Low Vision Rehabilitation in Older Adults

Open globe injuries in geriatric population in Iran: characteristics and outcomes

AIM

To investigate the patterns and outcomes of open globe injuries in the elderly population in Iran.

METHODS

In this retrospective cross-sectional chart review, medical records of 248 patients (aged 60y and more) with the diagnosis of open globe injury from 2006 to 2016 were reviewed. Demographic features, type, and mechanism of open globe injury, ocular trauma score (OTS), visual acuity before and after treatment, the zone of injuries, and the associated injuries found at the presentation or thereafter were documented.

RESULTS

A total of 248 eyes of 248 patients were included. The mean age was 69.2±5.8y (range: 60-90y). Male/ female ratio was about 3:1 (187 vs 61). The three most common causes of injury were falling (25.2%), sharp objects (18.9%), and tree branches (13.9%). Penetrating injury accounted for most of the geriatric ocular trauma (50.4%), followed by globe rupture (40.3%), intraocular foreign body (IOFB; 7.3%), and perforating injury (2.0%). The median raw OTS for the population was 60.5 and the most common OTS class was 3. The injuries tend to affect zone I more than zone II and zone III. The only predictor of final visual acuity was the class of OTS (P<0.001).

CONCLUSION

Geriatric open globe injury should be valued specifically. The most common type of open globe injury in Iran is penetrating injuries but falling remain the main cause. The OTS class must be considered as an important predictor of final visual acuity.

Is the high contrast visual acuity chart a good predictor of improvement in visual acuity with low vision aids?

Purpose:

To assess whether the objective improvement seen with HCVA chart using LVAs correlates with subjective improvement in the quality of life as measured on low vision quality of life (LVQOL) questionnaire of such patients.

Methods:

This was a prospective, consecutive, observational study. Objective improvement in visual function was assessed using LVAs with high contrast LogMAR visual acuity chart for near and distance. Subjective improvement for distance was assessed using LVQOL score for “distance mobility and lighting”, whereas for near it was assessed using the LVQOL score for “near and fine work”. A total of 46 patients completed one follow-up after low vision trial and were included in the study.

Results:

Improvement in objective visual acuity was highly significant for both near and distance (P < 0.001) with LVAs. LVQOL score improved from 65.85 to 76.83 after one of using low vision aids (P < 0.001). The improvement in LVQOL score for distance and mobility was also highly significant (2.55; P < 0.001); and so was for near and fine work (5.89; P < 0.001). However, Spearman rank correlation coefficient showed no correlation between improvement in visual acuity for distance and LVQOL score improvement for distance (r_s = –.086; P = 0.57). For near also, improvement in acuity did not correlate with the LVQOL score improvement for near and fine work (r_s = 0.036; P = 0.81).

Conclusion:

No statistical correlation was observed between the improvements measured by objective HCVA charts and subjective improved as perceived by the patient after use of low vision devices.

Causes of Blindness in the Adult Population in Somalia

Objectives

To evaluate the causes and frequency of blindness among the adult Somali population according to the World Health Organization (WHO) criteria.

Materials and Methods

The data of 2,605 patients over 18 years old who presented to our tertiary hospital in Mogadishu (the capital of Somalia) were evaluated. Patients with best corrected visual acuity of less than 3/60 in both eyes were categorized as bilaterally blind and those with best corrected visual acuity of less than 3/60 in one eye but 3/60 or better in the other eye were classified as monocularly blind, as per the WHO classification.

Results

Of 2,605 patients, 1,251 (48%) were female and 1,354 (52%) were male. Among these, 256 patients were determined to have blindness in one or both eyes and were included in the study. The patients ranged in age from 19 to 85, and the mean age was 52.4±14.6 years. The overall blindness rate in the Somali population was 9.8%. In the monocularly blind group, the most common factor was trauma complication (23.6%), followed by cataract (19%) and diabetic retinopathy (13.2%). In the bilaterally blind group, the most common factors were cataract (26.9%), diabetic retinopathy (21.1%), and glaucoma (15.4%).

Conclusion

Trauma is the leading cause of blindness due to the security conditions in the country. Establishing and increasing the number of free public health centers in Somalia can reduce the frequency of blindness.