Exploring ethnic and racial differences in intraocular pressure and glaucoma: The Canadian Longitudinal Study on aging

Purpose

To determine whether self-reported race/ethnicity is associated with intraocular pressure (IOP) and glaucoma and to explore whether any associations are due to social, behavioral, genetic, or health differences.

Design

Cross-sectional analysis of population-based data.

Methods

We used the Canadian Longitudinal Study on Aging Comprehensive Cohort, which consists of 30,097 adults aged 45-85 years. Race/ethnicity was self-reported. Corneal-compensated intraocular pressure (IOP) was measured in mmHg using the Reichert Ocular Response Analyzer. Participants were asked to report if they have ever had a diagnosis of glaucoma and whether they used eye care in the past year. A glaucoma polygenic risk score (PRS) was calculated. Logistic and linear regression models were used.

Results

Black individuals had higher mean IOP levels (beta coefficient (β) = 1.46; 95% confidence interval [CI], 0.62, 2.30) while Chinese, Japanese and Korean (β = -1.00; 95% CI, -1.63, -0.38) and Southeast Asian and Filipino individuals (β = -1.56; 95% CI, -2.68, -0.43) had lower mean IOP levels as compared to White individuals after adjustment for sociodemographic, behavioral, genetic, and health-related variables. Black people were more likely to report glaucoma as compared to White people after adjustment (odds ratio [OR] = 2.43; 95% CI, 1.27, 4.64).

Conclusion

Racial and ethnic differences in IOP and glaucoma were identified. Adjusting for sociodemographic, behavioral, genetic, and health-related variables did not fully explain these differences. Longitudinal research is needed to further explore the reasons for these differences and to understand their relevance to disease pathogenesis and progression.

A Systematic Review and Meta-analysis of Systemic Antihypertensive Medications With Intraocular Pressure and Glaucoma

PURPOSE

We synthesized the literature on the association between systemic antihypertensive medications with intraocular pressure (IOP) and glaucoma. Antihypertensive medications included β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics.

DESIGN

Systematic review and meta-analysis.

METHODS

Databases were searched for relevant articles until December 5, 2022. Studies were eligible if they examined (1) the association between systemic antihypertensive medications with glaucoma or (2) the association between systemic antihypertensive medications with IOP in those without glaucoma or ocular hypertension. The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews; registration ID: CRD42022352028).

RESULTS

A total of 11 studies were included in the review and 10 studies in the meta-analysis. The 3 studies on IOP were cross-sectional, whereas the 8 studies on glaucoma were primarily longitudinal. In the meta-analysis, β-blockers were associated with a lower odds of glaucoma (odds ratio: 0.83, 95% CI: 0.75-0.92, 7 studies, n = 219,535) and lower IOP (β: -0.53, 95% CI: -1.05 to -0.02, 3 studies, n = 28,683). Calcium channel blockers were associated with a higher odds of glaucoma (odds ratio: 1.13, 95% CI: 1.03-1.24, 7 studies, n = 219,535) but not with IOP (β: -0.11, 95% CI: -0.25 to 0.03, 2 studies, n = 20,620). There were no consistent associations between angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or diuretics with glaucoma or IOP.

CONCLUSIONS

Systemic antihypertensive medications have heterogeneous effects on glaucoma and IOP. Clinicians should be aware that systemic antihypertensive medications may mask elevated IOP or positively or negatively affect the risk of glaucoma.

Impact of the COVID-19 Pandemic on Mental Health among Patients with Chronic Ocular Conditions

The COVID-19 pandemic had significant impacts on the mental and visual health of patients. This cross-sectional, survey-based, multicentric study evaluates the state of mental and visual health among patients with chronic ocular diseases such as glaucoma, neovascular age-related macular degeneration, diabetic retinopathy, or chronic uveitis during the lockdown period of the COVID-19 pandemic. Mental health was assessed using three questionnaires: the Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale-Revised (IES-R), and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). A total of 145 patients completed the questionnaires. The PHQ-9 showed that most respondents (n = 89, 61%) had none or minimal depressive symptoms, while 31 (21%) had mild depressive symptoms, 19 (13%) had moderate depressive symptoms, 5 (3%) had moderately severe depressive symptoms, and 1 (1%) had severe depressive symptoms. Regarding stress surrounding the pandemic, the median IES-R showed mild distress in 16 (11%), moderate distress in 7 (5%), and severe distress in 4 (3%). The COVID-19 pandemic lockdowns had a negative impact on patients' mental health with close to 20% of the patients reporting at least moderately depressive symptoms and 19% reporting at least mildly distressful symptoms.

Alcohol Consumption, Genetic Risk, and Intraocular Pressure and Glaucoma: The Canadian Longitudinal Study on Aging

Purpose

The purpose of this study was to examine the association of alcohol consumption with intraocular pressure (IOP) and glaucoma and to assess whether any associations are modified by a glaucoma polygenic risk score (PRS).

Methods

Cross-sectional analysis of data from the Canadian Longitudinal Study on Aging Comprehensive Cohort, consisting of 30,097 adults ages 45 to 85 years, was done. Data were collected from 2012 to 2015. Alcohol consumption frequency (never, occasional, weekly, and daily) and type (red wine, white wine, beer, liquor, and other) were measured by an interviewer-administered questionnaire. Total alcohol intake (grams/week) was estimated. IOP was measured in mm Hg using the Reichert Ocular Response Analyzer. Participants reported a diagnosis of glaucoma from a doctor. Logistic and linear regression models were used to adjust for demographic, behavioral, and health variables.

Results

Daily drinkers had higher IOP compared to those who never drank (β = 0.45, 95% confidence interval (CI) = 0.05, 0.86). An increase in total weekly alcohol intake (per 5 drinks) was also associated with higher IOP (β = 0.20, 95% CI = 0.15, 0.26). The association between total alcohol intake and IOP was stronger in those with a higher genetic risk of glaucoma (P for interaction term = 0.041). There were 1525 people who reported being diagnosed with glaucoma. Alcohol consumption frequency and total alcohol intake were not associated with glaucoma.

Conclusions

Alcohol frequency and total alcohol intake were associated with elevated IOP but not with glaucoma. The PRS modified the association between total alcohol intake and IOP. Findings should be confirmed in longitudinal analyses.

The Mental Health State of Canadian Ophthalmologists during the COVID-19 Pandemic: A Survey-Based Study and Review

The coronavirus disease 2019 (COVID-19) pandemic disrupted the practice of medicine, causing stress and uncertainty among ophthalmologists. This cross-sectional, survey-based study of Canadian Ophthalmological Society members (n = 1152) aims to report on Canadian ophthalmologists’ mental health during the COVID-19 pandemic. Four questionnaires were administered between December 2020 and May 2021: the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the 7-item Insomnia Severity Index (ISI), and the Impact of Event Scale—Revised (IES-R). From all of the responses, 60/85 answers were deemed complete and were included. The median age was 50–59 years and 53% were women. On PHQ-9, most respondents had no or minimal depressive symptoms (n = 38, 63%), while 12% (n = 7) had moderately severe depressive symptoms and 12% (n = 7) reported impaired daily functioning and/or thoughts of suicide or self-harm. On the GAD-7 scale, 65% (n = 39) had no significant anxiety, while 13% (n = 8) had moderate to severe anxiety. Most respondents did not have clinically significant insomnia (n = 41, 68%). Finally, 16 respondents (27%) had an IES-R score ≥24 suggesting possible post-traumatic stress disorder. No significant differences were found based on demographics. During the COVID-19 pandemic, up to 40% of respondents experienced varying degrees of depression, anxiety, insomnia, and distress from the event. In 12%, there were concerns for impaired daily functioning and/or suicidal thoughts.

GENLIB: new function to simulate haplotype transmission in large complex genealogies

SUMMARY

Founder populations with deep genealogical data are well suited for investigating genetic variants contributing to diseases. Here, we present a major update of the genealogical analysis R package GENLIB, centered around a new function which can simulate the transmission of haplotypes from founders to probands along very large and complex user-specified genealogies.

AVAILABILITY AND IMPLEMENTATION

The latest update of the GENLIB package (v1.1.9) contains the new gen.simuHaplo() function and is available on the CRAN repository and from https://github.com/R-GENLIB/GENLIB. Examples can be accessed at https://github.com/R-GENLIB/simuhaplo_functions.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Air pollution and the onset of balance problems: The Canadian longitudinal study on aging

PURPOSE

To understand the relationship between ambient air pollution and the onset of balance problems.

DESIGN

Population-based prospective cohort study.

METHODS

Baseline and 3-year follow-up data were used from the Canadian Longitudinal Study on Aging. The Comprehensive Cohort included adults aged 45-85 years old recruited from 11 sites across 7 provinces. Data on air pollution came from the Canadian Urban Environmental Health Research Consortium. Annual mean levels of ozone, fine particulate matter (PM_2.5), and sulfur dioxide for each participant's postal code were estimated from satellite data. Balance was measured at both time points using the one-leg balance test with those who could not stand on one leg for at least 60 s defined as failing the balance test. Our outcome was the new development of failing the balance test at follow-up in those who passed the balance test at baseline. Logistic regression was used.

RESULTS

Of the 12,158 people who could stand for 60 s on one leg at baseline, 18% were unable to do so 3 years later. In single pollutant models, living in an area with higher ozone levels was associated with the 3-year onset of balance problems (odds ratio (OR) = 1.13 per interquartile range of ozone, 95% CI 1.02, 1.24) after adjustment for demographic, lifestyle, and health variables. In a multipollutant model, the association with ozone increased slightly (OR = 1.16, 95% CI 1.04, 1.30). There were no associations with PM_2.5 or sulfur dioxide.

CONCLUSION

Our findings provide longitudinal evidence that higher ozone levels are associated with the odds of developing balance problems over a 3-year period. Further work should attempt to confirm our findings and explore the potential mechanism of action.

Inverse Association of APOE ε4 and Glaucoma Modified by Systemic Hypertension: The Canadian Longitudinal Study on Aging

Purpose

Studies examining the apolipoprotein E (APOE) ε4 allele and glaucoma are inconsistent, which could be due to interactions with other factors. We examined the relationship between the APOE ε4 allele and glaucoma and intraocular pressure in a large, population-based random sample and explored whether the APOE ε4 allele interacted with systemic hypertension.

Methods

Data came from the Canadian Longitudinal Study on Aging, a population-based study that included 24,655 adults ages 45 to 85 years old in the European ancestry cohort. APOE genotypes were derived from single-nucleotide polymorphisms rs429358 and rs7412. Participants were asked about a prior diagnosis of glaucoma from a doctor. Corneal compensated intraocular pressure (IOP) was measured using the Reichart Ocular Response Analyzer.

Results

Having an APOE ε4 allele was associated with a lower odds of glaucoma after adjusting for age, sex, IOP, and the top 10 population structure principal components (odds ratio [OR] = 0.83; 95% confidence interval [CI], 0.69-0.98; P = 0.033). A novel statistically significant interaction was found in that having an APOE ε4 allele was only associated with glaucoma in those without systemic hypertension (OR = 0.62; 95% CI, 0.46-0.85) although it was not associated in those with it (OR = 0.97; 95% CI, 0.79-1.21) (interaction term P value = 0.017). APOE ε4 was not associated with IOP (β = -0.01; 95% CI, -0.13 to 0.10).

Conclusions

Evidence increasingly points to the APOE ε4 allele having protective benefits against glaucoma, but this association was limited to those without systemic hypertension. Further research is needed to understand the biological mechanisms for these findings and the treatment potential they hold.

Ambient Air Pollution and Age-Related Eye Disease: A Systematic Review and Meta-Analysis

Purpose

To compare the burden of age-related eye diseases among adults exposed to higher versus lower levels of ambient air pollutants.

Methods

MEDLINE, EMBASE, and Scopus were searched for relevant articles until September 30, 2021. Inclusion criteria included studies of adults, aged 40+ years, that provided measures of association between the air pollutants (nitrogen dioxide, carbon monoxide [CO], sulfur dioxide, ozone [O3], particulate matter [PM] less than 2.5 µm in diameter [PM2.5], and PM less than 10 µm in diameter [PM10]) and the age-related eye disease outcomes of glaucoma, age-related macular degeneration (AMD), or cataract. Pooled odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis model. PROSPERO registration ID: CRD42021250078.

Results

A total of eight studies were included in the review. Consistent evidence for an association was found between PM2.5 and glaucoma, with four of four studies reporting a positive association. The pooled OR for each 10-µg/m3 increase of PM2.5 on glaucoma was 1.18 (95% CI, 0.95-1.47). Consistent evidence was also found for O3 and cataract, with three of three studies reporting an inverse association. Two of two studies reported a null association between PM2.5 and cataract, while one of one studies reported a positive association between PM10 and cataract. One of one studies reported a positive relationship between CO and AMD. Other relationships were less consistent between studies.

Conclusions

Current evidence suggests there may be an association between some air pollutants and cataract, AMD, and glaucoma.

Correspondence Between Genomic- and Genealogical/Coalescent-Based Inference of Homozygosity by Descent in Large French-Canadian Genealogies

Research on the genetics of complex traits overwhelmingly focuses on the additive effects of genes. Yet, animal studies have shown that non-additive effects, in particular homozygosity effects, can shape complex traits. Recent investigations in human studies found some significant homozygosity effects. However, most human populations display restricted ranges of homozygosity by descent (HBD), making the identification of homozygosity effects challenging. Founder populations give rise to higher HBD levels. When deep genealogical data are available in a founder population, it is possible to gain information on the time to the most recent common ancestor (MRCA) from whom a chromosomal segment has been transmitted to both parents of an individual and in turn to that individual. This information on the time to MRCA can be combined with the time to MRCA inferred from coalescent models of gene genealogies. HBD can also be estimated from genomic data. The extent to which the genomic HBD measures correspond to the genealogical/coalescent measures has not been documented in founder populations with extensive genealogical data. In this study, we used simulations to relate genomic and genealogical/coalescent HBD measures. We based our simulations on genealogical data from two ongoing studies from the French-Canadian founder population displaying different levels of inbreeding. We simulated single-nucleotide polymorphisms (SNPs) in a 1-Mb genomic segment from a coalescent model in conjunction with the observed genealogical data. We compared genealogical/coalescent HBD to two genomic methods of HBD estimation based on hidden Markov models (HMMs). We found that genomic estimates of HBD correlated well with genealogical/coalescent HBD measures in both study genealogies. We described generation time to coalescence in terms of genomic HBD estimates and found a large variability in generation time captured by genomic HBD when considering each SNP. However, SNPs in longer segments were more likely to capture recent time to coalescence, as expected. Our study suggests that estimating the coalescent gene genealogy from the genomic data to use in conjunction with observed genealogical data could provide valuable information on HBD.

Visual Impairment, Eye Disease, and 3-Year Cognitive Decline: The Canadian Longitudinal Study on Aging

PURPOSE

To examine the longitudinal association between vision-related variables and the 3-year change in cognitive test scores in a community-dwelling sample of adults and to explore whether sex, education, or hearing loss act as effect modifiers.

METHODS

Data came from two waves of a 3-year population-based prospective cohort study (Canadian Longitudinal Study on Aging), which consisted of 30,097 randomly selected people aged 45-85 years from 7 Canadian provinces. Visual impairment (VI) was defined as binocular presenting visual acuity worse than 20/40. Participants were asked if they had ever had a diagnosis of age-related macular degeneration (AMD), glaucoma, or cataract. Cognitive change over 3 years was examined by calculating the difference between baseline and follow-up scores for the Rey Auditory Verbal Learning Test (RAVLT) and the RAVLT delayed test (memory tests), the Controlled Oral Word Association Test (COWAT) and the Animal Naming Test (ANT) (verbal fluency tests), and the Mental Alternation Test (MAT) (processing speed test). Multiple linear regression was used.

RESULTS

VI, AMD, and cataract were not associated with 3-year changes on any of the 5 cognitive tests after adjusting for age, sex, ethnicity, education, income, smoking, diabetes, stroke, heart disease, and province. A report of glaucoma was associated with greater declines in MAT scores (β = -0.60, 95% CI -1.03, -0.18). No effect modification was detected.

CONCLUSIONS

Glaucoma was associated with worsening processing speed. Further research to confirm this finding and to understand the possible reason is necessary.

Fine Particulate Matter and Age-Related Eye Disease: The Canadian Longitudinal Study on Aging

Purpose

To determine the relationship between fine particulate matter (PM2.5) and ocular outcomes such as visual impairment and age-related eye disease.

Methods

Baseline data were used from the Canadian Longitudinal Study on Aging. The Comprehensive Cohort consisted of 30,097 adults ages 45 to 85 years. Annual mean PM2.5 levels (µg/m3) for each participant's postal code were estimated from satellite data. Ozone, sulfur dioxide, and nitrogen dioxide levels were also estimated. Binocular presenting visual acuity was measured using a visual acuity chart. Intraocular pressure (IOP) was measured in millimeters of mercury using the Reichart Ocular Response Analyzer. Participants were asked about a diagnosis of glaucoma, macular degeneration, or cataract. Logistic and linear regression models were used.

Results

The overall mean PM2.5 level was 6.5 µg/m3 (SD = 1.8). In the single pollutant models, increased PM2.5 levels (per interquartile range) were associated with visual impairment (odds ratio [OR] = 1.12; 95% confidence interval [CI], 1.02-1.24), glaucoma (OR = 1.14; 95% CI, 1.01-1.29), and visually impairing age-related macular degeneration (OR = 1.52; 95% CI, 1.10-2.09) after adjustment for sociodemographics and disease. PM2.5 had a borderline adjusted association with cataract (OR = 1.06; 95% CI, 0.99-1.14). In the multi-pollutant models, increased PM2.5 was associated with glaucoma and IOP only after adjustment for sociodemographics and disease (OR = 1.24; 95% CI, 1.05-1.46 and β = 0.24; 95% CI, 0.12-0.37).

Conclusions

Increased PM2.5 is associated with glaucoma and IOP. These associations should be confirmed using longitudinal data and potential mechanisms should be explored. If confirmed, this work may have relevance for revision of World Health Organization thresholds to protect human health.

The Importance of Understanding Individual Differences of Emotion Regulation Abilities in 22q11.2 Deletion Syndrome

Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4-22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.

Incidence of visual impairment in Canada: The Canadian Longitudinal Study on Aging

OBJECTIVE

Determine the 3-year incidence of visual impairment (VI) in Canada and its risk factors.

DESIGN

Prospective 3-year cohort study PARTICIPANTS: Data from 23 973 adults taking part in the Canadian Longitudinal Study on Aging Comprehensive Cohort baseline and 3-year follow-up exams were included.

METHODS

Inclusion criteria were 45 to 85 years of age, community-dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. Presenting binocular visual acuity was measured using the Early Treatment of Diabetic Retinopathy study chart. Incidence of VI was defined as the development at follow-up of visual acuity worse than 20/40 in those with acuity better than or equal to 20/40 at baseline.

RESULTS

3.88% (95% confidence interval [CI] 3.61-4.17) of Canadian adults developed VI over a 3-year period. There was a high degree of variability in the incidence between Canadian provinces with a low of 1.42% in Manitoba and a high of 7.33% in Nova Scotia. Uncorrected refractive error was the leading cause. Risk factors for incident VI included older age (odds ratio [OR] = 1.07, 95% CI 1.06-1.07), Black race (OR = 2.64, 95% CI 1.36-5.14), lower household income (OR = 1.73 for those making less than $20,000 per year, 95% CI 1.24-2.40), current smoker (OR = 1.78, 95% CI 1.37-2.32), and province.

CONCLUSION

The incidence of visual impairment is common in older Canadian adults, varies markedly between provinces, and is largely owing to treatable causes. Risk factors for VI suggest subgroups that may benefit from interventions to improve access to eye care.

Impact of the Improper Adjustment for Age in Research on Age-Related Macular Degeneration: An Example Using Data from the Canadian Longitudinal Study on Aging

Purpose: Confounding is an important problem in observational research. Improper modeling of the confounder will lead to residual confounding that may distort results and impact inferences. An example of this will be presented from research on age-related macular degeneration and depression. Methods: A 3-year prospective cohort study was performed using data from the Canadian Longitudinal Study on Aging consisting of 30,097 individuals aged 45-85 years. Incident depression was assessed using the Center for Epidemiologic Studies Depression scale. Participants were asked if they had ever had a physician diagnosis of age-related macular degeneration (AMD). Multivariable Poisson regression was used. Age was modeled in four ways including as a linear term, as a 4-category variable, as a spline, and as a polynomial. Models were compared using the Akaike's Information Criteria (AIC) with lower scores indicating better performance. Results: The point estimates and inferences differed depending on how age was modeled. Age had a J-shape relationship with the incidence of depression. The model with the lowest AIC was when age was entered as a categorical variable. When age was modeled in this way, AMD was not significantly associated with the incidence of depression (relative risk (RR) = 1.21, 95% Confidence Interval (CI) 0.97, 1.53). By contrast, when age was modeled as a linear term, AMD was significantly associated with the incidence of depression (RR = 1.28, 95% CI 1.02, 1.61). Conclusions: Researchers should clearly report their adjustment strategies and should be cautious when modeling the relationship between age and depression in order to minimize residual confounding.

Visual Impairment, Eye Disease, and the 3-year Incidence of Depressive Symptoms: The Canadian Longitudinal Study on Aging

PURPOSE

Our goal was to explore the longitudinal association between vision-related variables and incident depressive symptoms in a community-dwelling sample of older adults and to examine whether sex, education, or hearing loss act as effect modifiers.

METHODS

A 3-year prospective cohort study was performed using data from the Canadian Longitudinal Study on Aging consisting of 30,097 individuals aged 45-85 years. Visual acuity was evaluated with habitual distance correction using an illuminated Early Treatment of Diabetic Retinopathy Study chart. Visual impairment was defined as binocular presenting visual acuity worse than 20/40. Incident depressive symptoms was defined using a cut-off score of 10 or greater on the Center for Epidemiologic Studies Depression scale. Participants were asked if they had ever had a physician diagnosis of age-related macular degeneration (AMD), glaucoma, or cataract. Multivariable Poisson regression was used.

RESULTS

Of 22,558 participants without depressive symptoms at baseline, 7.7% developed depressive symptoms within 3 years. Cataract was associated with incident depressive symptoms (relative risk = 1.20, 95% confidence interval 1.05, 1.37) after adjusting for age, sex, income, education, partner status, smoking, level of comorbidity, hearing loss, and province. Visual impairment, AMD, and glaucoma were not associated with incident depressive symptoms. No effect modification was detected.

CONCLUSIONS

Our longitudinal data confirm that the risk of depressive symptoms is higher in those who report ever having a cataract. Further research should confirm this and interventions should be considered.

Visual impairment and the use of formal and informal home care in Canada: the Canadian Longitudinal Study on Aging

OBJECTIVE

To determine the use of home care services in those with and without visual impairment in Canada.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

Participants came from the baseline examination of the Canadian Longitudinal Study on Aging Comprehensive Cohort. Inclusion criteria included age between 45 and 85 years, community dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. People were excluded if they were in an institution, were living on a First Nations reserve, were full-time members of the Canadian Armed Forces, did not speak French or English, or had cognitive impairment.

METHODS

Presenting visual acuity was measured using the Early Treatment of Diabetic Retinopathy Study chart at 2 meters. Visual impairment was defined as binocular acuity worse than 20/60. The use of formal, informal, and both types of home care was determined by questionnaire.

RESULTS

For 29 666 participants, the use of any home care was greater in those with visual impairment than in those without (28% vs 12%, respectively, p < 0.01). After adjusting for demographics and health, people with visual impairment were more likely to use informal home care (odds ratio [OR] = 1.89, 95% CI 1.35-2.63) and formal home care/both types of home care (OR = 2.70, 95% CI 1.79-4.07) than those without visual impairment. Marital status was a modifier.

CONCLUSION

Visual impairment is associated with use of home care services. These findings warrant further exploration and, if confirmed, have major health service implications, given the rising prevalence of visual impairment due to age-related eye diseases.

Prevalence and determinants of visual impairment in Canada: cross-sectional data from the Canadian Longitudinal Study on Aging

OBJECTIVE

To determine the prevalence and determinants of visual impairment in Canada.

DESIGN

Cross-sectional population-based study.

PARTICIPANTS

30,097 people in the Comprehensive Cohort of the Canadian Longitudinal Study on Aging METHODS: Inclusion criteria included being between the ages of 45 and 85 years old, community-dwelling, and living near one of the 11 data collection sites across 7 Canadian provinces. People were excluded if they were in an institution, living on a First Nations reserve, were a full-time member of the Canadian Armed Forces, did not speak French or English, or had cognitive impairment. Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart while participants wore their usual prescription for distance, if any. Visual impairment was defined as presenting binocular acuity worse than 20/40.

RESULTS

Of Canadian adults, 5.7% (95% CI 5.4-6.0) had visual impairment. A wide variation in the provincial prevalence of visual impairment was observed ranging from a low of 2.4% (95% CI 2.0-3.0) in Manitoba to a high of 10.9% (95% CI 9.6-12.2) in Newfoundland and Labrador. Factors associated with a higher odds of visual impairment included older age (odds ratio [OR] = 1.07, 95% CI 1.06-1.08), lower income (OR = 2.07 for those earning less than $20 000 per year, 95% CI 1.65-2.59), current smoking (OR = 1.52, 95% CI 1.25-1.85), type 2 diabetes (OR = 1.20, 95% CI 1.03-1.41), and memory problems (OR = 1.44, 95% CI 1.04-2.01).

CONCLUSIONS

Refractive error was the leading cause of visual impairment. Older age, lower income, province, smoking, diabetes, and memory problems were associated with visual impairment.

Age-Related Eye Disease and Participation in Cognitive Activities

Studies have found a benefit to living a cognitively active life in older age. Our goal was to quantify participation in cognitively stimulating activities in adults with and without age-related eye disease. We conducted a cross-sectional hospital-based study in Montreal, Canada of older adults (n = 303) having either age-related macular degeneration (AMD) (n = 96), glaucoma (n = 93), or normal vision (n = 114). To be eligible, the AMD group had to have bilateral late stage AMD with a better eye visual acuity of 20/30 or worse. The glaucoma group had to have a diagnosis of bilateral primary open-angle glaucoma with visual field mean deviation <  = −4 dB in their better eye. Further inclusion criteria included age ≥ 65 and a Mini-Mental State Exam Blind score ≥ 10. Cognitive activities were measured using the Victoria Longitudinal Study Activity Questionnaire. Linear regression was used. Patients with AMD (β = −4.2, 95% confidence interval (CI) −6.0, −2.4) and glaucoma (β = −1.8, 95% CI −3.3, −0.3) participated in fewer cognitive activities per month compared to those with normal vision after adjusting for age, sex, education, diabetes, number of comorbidities, cognition, and cataract. People with AMD and glaucoma participated in fewer cognitive activities, which could put them at risk for future cognitive impairment.

Fear of falling and its association with life-space mobility of older adults: a cross-sectional analysis using data from five international sites

Background

fear of falling (FOF) is a major health concern among community-dwelling older adults that could restrict mobility.

Objective

to examine the association of FOF with life-space mobility (i.e. the spatial area a person moves through in daily life) of community-dwelling older adults from five diverse sites.

Methods

in total, 1,841 older adults (65-74 years) were recruited from Kingston, Canada; Saint-Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia and Natal, Brazil. FOF was assessed using the Fall Efficacy Scale-International (FES-I total score), and the life space was quantified using the Life-Space Assessment (LSA), a scale that runs from 0 (minimum life space) to 120 (maximum life space).

Results

the overall average LSA total score was 68.7 (SD: 21.2). Multiple-linear regression analysis demonstrated a significant relationship of FOF with life-space mobility, even after adjusting for functional, clinical and sociodemographic confounders (B = -0.15, 95% confidence interval (CI) -0.26 to -0.04). The FOF × site interaction term was significant with a stronger linear relationship found in the Canadian sites and Tirana compared with the South American sites. After adjusting for all confounders, the association between FOF with LSA remained significant at Kingston (B = -0.32, 95% CI -0.62 to -0.01), Saint-Hyacinthe (B = -0.81, 95% CI -1.31 to -0.32) and Tirana (B = -0.57, 95% CI -0.89 to -0.24).

Conclusion

FOF is an important psychological factor that is associated with reduction in life space of older adults in different social and cultural contexts, and the strength of this association is site specific. Addressing FOF among older adults would help improve their mobility in local communities, which in turn would improve social participation and health-related quality of life.

Maladaptive coping strategies and glaucoma progression

The identification of modifiable risk factors for glaucoma progression is needed. Our objective was to determine whether maladaptive coping styles are associated with recent glaucoma progression or worse visual field mean deviation.A hospital-based case-control study was conducted in the Glaucoma Service of Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients with primary open angle glaucoma or normal tension glaucoma with ≥4 years of follow-up and ≥5 Humphrey visual fields were included. Cases had recent visual field progression as defined according to the Early Manifest Glaucoma Trial pattern change probability maps. Controls had stable visual fields. The Brief Cope questionnaire, a 28-item questionnaire about 14 different ways of coping with the stress of a chronic disease, was asked. Questions were also asked about demographic and medical factors, and the medical chart was examined. Outcomes included glaucoma progression (yes, no) and visual field mean deviation. Logistic and linear regressions were used.A total of 180 patients were included (82 progressors and 98 nonprogressors). Although none of the 14 coping scales were associated with glaucoma progression (P > 0.05), higher denial was correlated with worse visual field mean deviation (r = -0.173, P = 0.024). In a linear regression model including age, sex, education, depression, intraocular pressure, and family history of glaucoma, greater levels of denial (β = -1.37, 95% confidence interval [CI] -2.32, -0.41), Haitian ethnicity (β = -7.78, 95% CI -12.52, -3.04), and the number of glaucoma medications (β = -1.20, 95% CI -2.00, -0.38) were statistically significantly associated with visual field mean deviation.The maladaptive coping mechanism of denial was a risk factor for worse visual field mean deviation. Further prospective research will be required to verify the pathways by which denial may exert an effect on glaucomatous visual field loss.

Activation and Self-Efficacy in a Randomized Trial of a Depression Self-Care Intervention

OBJECTIVES

In a sample of primary care participants with chronic physical conditions and comorbid depressive symptoms: to describe the cross-sectional and longitudinal associations of activation and self-efficacy with demographic, physical and mental health status, health behaviors, depression self-care, health care utilization, and use of self-care tools; and to examine the effects of a depression self-care coaching intervention on these two outcomes. Design/Study Setting. A secondary analysis of activation and self-efficacy data collected as part of a randomized trial to compare the effects of a telephone-based coached depression self-care intervention with a noncoached intervention. Activation (Patient Activation Measure) was measured at baseline and 6 months. Depression self-care self-efficacy was assessed at baseline, at 3 months, and at 6 months.

PRINCIPAL FINDINGS

In multivariable cross-sectional analyses (n = 215), activation and/or self-efficacy were associated with language, birthplace, better physical and mental health, individual exercise, specialist visits, and antidepressant nonuse. In longitudinal analyses (n = 158), an increase in activation was associated with increased medication adherence; an increase in self-efficacy was associated with use of cognitive self-care strategies and increases in social and solitary activities. There were significant improvements from baseline to 6 months in activation and self-efficacy scores both among coached and noncoached groups. The self-care coaching intervention did not affect 6-month activation or self-efficacy but was associated with quicker improvement in self-efficacy.

CONCLUSIONS

Overall, the results for activation and self-efficacy were similar, although self-efficacy correlated more consistently than activation with depression-specific behaviors and was responsive to a depression self-care coaching intervention.

Age-related eye disease and cognitive function

PURPOSE

To determine whether people with age-related eye disease have lower cognitive scores than people with healthy vision.

METHODS

A hospital-based cross-sectional study was performed in which 420 people aged 65 and older from the ophthalmology clinics at Maisonneuve-Rosemont Hospital (Montreal, Canada) were recruited who had age-related macular degeneration (AMD), Fuch's corneal dystrophy, or glaucoma. Patients with AMD and Fuchs had to have visual acuity in the better eye of worse than 20/40 while patients with glaucoma had to have visual field in their worse eye of at least -4 dB. Controls, recruited from the same clinics, did not have significant vision loss. Cognitive status was measured using the Mini-Mental State Exam Blind Version (range, 0-22) which excludes eight items that rely on vision. Linear regression with bootstrapped standard errors was used to adjust for demographic and medical factors.

RESULTS

People with AMD, Fuch's corneal dystrophy, and glaucoma had lower cognitive scores, on average, than controls (P < 0.05). These relationships remained statistically significant after adjusting for factors such as age, sex, race, education, living alone, systemic comorbidities, and lens opacity.

CONCLUSIONS

People with vision loss due to three different age-related eye diseases had lower cognitive scores. Reasons for this should be explored using longitudinal studies and a full battery of cognitive tests that do not rely on vision.

The Perceived Needs and Availability of Eye Care Services for Older Adults in Long-term Care Facilities

Background

The objective was to evaluate the eye care services offered to older residents living in long-term care facilities (LTCFs).

Methods

A questionnaire targeting residents aged ≥65 years was sent to all LTCFs in Quebec. Questions related to the institution’s characteristics, demographic data related to residents, oculovisual health of residents and barriers to eye care, eye care services offered within and outside the institution, and degree of satisfaction regarding the eye care services offered to residents.

Results

196/428 (45.8%) LTCFs completed the questionnaire. Participating LTCFs had an average of 97.0 ± 5.1 residents with a mean age of 82.8 ± 3.0 yrs and 69% women. Eye care services were mostly offered outside the institution, on a “per request” basis. The main barriers to eye care were the perception that residents could not cooperate and the lack of eye care professionals. Most LTCFs were satisfied with the eye care services offered to residents.

Conclusions

The fact that the LTCFs were satisfied with the eye care services offered to their residents, although it was neither provided on a regular basis nor to all residents, suggests that eye care professionals should take a proactive educational role for improving services to older institutionalized adults.

The global burden of visual difficulty in low, middle, and high income countries

Purpose

Using a world-wide, population-based dataset of adults, we sought to determine the frequency of far visual difficulty and its associated risk factors.

Methods

The World Health Survey (WHS) was conducted in 70 countries throughout the world in 2003 using a random, multi-stage, stratified, cluster sampling design of adults ages 18 years and older. Far vision was assessed by asking “In the last 30 days, how much difficulty did you have in seeing and recognizing a person you know across the road (i.e. from a distance of about 20 meters)?”. Responses included none, mild, moderate, severe, or extreme/unable. The income status of countries was estimated using gross national income per capita data from 2003 from the World Bank. Prevalence and regression estimates were adjusted to account for the complex sample design.

Results

21% of adults reported any visual difficulty. The rate varied by the income status of the country with the percentage who had any visual difficulty being 24%, 23%, and 13% in low, middle, and high income countries, respectively. Five percent of people reported severe or extreme visual difficulty with rates in low, middle, and high income countries of 6%, 5%, and 2% respectively. Risk factors for visual difficulty included older age, female sex, poorer socioeconomic status, little to no formal education, and diabetes (P<0.05).

Conclusions

One out of five adults in the WHS reported some degree of far visual difficulty. Given the importance of vision to living an independent life, better access to quality eye care services and life course factors affecting vision health (e.g. repeated eye infections, diet lacking vitamin A) must receive adequate attention and resources, especially in low and middle income countries.

The heritability of glaucoma-related traits corneal hysteresis, central corneal thickness, intraocular pressure, and choroidal blood flow pulsatility

Purpose

The purpose of this work was to investigate the heritability of potential glaucoma endophenotypes. We estimated for the first time the heritability of the pulsatility of choroidal blood flow. We also sought to confirm the heritability of corneal hysteresis, central corneal thickness, and 3 ways of measuring intraocular pressure.

Methods

Measurements were performed on 96 first-degree relatives recruited from Maisonneuve-Rosemont Hospital in Montreal. Corneal hysteresis was determined using the Reichert Ocular Response Analyser. Central corneal thickness was measured with an ultrasound pachymeter. Three measures of intraocular pressure were obtained: Goldmann-correlated and corneal compensated intraocular pressure using the Ocular Response Analyser, and Pascal intraocular pressure using the Pascal Dynamic Contour Tonometer. The pulsatility of choroidal blood velocity and flow were measured in the sub-foveolar choroid using single-point laser Doppler flowmetry (Oculix). We estimated heritability using maximum-likelihood variance components methods implemented in the SOLAR software.

Results

No significant heritability was detected for the pulsatility of choroidal blood flow or velocity. The Goldman-correlated, corneal compensated, and Pascal measures of intraocular pressure measures were all significantly heritable at 0.94, 0.79, and 0.53 after age and sex adjustment (p = 0.0003, p = 0.0023, p = 0.0239). Central corneal thickness was significantly heritable at 0.68 (p = 0.0078). Corneal hysteresis was highly heritable but the estimate was at the upper boundary of 1.00 preventing us from giving a precise estimate.

Conclusion

Corneal hysteresis, central corneal thickness, and intraocular pressure are all heritable and may be suitable as glaucoma endophenotypes. The pulsatility of choroidal blood flow and blood velocity were not significantly heritable in this sample.

Activity limitation due to a fear of falling in older adults with eye disease

PURPOSE

To examine whether patients with age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy report limiting their activity due to a fear of falling as compared with a control group of older adults with good vision.

METHODS

We recruited 345 patients (93 with AMD, 57 with Fuchs, 98 with glaucoma, and 97 controls) from the ophthalmology clinics of Maisonneuve-Rosemont Hospital (Montreal, Canada) to participate in a cross-sectional study from September 2009 until July 2012. Control patients who had normal visual acuity and visual field were recruited from the same clinics. Participants were asked if they limited their activity due to a fear of falling. Visual acuity, contrast sensitivity, and visual field were measured and the medical record was reviewed.

RESULTS

Between 40% and 50% of patients with eye disease reported activity limitation due to a fear of falling compared with only 16% of controls with normal vision. After adjustment for age, sex, race, number of comorbidities, cognition, and lens opacity, the Fuchs groups was most likely to report activity limitation due to a fear of falling (odds ratio [OR] = 3.07; 95% confidence interval [CI], 1.33-7.06) followed by the glaucoma group (OR = 2.84; 95% CI, 1.36-5.96) and the AMD group (OR = 2.42; 95% CI, 1.09-5.35). Contrast sensitivity best explained these associations.

CONCLUSIONS

Activity limitation due to a fear of falling is very common in older adults with visually impairing eye disease. Although this compensatory strategy may protect against falls, it may also put people at risk for social isolation and disability.

The gender gap in mobility: a global cross-sectional study

Background

Several studies have demonstrated that women have greater mobility disability than men. The goals of this research were: 1) to assess the gender gap in mobility difficulty in 70 countries; 2) to determine whether the gender gap is explained by sociodemographic and health factors; 3) to determine whether the gender gap differs across 6 regions of the world with different degrees of gender equality according to United Nations data.

Methods

Population-based data were used from the World Health Survey (WHS) conducted in 70 countries throughout the world. 276,647 adults aged 18 years and over were recruited from 6 world regions. Mobility was measured by asking the level of difficulty people had moving around in the last 30 days and then creating a dichotomous measure (no difficulty, difficulty). The human development index and the gender-related development index for each country were obtained from the United Nations Development Program website. Poisson regression with Taylor series linearized variance estimation was used.

Results

Women were more likely than men to report mobility difficulty (38% versus 27%, P < 0.0001). The age-adjusted prevalence rate ratio for female gender was 1.35 (95% CI 1.31–1.38). The addition of education, marital status, and urban versus rural setting reduced the prevalence rate ratio to 1.30 (95% CI 1.26–1.33). The addition of the presence of back pain, arthritis, angina, depressive symptoms, and cognitive difficulties further reduced the prevalence rate ratio to 1.12 (95% CI 1.09–1.15). There was statistical interaction on the multiplicative scale between female gender and region (P < 0.01). The Eastern Mediterranean region, which had the greatest loss of human development due to gender inequality, showed the largest gender gap in mobility difficulty, while the Western Pacific region, with the smallest loss of human development due to gender inequality, had the smallest gender gap in mobility difficulty.

Conclusions

These are the first world-wide data to examine the gender gap in mobility. Differences in chronic diseases are the main reasons for this gender gap. The gender gap seems to be greater in regions with the largest loss of human development due to gender inequality.

Explaining the relationship between three eye diseases and depressive symptoms in older adults

PURPOSE

The purpose of this study is to examine whether patients with age-related eye diseases, like age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy, are more likely to show signs of depression compared to a control group of older adults with good vision, and to determine whether reduced mobility mediates these relationships.

METHODS

We recruited 315 eligible patients (81 with AMD, 55 with Fuchs, 91 with glaucoma, and 88 controls) from the ophthalmology clinics of a Montreal hospital from September 2009 until December 2011. Depressive symptoms were assessed using the Geriatric Depression Scale Short Form (GDS-15). Life space was measured using the Life Space Assessment. Logistic regression was used to adjust for demographic, health, and social factors, and mediation was assessed using the methods of Baron and Kenny.

RESULTS

There were 78 people (25%) meeting the criteria for depression in the cohort. All three groups with eye disease were more likely to be depressed than the control group after adjusting for age, sex, ethnicity, education, cognitive score, limitations in activities of daily living, social support, and lens opacity (P < 0.05). Life space and limited activities due to a fear of falling appeared to mediate the relationship between eye disease and depression.

CONCLUSIONS

Visually limiting eye disease is associated with depression in older adults. Further research on interventions to prevent depression in patients with eye disease is warranted and should consider strategies to alleviate mobility limitation. Greater attention from families, physicians, and society to the mental health needs and mobility challenges of patients with eye disease is needed.

Eye care utilization by older adults in low, middle, and high income countries

Background

The risk of visual impairment increases dramatically with age and therefore older adults should have their eyes examined at least every 1 to 2 years. Using a world-wide, population-based dataset, we sought to determine the frequency that older people had their eyes examined. We also examined factors associated with having a recent eye exam.

Methods

The World Health Surveys were conducted in 70 countries throughout the world in 2002-2003 using a random, multi-stage, stratified, cluster sampling design. Participants 60 years and older from 52 countries (n = 35,839) were asked "When was the last time you had your eyes examined by a medical professional?". The income status of countries was estimated using gross national income per capita data from 2003 from the World Bank website. Prevalence estimates were adjusted to account for the complex sample design.

Results

Overall, only 18% (95% CI 17, 19) of older adults had an eye exam in the last year. The rate of an eye exam in the last year in low, lower middle, upper middle, and high income countries was 10%, 24%, 22%, and 37% respectively. Factors associated with having an eye exam in the last year included older age, female gender, more education, urban residence, greater wealth, worse self-reported health, having diabetes, and wearing glasses or contact lenses (p < 0.05).

Conclusions

Given that older adults often suffer from age-related but treatable conditions, they should be seen on a regular basis to prevent visual impairment and its disabling consequences.

Heavy burden of non-communicable diseases at early age and gender disparities in an adult population of Burkina Faso: World Health Survey

Background

WHO estimates suggest that age-specific death rates from non-communicable diseases are higher in sub-Saharan Africa than in high-income countries. The objectives of this study were to examine, in Burkina Faso, the prevalence of non-communicable disease symptoms by age, gender, socioeconomic group and setting (rural/urban), and to assess gender and socioeconomic inequalities in the prevalence of these symptoms.

Methods

We obtained data from the Burkina Faso World Health Survey, which was conducted in an adult population (18 years and over) with a high response rate (4822/4880 selected individuals). The survey used a multi-stage stratified random cluster sampling strategy to identify participants. The survey collected information on socio-demographic and economic characteristics, as well as data on symptoms of a variety of health conditions. Our study focused on joint disease, back pain, angina pectoris, and asthma. We estimated prevalence correcting for the sampling design. We used multiple Poisson regression to estimate associations between non-communicable disease symptoms, gender, socioeconomic status and setting.

Results

The overall crude prevalence and 95% confidence intervals (CI) were: 16.2% [13.5; 19.2] for joint disease, 24% [21.5; 26.6] for back pain, 17.9% [15.8; 20.2] for angina pectoris, and 11.6% [9.5; 14.2] for asthma. Consistent relationships between age and the prevalence of non-communicable disease symptoms were observed in both men and women from rural and urban settings. There was markedly high prevalence in all conditions studied, starting with young adults. Women presented higher prevalence rates of symptoms than men for all conditions: prevalence ratios and 95% CIs were 1.20 [1.01; 1.43] for joint disease, 1.42 [1.21; 1.66] for back pain, 1.68 [1.39; 2.04] for angina pectoris, and 1.28 [0.99; 1.65] for asthma. Housewives and unemployed women had the highest prevalence rates of non-communicable disease symptoms.

Conclusions

Our work suggests that social inequality extends into the distribution of non-communicable diseases among social groups and supports the thesis of a differential vulnerability in Burkinabè women. It raises the possibility of an abnormally high rate of premature morbidity that could manifest as a form of premature aging in the adult population. Increased prevention, screening and treatment are needed in Burkina Faso to address high prevalence and gender inequalities in non-communicable diseases.

Gender differences in mobility disability during young, middle and older age in West African adults

The objective of this study was to assess the prevalence and the contribution of socio-demographic factors and chronic diseases to mobility disability in West African countries. Data were obtained from the World Health Survey (2002-2003) in which adults≥18 years participated, from Burkina Faso (n=4822), Mali (n=4230) and Senegal (n=3197). Participants reporting mild, moderate, severe, extreme difficulty or inability to move around were defined as having mobility disability. All estimates were corrected for sampling design. Association measures were estimated using logistic regression methods. Mobility disability was frequent at young ages (35-44 years old) in men and women, respectively: 17% and 23% in Burkina Faso, 12% and 23% in Mali and 22% and 34% in Senegal. Women had higher odds of mobility difficulty than men at every age group in the three countries: 1.34 (95%CI 1.06; 1.70) in Burkina Faso; 2.33 (95% CI 1.84; 2.71) in Mali and 1.82 (95%CI 1.41; 2.36) in Senegal. Controlling for socio-economic factors and chronic disease, these odds changed respectively to 0.94 (95%CI 0.70; 1.25), 2.19 (95%CI 1.61; 2.96) and 1.90 (95%CI 1.27; 2.84). These results constitute a benchmark for the study of trends of mobility disability in West Africa and could be used by policy planners.

Prevalence and risk factors for near and far visual difficulty in Burkina Faso

PURPOSE

To determine the prevalence and risk factors for near and far visual difficulty in Burkina Faso.

METHODS

Population-based data were used from the World Health Survey done in Burkina Faso in 2002-2003;2003 (n=4,822 adults). Near and far visual difficulty were assessed by questions about difficulty seeing and recognizing an object at arm's length and about difficulty seeing and recognizing a person across the road. Prevalence estimates were adjusted for the multi-stage, stratified, random cluster sampling design. Logistic regression was used to identify independent risk factors.

RESULTS

The overall prevalence of any near and far visual difficulty was 10% (standard error [SE] = 0.7%) and 13% (SE=0.9%) respectively. Prevalence estimates were strongly associated with age with 48% (SE=4.2%) and 66% (SE=3.9%) of those >or= 65 years old having near or far visual difficulty (P < 0.001). Only 5% (SE=0.6%) of people wore glasses. We identified two potentially modifiable variables associated with near visual difficulty: a cooking stove in the same room as sleeping area (Odds Ratio [OR]=1.45, 95% Confidence Interval [CI] 1.01, 2.02) and high fruit consumption (OR=0.65, 95% CI 0.50, 0.86).

CONCLUSION

The prevalence of visual difficulty was high in Burkina Faso. Efforts to confirm these findings with cooking stove location and fruit consumption should be undertaken in this population.

Rate of endophthalmitis after cataract surgery in quebec, Canada, 1996-2005

OBJECTIVE

To estimate the annual incidence of endophthalmitis after cataract surgery from January 1, 1996, through December 31, 2005, in Quebec, Canada.

METHODS

Deidentified data were obtained from an outpatient physician billing database (Quebec State Control for Health Insurance [RAMQ]) with regard to all cataract surgical procedures performed from January 1, 1996, through December 31, 2005, in Quebec. For this cohort, records of an International Classification of Diseases, Ninth Revision (ICD-9) code for endophthalmitis during the same years were requested from 2 sources: the RAMQ outpatient database and an inpatient hospital discharge database (Maintenance and Exploitation of Data for the Study of Hospitalized Patients [MED-ECHO]). Endophthalmitis after cataract surgery was assumed if it occurred within 90 days of the surgery. Risk factors were examined using chi(2) tests and logistic regression.

RESULTS

After exclusions, 490 690 cataract surgical procedures were performed from January 1, 1996, through December 31, 2005. A total of 754 cases of endophthalmitis occurred within 90 days after surgery for an overall incidence rate of 1.5 per 1000 surgical procedures (95% confidence interval [CI], 1.4-1.7). Factors associated with endophthalmitis included age of 85 years or older (odds ratio [OR], 1.34; 95% CI, 1.06-1.70), male sex (1.44; 1.24-1.66), later year of surgery (0.94; 0.92-0.97), and region of cataract surgery, because regions 6 (2.21; 1.91-2.55) and 9 (4.00; 2.48-6.43) had higher rates compared with all other regions.

CONCLUSION

Reasons that explain the apparent decrease in endophthalmitis, especially in 2005, should be explored and further research performed to understand why certain patients and regions have higher risks of endophthalmitis after cataract surgery.