: Eligible studies were identified by searching PubMed, Web of Science, Scopus, and Cochrane Library databases for all articles published up to April 2021. The literature search yielded 1,134 articles, and a total of 16 studies were included in the systematic review. A meta-analysis of 11 intervention trials involving a total of 724 participants was performed. Results: Using a random-effects model, the pooled results revealed an overall significant effect of flavonoids on common ophthalmic disorders (standard mean difference = −0.39; 95% CI: −0.56, −0.21, p < 0.01). Of the subclasses of flavonoids, flavan-3-ols (standard mean difference = −0.62; 95% CI: −1.03, −0.22, p < 0.01), and anthocyanins (standard mean difference = −0.42; 95% CI: −0.63, −0.21, p < 0.01) were the only effective intervention for improving the outcomes of ocular conditions. For several of the other flavonoid subclasses, evidence on efficacy was insufficient. Conclusion: Our findings indicate that flavonoids may improve the clinical manifestations associated with ocular disorders. However, further well-constructed clinical trials are required to confirm these results and examine the effect of flavonoids on eye disorders other than those identified in this review. Systematic Review Registration: PROSPERO, identifier CRD42021247332.
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Affiliation(s)
- Sergio Davinelli
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Sawan Ali
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Giovanni Scapagnini
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
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Ehrlich JR, Ramke J, Macleod D, Burn H, Lee CN, Zhang JH, Waldock W, Swenor BK, Gordon I, Congdon N, Burton M, Evans JR. Association between vision impairment and mortality: a systematic review and meta-analysis. Lancet Glob Health 2021; 9:e418-e430. [PMID: 33607015 PMCID: PMC7966688 DOI: 10.1016/s2214-109x(20)30549-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The number of individuals with vision impairment worldwide is increasing because of an ageing population. We aimed to systematically identify studies describing the association between vision impairment and mortality, and to assess the association between vision impairment and all-cause mortality. METHODS For this systematic review and meta-analysis, we searched MEDLINE (Ovid), Embase, and Global Health database on Feb 1, 2020, for studies published in English between database inception and Feb 1, 2020. We included prospective and retrospective cohort studies that measured the association between vision impairment and all-cause mortality in people aged 40 years or older who were followed up for 1 year or more. In a protocol amendment, we also included randomised controlled trials that met the same criteria as for cohort studies, in which the association between visual impairment and mortality was independent of the study intervention. Studies that did not report age-adjusted mortality data, or that focused only on populations with specific health conditions were excluded. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We graded the overall certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. We did a random-effects meta-analysis to calculate pooled maximally adjusted hazard ratios (HRs) for all-cause mortality for individuals with a visual acuity of <6/12 versus those with ≥6/12; <6/18 versus those with ≥6/18; <6/60 versus those with ≥6/18; and <6/60 versus those with ≥6/60. FINDINGS Our searches identified 3845 articles, of which 28 studies, representing 30 cohorts (446 088 participants) from 12 countries, were included in the systematic review. The meta-analysis included 17 studies, representing 18 cohorts (47 998 participants). There was variability in the methods used to assess and report vision impairment. Pooled HRs for all-cause mortality were 1·29 (95% CI 1·20-1·39) for visual acuity <6/12 versus ≥6/12, with low heterogeneity between studies (n=15; τ2=0·01, I2=31·46%); 1·43 (1·22-1·68) for visual acuity <6/18 versus ≥6/18, with low heterogeneity between studies (n=2; τ2=0·0, I2=0·0%); 1·89 (1·45-2·47) for visual acuity <6/60 versus ≥6/18 (n=1); and 1·02 (0·79-1·32) for visual acuity <6/60 versus ≥6/60 (n=2; τ2=0·02, I2=25·04%). Three studies received an assessment of low risk of bias across all six domains, and six studies had a high risk of bias in one or more domains. Effect sizes were greater for studies that used best-corrected visual acuity compared with those that used presenting visual acuity as the vision assessment method (p=0·0055), but the effect sizes did not vary in terms of risk of bias, study design, or participant-level factors (ie, age). We judged the evidence to be of moderate certainty. INTERPRETATION The hazard for all-cause mortality was higher in people with vision impairment compared with those that had normal vision or mild vision impairment, and the magnitude of this effect increased with more severe vision impairment. These findings have implications for promoting healthy longevity and achieving the Sustainable Development Goals. FUNDING Wellcome Trust, Commonwealth Scholarship Commission, National Institutes of Health, Research to Prevent Blindness, the Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity, National Institute for Health Research, Moorfields Biomedical Research Centre, Sightsavers, the Fred Hollows Foundation, the Seva Foundation, the British Council for the Prevention of Blindness, and Christian Blind Mission.
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Affiliation(s)
- Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - David Macleod
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK
| | - Chan Ning Lee
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Justine H Zhang
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Manchester Royal Eye Hospital, Manchester, UK
| | | | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nathan Congdon
- Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Guangzhou, China
| | - Matthew Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Moorfields Eye Hospital, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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Wang Y, Grenell A, Zhong F, Yam M, Hauer A, Gregor E, Zhu S, Lohner D, Zhu J, Du J. Metabolic signature of the aging eye in mice. Neurobiol Aging 2018; 71:223-233. [PMID: 30172221 DOI: 10.1016/j.neurobiolaging.2018.07.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/28/2018] [Accepted: 07/29/2018] [Indexed: 12/29/2022]
Abstract
Aging is a major risk factor for age-related ocular diseases including age-related macular degeneration in the retina and retinal pigment epithelium (RPE), cataracts in the lens, glaucoma in the optic nerve, and dry eye syndrome in the cornea. We used targeted metabolomics to analyze metabolites from young (6 weeks) and old (73 weeks) eyes in C57 BL6/J mice. Old mice had diminished electroretinogram responses and decreased number of photoreceptors in their retinas. Among the 297 detected metabolites, 45-114 metabolites are significantly altered in aged eye tissues, mostly in the neuronal tissues (retina and optic nerve) and less in cornea, RPE/choroid, and lens. We noted that changes of metabolites in mitochondrial metabolism and glucose metabolism are common features in the aged retina, RPE/choroid, and optic nerve. The aging retina, cornea, and optic nerve also share similar changes in Nicotinamide adenine dinucleotide (NAD), 1-methylnicotinamides, 3-methylhistidine, and other methylated metabolites. Metabolites in taurine metabolism are strikingly influenced by aging in the cornea and lens. In conclusion, the aging eye has both common and tissue-specific metabolic signatures. These changes may be attributed to dysregulated mitochondrial metabolism, reprogrammed glucose metabolism and impaired methylation in the aging eye. Our findings provide biochemical insights into the mechanisms of age-related ocular changes.
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Affiliation(s)
- Yekai Wang
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA; Department of Biochemistry, West Virginia University, Morgantown, WV, USA
| | - Allison Grenell
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA; Department of Biochemistry, West Virginia University, Morgantown, WV, USA
| | - Fanyi Zhong
- Department of Chemistry and Biochemistry, Miami University, Oxford, OH, USA
| | - Michelle Yam
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA; Department of Biochemistry, West Virginia University, Morgantown, WV, USA
| | - Allison Hauer
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA; Department of Biochemistry, West Virginia University, Morgantown, WV, USA
| | - Elizabeth Gregor
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA; Department of Biochemistry, West Virginia University, Morgantown, WV, USA
| | - Siyan Zhu
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA; Department of Biochemistry, West Virginia University, Morgantown, WV, USA
| | - Daniel Lohner
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA; Department of Biochemistry, West Virginia University, Morgantown, WV, USA
| | - Jiangjiang Zhu
- Department of Chemistry and Biochemistry, Miami University, Oxford, OH, USA
| | - Jianhai Du
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA; Department of Biochemistry, West Virginia University, Morgantown, WV, USA.
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Pathai S, Lawn SD, Weiss HA, Cook C, Bekker LG, Gilbert CE. Retinal nerve fibre layer thickness and contrast sensitivity in HIV-infected individuals in South Africa: a case-control study. PLoS One 2013; 8:e73694. [PMID: 24069225 PMCID: PMC3777952 DOI: 10.1371/journal.pone.0073694] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/26/2013] [Indexed: 12/11/2022] Open
Abstract
Background Antiretroviral treatment (ART) has altered the spectrum of HIV-related eye disease, resulting in a lower prevalence of retinal opportunistic infections (OIs). However, abnormalities in visual function have been reported in HIV-infected individuals despite effective viral suppression and the absence of retinal OIs. These changes may be mediated by an HIV-associated ‘neuroretinal disorder’, characterized by changes in the retinal nerve fibre layer (RNFL). HIV infection may also be associated with accelerated biological aging. The aim of this study was to investigate the relationships between contrast sensitivity, RNFL thickness, HIV infection and frailty in South African adults. Methods Case-control study of 225 HIV-infected individuals without retinal OIs and 203 gender/age-matched HIV-seronegative individuals. Peri-papillary RNFL thickness was determined with spectral domain optical coherence tomography in four quadrants. CS was measured using a Pelli-Robson chart. Frailty was assessed using standard criteria. Multivariable linear and logistic regression were used to assess associations between HIV status and RNFL/CS and frailty. Results The median age of both groups was similar (41.2 vs. 41.9 years, p = 0.37). 88% of HIV-infected individuals were receiving ART and their median CD4 count was 468 cells/μl. Adjusted CS score was lower in HIV-infected participants compared to HIV-seronegative individuals (1.76 vs. 1.82, p = 0.002). Independent predictors of poor CS in the HIV-infected group were positive frailty status and current HIV viral load >2 log copies/ml. Lower CS score was also associated with thin temporal RNFL in HIV-infected individuals (p = 0.04). Superior quadrant RNFL thickness was greatest in ART-naïve participants relative to the HIV-uninfected group (p-trend = 0.04). Longer ART duration was associated with thinning of inferior and nasal RNFL quadrants (p-trend = 0.03 and 0.04, respectively). Conclusions Contrast sensitivity is reduced in HIV-infected individuals and functionally associated with frailty and unsuppressed viraemia. This may reflect structural changes in the RNFL that are evident despite the absence of OIs.
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Affiliation(s)
- Sophia Pathai
- International Centre for Eye Health, Dept. of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom ; Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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The eye as a model of ageing in translational research--molecular, epigenetic and clinical aspects. Ageing Res Rev 2013; 12:490-508. [PMID: 23274270 DOI: 10.1016/j.arr.2012.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 11/16/2012] [Accepted: 11/19/2012] [Indexed: 12/13/2022]
Abstract
The eye and visual system are valuable in many areas of translational research such as stem cell therapy, transplantation research and gene therapy. Changes in many ocular tissues can be measured directly, easily and objectively in vivo (e.g. lens transparency; retinal blood vessel calibre; corneal endothelial cell counts) and so the eye may also be a uniquely useful site as a model of ageing. This review details cellular, molecular and epigenetic mechanisms related to ageing within the eye, and describes ocular parameters that can be directly measured clinically and which might be of value in ageing research as the translational "window to the rest of the body". The eye is likely to provide a valuable model for validating biomarkers of ageing at molecular, epigenetic, cellular and clinical levels. A research agenda to definitively establish the relationship between biomarkers of ageing and ocular parameters is proposed.
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