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Sonnenfeld ML, Pappadis MR, Reistetter TA, Raji MA, Ottenbacher K, Al Snih S. Vision Impairment and Frailty Among Mexican American Older Adults: A Longitudinal Study. J Appl Gerontol 2024; 43:755-764. [PMID: 38412864 PMCID: PMC11052670 DOI: 10.1177/07334648241231374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
We examined the relationship between vision impairment (VI) and new-onset frailty among non-frail Mexican American older adults (≥70 years) at baseline and determined the differential impact of VI on each frailty criteria. Data were from an 18-year prospective cohort from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1998/1999, N = 1072 to 2016, N = 175). Frailty was defined as ≥3 criteria: unintentional weight loss of >10 pounds, weakness, exhaustion, low physical activity, and slowness. VI was defined as difficulty in recognizing a friend at arm's length's away, across the room, or across the street. We found that participants with VI (near or distant) and distant VI had greater odds of frailty (near or distant VI, OR = 1.89, 95% CI = 1.30-2.73 and distant VI, OR = 1.95, 95% CI = 1.34-2.86, respectively) after controlling for covariates over time. Early screening (optimal management) of VI may prevent or delay onset of frailty among older Mexican Americans.
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Affiliation(s)
- Mandi L Sonnenfeld
- Michael E. DeBakey Veterans Affairs Medical Center, Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Houston, TX, USA
| | - Monique R Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Timothy A Reistetter
- Department of Occupational Therapy, School of Health Professions, UT Health San Antonio, San Antonio, TX, USA
| | - Mukaila A Raji
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth Ottenbacher
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Soham Al Snih
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
- Division of Geriatrics and Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
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Heinze N, Jones L. Access to eye care and support services among adults from minority ethnic communities living with visual impairment in the United Kingdom. Front Public Health 2024; 11:1277519. [PMID: 38259735 PMCID: PMC10800624 DOI: 10.3389/fpubh.2023.1277519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Background Despite an increased risk of certain eye conditions which can lead to visual impairment (V.I.), there is evidence of a greater delay to treatment-seeking among adults from minority ethnic communities (MEC). MEC adults may also be underrepresented on V.I. registers, within early intervention services, and among the beneficiaries of national V.I. charities. However, much of this evidence is outdated or anecdotal. Methods This secondary analysis of V.I. Lives survey data explored use of eye health and support services and mobility aids among a matched control sample of 77 MEC and 77 adults aged 18 and over from white communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Additional subgroup analysis was conducted for Asian (n = 46) and black participants (n = 22). Results There were no significant group differences in areas such as eye health service use, registration status, contact with charities, and level of practical support received. But MEC participants were significantly more likely than WC participants to have received direct payments from social services to cover their care needs, Χ2 (1, 154) = 8.27, p = 0.004, and to use apps on their mobile for mobility, Χ2 (1, 154) = 5.75, p = 0.017. In contrast, WC participants were significantly more likely to agree that they were getting the level of emotional support to get on with their life, U = 3,638, p = 0.010, to feel confident to ask their friends for support, U = 2,416, p = 0.040, and to have a guide dog for mobility, Χ2 (1, 154) = 3.62, p = 0.057, although the latter did not reach statistical significance. Within the MEC group, Asian participants were significantly more likely than black participants to use a long cane, Χ2 (1, 68) = 7.24, p = 0.007, but they were significantly less likely to agree that they had received the right level of support when they started to experience V.I., U = 236.5, p = 0.040. Conclusion The preliminary findings suggests that there is scope to increase support provided by V.I. charities and the V.I. register, although, contrary to existing evidence, there were no statistically significant differences in eye health service use, registration status and use of wider support services. Further research is required to confirm these findings and explore reasons for differences.
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Affiliation(s)
| | - Lee Jones
- BRAVO VICTOR, Research, London, United Kingdom
- UCL, Institute of Ophthalmology, London, United Kingdom
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Miller AM, Gill MK. A Review of the Prevalence of Ophthalmologic Diseases in Native American Populations. Am J Ophthalmol 2023; 254:54-61. [PMID: 37336384 DOI: 10.1016/j.ajo.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Compared with the general population in North America, Native American/American Indian and Alaska Native (AI/AN) populations experience a disparate prevalence of eye diseases. Visual impairment is a barrier to communication, interferes with academic and social success, and decreases overall quality of life. The prevalence of ocular pathology could serve as an indicator of health and social disparities. Therefore, the objective of this research was to perform a thorough review comparing the prevalence of common ophthalmological pathologies between AI/AN and non-AI/AN individuals in North America. DESIGN Retrospective, cross-sectional study. METHODS A total of 57 articles were retrieved and reviewed, and 14 met the criteria outlined for inclusion. These articles were retrieved from PubMed, MEDLINE, and ISI Web of Knowledge. Only studies that were peer reviewed in the last 25 years and reported on the prevalence of eye diseases in AI/AN compared with a non-AI/AN population met criteria. RESULTS Rates of retinopathy, cataracts, visual impairment, and blindness were clearly higher for AI/AN compared with non-AI/AN counterparts. Although rates of macular degeneration and glaucoma were similar between AI/AN and non-AI/AN populations, the treatment rates were lower and associated with poorer outcomes in AI/AN individuals. CONCLUSIONS There are considerable inequities in the prevalence and treatment rates of ophthalmologic conditions in AI/AN individuals. A likely explanation is the barrier of lack of access to adequate health and eye care. Because of substantial underinsurance and geographic variability, attention needs to be brought to expanding eye care access to AI/AN communities. The results are subject to the availability of appropriate technology, health literacy, and language.
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Affiliation(s)
- Alyssa M Miller
- From the Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (A.M.M., M.K.G.)
| | - Manjot K Gill
- From the Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA (A.M.M., M.K.G.)..
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Mahanna-Gabrielli E, Kuwayama S, Tarraf W, Kaur S, DeBuc DC, Cai J, Daviglus ML, Joslin CE, Lee DJ, Mendoza-Santiesteban C, Stickel AM, Zheng D, González HM, Ramos AR. The Effect of Self-Reported Visual Impairment and Sleep on Cognitive Decline: Results of the Hispanic Community Health Study/Study of Latinos. J Alzheimers Dis 2023; 92:1257-1267. [PMID: 36872780 PMCID: PMC10792435 DOI: 10.3233/jad-221073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Visual impairment could worsen sleep/wake disorders and cognitive decline. OBJECTIVE To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site. METHOD HCHS/SOL Miami-site participants ages 45-74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations. RESULT Sleepiness (β= 0.04; p < 0.01) and insomnia (β= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (β= -0.16; p < 0.001) and on average 7-years later (β= -0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (β= -0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations. CONCLUSION Self-reported visual impairment was independently associated with worse cognitive function and decline.
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Affiliation(s)
| | | | | | - Sonya Kaur
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jianwen Cai
- University of North Carolina, Chapel Hill, NC, USA
| | | | | | - David J Lee
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Diane Zheng
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Alberto R Ramos
- University of Miami Miller School of Medicine, Miami, FL, USA
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Hamm LM, Johnson IA, Jacobs RJ, Paterson JE, Tautolo ES, Iusitini L, Garrett N, Purdy SC. Visual impairment and its correction among Pacific youth in Aotearoa: findings from the Pacific Islands Families Study. N Z Med J 2021; 134:39-50. [PMID: 34695075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM Childhood visual impairment has a life-long impact that, with early access to eyecare, is largely avoidable. We aimed to understand visual impairment and its correction among Pacific youth in Aotearoa New Zealand. METHOD The Pacific Islands Families Study is a birth cohort study that tracks an original sample of 1,398 Pacific children born at Middlemore Hospital (Auckland). This analysis focuses on assessed visual acuity (at 9- and 18-years, using 0.3logMAR or 6/12 as the cut-off for visual impairment) and participants' self-reports about accessing eyecare services. RESULTS Less than a fifth of children (111/729, 15.2%) and teens (86/457, 18.8%) reported having sought eyecare. The percentage of participants with refractive correction was 3.6% (32/887) at 9-years and 14.3% (66/463) at 18-years. At 9-years, 1.9% of children (16/853) had visual impairment in one eye only, and 0.9% (8/853) had visual impairment impacting both eyes. By 18-years these values increased to 7.9% (36/456) and 4.2% (19/456), respectively. Among those with visual impairment, most children (15/24, 62.5%) and teens (32/55, 58.2%) reported they did not have refractive correction. CONCLUSION Although prevalence of visual impairment is relatively low compared to non-Pacific youth, much of the reported impairment appears to be avoidable with improved eyecare.
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Affiliation(s)
- Lisa M Hamm
- Postdoctoral Research Fellow, School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Isabel A Johnson
- Research Officer, Department of Biostatistics and Epidemiology, Faculty of Health, Auckland University of Technology, Auckland, New Zealand
| | - Robert J Jacobs
- Associate Professor, School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Janis E Paterson
- Professor, AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - El-Shadan Tautolo
- Associate Professor, AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - Leon Iusitini
- Senior Research Officer, AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| | - Nick Garrett
- Associate Professor, Department of Biostatistics and Epidemiology, Faculty of Health, Auckland University of Technology, Auckland, New Zealand
| | - Suzanne C Purdy
- Professor, School of Psychology, Eisdell Moore Centre, University of Auckland, Auckland, New Zealand
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Ben-Simon GJ, Peiss M, Anis E, Nakra T, Luski A, Spierer A. Spectacle use and reduced unaided vision in third grade students: a comparative study in different educational settings. Clin Exp Optom 2021; 87:175-9. [PMID: 15186209 DOI: 10.1111/j.1444-0938.2004.tb03171.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2003] [Revised: 03/04/2004] [Accepted: 03/08/2004] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The development of myopia is influenced by hereditary factors, environmental factors and gene-environment interaction. Reading and near-work activity are associated with myopia and myopic progression. This study sought to determine and compare the prevalence of reduced unaided vision and spectacle use among third grade Israeli students from three different educational settings. METHOD A sample of 917 students (mean age 8.5 years, range seven to 10 years) was drawn from the three Israeli educational streams: secular, Orthodox and ultra-Orthodox. Children in the ultra-Orthodox education pathway begin studying at the age of three years and their daily reading involves sustained near work with increased accommodative effort accompanied by head-rocking movements. Reduced distance vision was used to indicate the likely development of or an increase in the amount of myopia. Spectacle lenses were measured to determine the prevalence of myopia. RESULTS Of the 917 students studied, 103 (11.2 per cent) wore spectacles (14.2 per cent of the males and eight per cent of the females); 82.5 per cent of those who wore spectacles were myopic. Males from ultra-Orthodox schools had the highest rate of reduced unaided vision (72.5 per cent) compared with males from secular schools (27.3 per cent), males from Orthodox schools (59.3 per cent) or with females from all three groups (average of 34.8 per cent, p < 0.0001, chi squared). Males had a higher rate of reduced unaided vision, especially in the Orthodox and ultra-Orthodox schools. CONCLUSIONS Our study suggests that Jewish ultra-Orthodox males have a higher prevalence and degree of myopia. The study habits of young children, including exposure to prolonged near tasks, high accommodative demands and possibly optical defocus induced by body sway, may contribute to the development of myopia.
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Affiliation(s)
- Guy J Ben-Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
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Kirthi V, Reed KI, Gunawardena R, Alattar K, Bunce C, Jackson TL. Do Black and Asian individuals wait longer for treatment? A survival analysis investigating the effect of ethnicity on time-to-clinic and time-to-treatment for diabetic eye disease. Diabetologia 2021; 64:749-757. [PMID: 33496821 PMCID: PMC7940160 DOI: 10.1007/s00125-020-05364-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS This study explored the impact of ethnicity on time-to-clinic, time-to-treatment and rates of vision loss in people referred to hospital with diabetic eye disease. METHODS A survival analysis was performed on all referrals from an inner-city diabetic eye screening programme to a tertiary hospital eye service between 1 October 2013 and 31 December 2017. Exclusion criteria were failure to attend hospital, distance visual acuity in both eyes too low to quantify with the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart and treatment received prior to referral. Demographic and screening grade data were collected at the point of referral. Small-area statistics and census data were used to calculate indices of multiple deprivation. The main outcome measures were time taken from the date of referral for an individual to achieve the following: (1) attend the first hospital clinic appointment; (2) receive the first macular laser, intravitreal anti-vascular endothelial growth factor injection or pan-retinal photocoagulation treatment, in either eye; and (3) lose at least ten ETDRS letters of distance visual acuity, in either eye. RESULTS Of 2062 referrals, 1676 individuals were included. Mean age (± SD) was 57.6 ± 14.7 years, with 52% male sex and 86% with type 2 diabetes. The ethnicity profile was 52% Black, 30% White, 10% Asian and 9% mixed/other, with similar disease severity at the time of referral. Time-to-clinic was significantly longer for Asian people than for Black people (p = 0.03) or White people (p = 0.001). Time-to-treatment was significantly longer for Black people than for White people (p = 0.02). Social deprivation did not significantly influence time-to-treatment. There were no significant differences in the rates of vision loss between ethnic groups. CONCLUSIONS/INTERPRETATION Black people wait longer for hospital eye treatment compared with their White counterparts. The reasons for this delay in treatment warrant further investigation.
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Affiliation(s)
- Varo Kirthi
- Faculty of Life Sciences and Medicine, King's College London, London, UK.
- King's College Hospital NHS Foundation Trust, London, UK.
| | - Kate I Reed
- King's College Hospital NHS Foundation Trust, London, UK
| | - Ramith Gunawardena
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Komeil Alattar
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Catey Bunce
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Timothy L Jackson
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
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Abstract
SIGNIFICANCE This study is the first to report high rates of uncorrected vision conditions among Australian secondary schoolchildren living in a rural area and to comment on the rate of eye examinations undertaken on Australian Indigenous children. Uncorrected vision problems that continue throughout the school years have significant implications for children's quality of life and education. PURPOSE This study aimed to investigate the prevalence of uncorrected vision conditions among Australian schoolchildren. METHODS Participants included 280 students from rural primary and secondary schools (aged 4 to 18 years), of whom 40% identified as being of Aboriginal and/or Torres Strait Islander descent (Indigenous). All participants underwent an eye examination including measurements of monocular distance and near visual acuity, assessment of accommodative and vergence function, stereoacuity, color vision, and cycloplegic autorefraction. A parental questionnaire was used to determine whether the child had previously had his/her eyes examined. RESULTS The overall prevalence of uncorrected vision conditions in this population was 35%. The odds of previously having had an eye examination were 2.3× higher for non-Indigenous compared with Indigenous children despite both groups exhibiting high rates of uncorrected vision conditions (Indigenous, 31 [29%]; non-Indigenous, 66 [40%]; χ21 = 3.24, P = .07). Of the children who had significant refractive error (Indigenous, 23 [21%]; non-Indigenous, 49 [30%]; χ21 = 2.70, P = .10), 82% were uncorrected, and only 39% of Indigenous children and 54% of non-Indigenous children had previously had an eye examination. CONCLUSIONS These findings suggest that high rates of uncorrected vision conditions are present among Australian primary and secondary schoolchildren from a rural area and highlight that Indigenous children are much less likely to have had an eye examination. Understanding factors that affect the rate of eye examinations and compliance with spectacle correction must be addressed given the potential impact of these vision conditions.
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Affiliation(s)
- Rebecca A Cox
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Shelley Hopkins
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Joanne M Wood
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Xiong X, Liu D, Liu S, Wu M, Zhan B, Wang H, Zhou X. The prevalence and causes of visual impairment among ethnic Tujia adults in a rural community in China. Medicine (Baltimore) 2020; 99:e22464. [PMID: 33181642 PMCID: PMC7668518 DOI: 10.1097/md.0000000000022464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/10/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022] Open
Abstract
We aimed to investigate the prevalence and causes of visual impairment (VI) in an elderly Tujia ethnic rural population in Southwest China.From June 1 to December 31, 2018, a random cluster sampling survey was conducted among Tujia individuals aged 50 years or older in the rural areas of Qianjiang District County in Chongqing. The sampling design used village-based clusters of approximately equal size (1000 people). The sampling frame was composed of 110 clusters including 26,527 adults aged 50 years or older; 10 clusters (2556 adults) were randomly selected, and 2122 subjects were examined. Ophthalmologic examinations and questionnaires were administered to all the participants. Low vision and blindness were defined using best-corrected visual acuity (BCVA) and presenting visual acuity, according to The World Health Organization standard. The prevalence of VI was estimated, and causes of VI were identified.The participation rate was 83.0%. The prevalence of VI was 15.2% (BCVA 8.0%). In the study population, the prevalence of low vision and blindness increased with age (P < .05) and was higher among those with a low education level (P < .01). The majority of VI was attributed to cataracts (50.0%) and uncorrected refractive error (35.7%). With BCVA, cataract (79.3%) was the most common cause of VI, followed by age-related macular degeneration (10.7%).The main causes of VI in Tujia ethnic were cataracts and refractive errors. Both cataracts and refractive errors are curable eye diseases; thus, local health institutions need to adopt a more active eye care project as a strategy to prevent blindness.
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Ahn SJ, Joung J, Lee BR. Evaluation of Hydroxychloroquine Retinopathy Using Ultra-Widefield Fundus Autofluorescence: Peripheral Findings in the Retinopathy. Am J Ophthalmol 2020; 209:35-44. [PMID: 31526798 DOI: 10.1016/j.ajo.2019.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the application of ultra-widefield fundus autofluorescence (UWF-FAF) imaging in evaluating hydroxychloroquine (HCQ) retinopathy and to report peripheral autofluorescence findings in Asian patients with this condition. DESIGN Retrospective case series. METHODS Setting: institutional. PATIENT POPULATION 58 eyes of 29 patients with HCQ retinopathy. OBSERVATION PROCEDURES UWF-FAF imaging was performed, and the images were compared to conventional FAF images obtained using a confocal digital ophthalmoscope. The sensitivities of detecting retinopathy using the 2 modalities were compared. Peripheral autofluorescence findings in the eyes with HCQ retinopathy were assessed, and their association with the Humphrey visual field test results obtained using the 30-2 and full-field 120 (FF-120) protocols was analyzed. Main outcome measurements were abnormal FAF findings. RESULTS In 41 of 58 eyes (70.7%) with HCQ retinopathy, abnormal FAF findings were noted in the retinal periphery outside the field of view of conventional FAF as hypoautofluorescent (23 eyes, 39.7%) and hyperautofluorescent (38 eyes, 65.5%) lesions. In 5 eyes (8.6%), differences were revealed between conventional FAF and UWF-FAF in detecting retinopathy. Most of the eyes with severe retinopathy showed the most extensive hypoautofluorescence in the nasal peripheral retina. The areas with abnormal FAF findings were significantly correlated with the number of unseen spots on FF-120 results and mean deviation and pattern standard deviation of the 30-2 test results (all P < .001). CONCLUSIONS Peripheral autofluorescence findings varied in eyes with HCQ retinopathy according to the severity of the retinopathy. The retinal findings with UWF-FAF were functionally correlated to visual field results. UWF-FAF may be useful for evaluating HCQ retinopathy, particularly in Asian patients.
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Affiliation(s)
- Seong Joon Ahn
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Jooyoung Joung
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Byung Ro Lee
- Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
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Black LI, Boersma P, Jen A. Vision Testing Among Children Aged 3-5 Years in the United States, 2016-2017. NCHS Data Brief 2019:1-8. [PMID: 31751209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Childhood vision screenings may provide early detection of vision disorders and opportunities for subsequent treatment (1). The United States Preventive Service Task Force recommends that children aged 3-5 years receive a vision screening at least once to detect amblyopia (lazy eye), or its risk factors (2). This report examines the percentage of children aged 3-5 years who have ever had a vision test by selected characteristics using data from the vision supplement included in the 2016-2017 National Health Interview Survey (NHIS).
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Soares RR, Rothschild M, Haddad D, Lenhart P. Visual Impairment and Eye Disease Among Children of Migrant Farmworkers. J Pediatr Ophthalmol Strabismus 2019; 56:28-34. [PMID: 30371918 DOI: 10.3928/01913913-20180905-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the prevalence of reduced visual acuity and ocular disease in the children of migrant farmworkers in Georgia. METHODS A retrospective chart review of data acquired by a vision screening was performed on 156 Haitian and Hispanic children of migrant farmworkers attending a summer school in Georgia. Reduced visual acuity at presentation was analyzed and stratified by ethnicity, type of ocular disease, and immediate resolution with refractive correction. RESULTS The authors found that 20% of migrant farmworker children have a high prevalence of reduced visual acuity in the worse eye. Of those with worse-eye reduced visual acuity, 83% had uncorrected refractive error. The prevalence of uncorrected refractive error from astigmatism and high astigmatism was significantly higher among Hispanics than Haitians. The prevalence of amblyopia suspects among migrant farmworker children was 3%. Of the amblyopia suspects, 80% were anisometropic. CONCLUSIONS Children of migrant farmworkers in Georgia have a higher rate of reduced visual acuity, largely from uncorrected refractive error, when compared to other Hispanic and African American children in the United States with a prevalence more aligned to children in Asian and Latin American countries than school children in the United States. This illustrates the need for improved access to screening and care in this vulnerable population. [J Pediatr Ophthalmol Strabismus. 2019;56(1):28-34.].
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Abstract
South East (SE) Asians accounted for a disproportionate percentage of the functional visual loss (FVL) seen in our area between 1983 and 1987. Moreover, 94% of the SE Asian FVL patients were Cambodian, although Cambodians only represented 20-30% of the local SE Asian patient population. Cambodian refugees are, at present, generally from lower socio-economic classes than the Vietnamese, and a much larger percentage of them have a history of camp incarceration and previous trauma. The Cambodians presenting with FVL may have conversion hysteria influenced by their wartime experience and cultural background. This study demonstrates that the SE Asian refugees in California are not a homogenous group with respect to visual problems, and that an awareness of cultural or historical factors can be important to the management of ophthalmic symptoms in our multi-cultural societies.
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Affiliation(s)
- M J Drinnan
- Department of Ophthalmology, Stanford University School of Medicine, California
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Abstract
PURPOSE To determine the prevalence of optic disc pits in the elderly Chinese population. METHODS. The Beijing Eye Study, a population-based, cross-sectional cohort study, included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%) with an age of 40+ years. The present study included 4027 (90.7%) subjects for whom readable optic disc photographs were available. RESULTS A pit of the optic nerve head was detected in one (0.02%) patient. Prevalence was 0.02 +/-1.58% (95% confidence interval: -0.02, 0.07). CONCLUSIONS A congenital optic disc pit was found in one subject of the present population-based study in mainland China. In a mathematical sense, the calculated prevalence of optic disc pits in the whole population would be 0.02 +/- 1.58% (95% confidence interval: -0.02, 0.07) or about 1:4.000 subjects. From a statistical point of view, however, population-based studies with about 10,000 subjects are necessary to confirm this finding.
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Affiliation(s)
- Y Wang
- Beiging Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing, China
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Zebardast N, Friedman DS, Vitale S. The Prevalence and Demographic Associations of Presenting Near-Vision Impairment Among Adults Living in the United States. Am J Ophthalmol 2017; 174:134-144. [PMID: 27865728 DOI: 10.1016/j.ajo.2016.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/02/2016] [Accepted: 11/09/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To estimate prevalence of presenting near-vision impairment (PNVI) among people aged ≥50 years in the United States (US) and examine associations with sociodemographic characteristics. DESIGN Cross-sectional study. METHODS A total of 11 016 of 12 781 (88.5%) US adults aged ≥50 years participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2008 with recorded near visual acuity. PNVI was defined as presenting near vision worse than 20/40; functional near-vision impairment (FNVI) was defined as at least "moderate difficulty" with either reading newsprint or near work. Prevalence of PNVI and FNVI were estimated accounting for National Health and Nutrition Examination Survey multistage probability sampling design. Multivariable regression models were used to determine sociodemographic characteristics associated with PNVI. RESULTS A total of 13.6% of participants had PNVI, with 25.9% reporting concurrent FNVI. Higher odds of PNVI was associated with nonwhite race, older age, male sex, less than high school education, lack of private health insurance, income less than poverty level, lacking/not using near-vision correction at time of examination, and impaired distance vision. Although the majority of participants with PNVI (82.9%) had normal distance vision or uncorrected refractive error, less than half (46.1%) used near-vision correction. Not using near correction was associated with nonwhite race, younger age, male sex, and lack of access to health care. CONCLUSIONS Approximately 1 in 8 Americans aged ≥50 years have PNVI, with 1 in 4 reporting concurrent FNVI. Demographic factors shown to be important in access to eye care likely influence PNVI and utilization of near-vision correction in the US. As the majority of PNVI is likely correctable with spectacles, allocation of resources to provide corrective lenses to those in need likely has great public health implications.
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Affiliation(s)
- Nazlee Zebardast
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland.
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland
| | - Susan Vitale
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Ore L, Garozli HJ, Schwartz N, Cohen-Dar M. Factors influencing prevalence of vision and ocular abnormalities among Jewish and Arab Israeli schoolchildren. Isr Med Assoc J 2014; 16:553-558. [PMID: 25351012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The detection and correction of refractive errors is one of the priorities of the World Health Organization Initiative Vision 2020. OBJECTIVES To determine the factors related to ocular abnormalities (poor vision, refractive error or other abnormality) among schoolchildren in northern Israel. METHODS A cross-sectional population-based study was conducted among 2113 students aged 6-7 and 13-14 years old in 70 schools in northern Israel. Medical examination included vision history, clinical eye examination and vision testing. If a parent's informed consent was available, eye drops (cycloplegia) were delivered for fundus and retinoscopy testing. An ophthalmologist was asked to determine the need for the child's referral for further diagnostic procedures, treatment and/or follow-up. Multivariate analysis was limited to 1708 children, using data pertaining to the ophthalmologist's decision regarding referral, as well as vision and retinoscopy results. RESULTS Vision and/or ocular abnormality was prevalent in 21.5% (95% confidence interval 17.4-26.6%), predominantly among 13-14 year olds and Jewish children. Abnormal clinical findings were found in 5.7% of the students. Retinoscopy showed a higher prevalence of hypermetropia among 6-7 year olds and a higher prevalence of myopia and astigmatism among the 13-14 year olds. The multivariate analysis suggests an independent effect of retinoscopy abnormality (odds ratio = 3.85), vision abnormality (OR = 2.42), Jewish ethnicity (OR = 1.62) and 13-14 year old age group (OR = 1.26) on the ophthalmologist's referral decision. CONCLUSIONS Vision and/or ocular abnormality is an important health problem among schoolchildren in northern Israel. The independent effect of ethnicity and age on the ophthalmologist's referral decision should be further explored.
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Tapp RJ, Anjou MD, Boudville AI, Taylor HR. The roadmap to close the gap for vision--diabetes-related eye care in the Indigenous Australian population. Diabet Med 2013; 30:1145-6. [PMID: 23586406 DOI: 10.1111/dme.12215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 11/30/2022]
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18
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Chong C, Dai S. Cross-sectional study on prevalence, causes and avoidable causes of visual impairment in Maori children. N Z Med J 2013; 126:31-38. [PMID: 24045350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS To provide information and comparison pertaining to visual impairment of Maori children with other children in New Zealand in particular: prevalence of blindness, causes of visual impairment, and avoidable causes of visual impairment. METHODS Retrospective data collection utilising the WHO/PBL eye examination record for children with blindness and low vision at Blind and Low Vision Education Network New Zealand (BLENNZ), Homai. Individuals not of Maori ethnicity or over the age of 16 were excluded from the study. RESULTS 106 blind and 64 low-vision Maori children were studied. The main cause of blindness in Maori children is cortical visual impairment. Twenty-eight percent of causes of blindness in this population are potentially avoidable with non-accidental injury as the main cause. CONCLUSION The prevalence of blindness and low vision in children amounts to 0.05% and 0.03%, respectively. The prevalence and causes of childhood blindness are comparable to the other ethnic groups in New Zealand. The main difference lies in avoidable causes of blindness, which appeared to be much higher in the Maori population. The leading cause of avoidable blindness in Maori children is caused by non-accidental injuries.
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Affiliation(s)
- Cheefoong Chong
- Department of Ophthalmology, Greenlane Clinical Centre, Private Bag 92-189, Auckland 1024, New Zealand.
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Kitsantas P, Kornides ML, Cantiello J, Wu H. Chronic physical health conditions among children of different racial/ethnic backgrounds. Public Health 2013; 127:546-53. [PMID: 23583033 PMCID: PMC4086459 DOI: 10.1016/j.puhe.2013.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 10/29/2012] [Accepted: 02/13/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES It is estimated that 20% of children in the USA are affected by at least one chronic disease. Although the burden of chronic conditions is greater for minority populations of children, research that has explored the prevalence and risk factors of chronic disease across different racial/ethnic groups is scarce. The aim of this study was to examine racial/ethnic disparities in the prevalence rates of common physical, chronic diseases in White, Black and Hispanic children; and assess the effect of several factors on the risk of having a chronic disease. METHODS Using the 2007 National Survey of Childrens Health, prevalence estimates were calculated for asthma, hearing impairment, visual impairment, joint/bone/muscle problems, brain injury and other illnesses for each racial/ethnic group. Multivariate logistic regression analyses were conducted to examine the effects of several risk factors on the risk of each of these health conditions. RESULTS The findings show that the prevalence for all health conditions was significantly higher (25.3%) among Black children than White (19.8%) and Hispanic (18.6%) children. Furthermore, 19.5% of Black children have had or currently have asthma compared with 12.2% of White and Hispanic children. More Black and Hispanic children were covered by public health insurance, while 19% of Hispanic children were currently uninsured. White children whose mothers had a health problem were associated with asthma, hearing impairment, visual impairment and joint/bone/muscle problems, while Black children were more likely to report asthma and Hispanics reported visual impairment and joint/bone muscle problems. Hispanic children who were living in poverty or were uninsured were at lower risk for any chronic disease. Regardless of race/ethnicity, children living in a single-parent household were more likely to be associated with any health condition. CONCLUSIONS This study provides evidence that racial/ethnic disparities in chronic physical conditions and health care among US children are extensive. It underscores that uninsured children who do not have access to the healthcare system are not being screened for chronic diseases, or are not obtaining medical care for such health problems. Healthcare providers should educate families about prevention measures and community services that might be able to assist them in improving the health of their children.
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Affiliation(s)
- P Kitsantas
- George Mason University, The College of Health and Human Services, Department of Health Administration and Policy, Fairfax, VA, USA.
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Haseltine SJ, Pae J, Ehrlich JR, Shammas M, Radcliffe NM. Variation in corneal hysteresis and central corneal thickness among black, hispanic and white subjects. Acta Ophthalmol 2012; 90:e626-31. [PMID: 22938724 DOI: 10.1111/j.1755-3768.2012.02509.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether differences in corneal hysteresis (CH) and central corneal thickness (CCT) between black, Hispanic and white subjects exist independently of one another. METHODS Retrospective, cross-sectional data were reviewed for 807 eyes of 410 patients consecutively evaluated for glaucoma. Included patients had open angles, at least one reliable 24-2 perimetric examination and no evidence of nonglaucomatous vision loss. Patients underwent CH measurement with the ocular response analyzer followed by CCT measurement and full ocular examination. Patients were asked to self-classify their race or ethnicity. Statistical analyses were performed to identify characteristics that varied between black, Hispanic and white subjects and to explain this variation. RESULTS Of the 270 patients (511 eyes) included, 84 were black, 96 Hispanic and 90 white. There were no significant differences in diagnosis, sex, age, intraocular pressure or glaucoma severity between races/ethnicities (p ≥ 0.16). Blacks were found to have lower CCT (529.3 μm) and CH (8.7 mmHg) compared to Hispanics (544.7 μm, p = 0.008; 9.4 mmHg, p = 0.007) and whites (549.9 μm, p < 0.001; 9.8 mmHg, p < 0.001). On multivariable analysis, inter-racial/ethnic differences in CCT were not found to exist independent of CH (p ≥ 0.10), whereas the significant intergroup variation in CH remained after adjustment for CCT and other covariates (p ≤ 0.005). CONCLUSIONS Variation in CCT between races/ethnicities does not exist independent of CH. However, significant intergroup variation in CH is present independent of CCT. This finding suggests that CH may be a preferable measurement to evaluate intergroup differences in corneal properties and their relationship to open-angle glaucoma.
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Affiliation(s)
- Sarah J Haseltine
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10021, USA
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Chou CF, Barker LE, Crews JE, Primo SA, Zhang X, Elliott AF, McKeever Bullard K, Geiss LS, Saaddine JB. Disparities in eye care utilization among the United States adults with visual impairment: findings from the behavioral risk factor surveillance system 2006-2009. Am J Ophthalmol 2012; 154:S45-52.e1. [PMID: 23158223 DOI: 10.1016/j.ajo.2011.09.025] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 09/23/2011] [Accepted: 09/23/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To estimate the prevalence of annual eye care among visually impaired United States residents aged 40 years or older, by state, race/ethnicity, education, and annual income. DESIGN Cross-sectional study. METHODS In analyses of 2006-2009 Behavioral Risk Factor Surveillance System data from 21 states, we used multivariate regression to estimate the state-level prevalence of yearly eye doctor visit in the study population by race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and other), annual income (≥$35,000 and <$35,000), and education (< high school, high school, and > high school). RESULTS The age-adjusted state-level prevalence of yearly eye doctor visits ranged from 48% (Missouri) to 69% (Maryland). In Alabama, Colorado, Indiana, Iowa, New Mexico, and North Carolina, the prevalence was significantly higher among respondents with more than a high school education than among those with a high school education or less (P < .05). The prevalence was positively associated with annual income levels in Alabama, Georgia, New Mexico, New York, Texas, and West Virginia and negatively associated with annual income levels in Massachusetts. After controlling for age, sex, race/ethnicity, education, and income, we also found significant disparities in the prevalence of yearly eye doctor visits among states. CONCLUSION Among visually impaired US residents aged 40 or older, the prevalence of yearly eye examinations varied significantly by race/ethnicity, income, and education, both overall and within states. Continued and possibly enhanced collection of eye care utilization data, such as we analyzed here, may help states address disparities in vision health and identify population groups most in need of intervention programs.
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Affiliation(s)
- Chiu-Fang Chou
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3727, USA.
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Tatemichi M, Nakano T, Hayashi T, Tanaka K, Hiro H, Miyamoto T, Aratake M, Nishinoue N, Yamazaki A, Nakadate T, Sugita M. Symptoms related to glaucomatous visual field abnormalities among male Japanese workers in a population-based setting. Acta Ophthalmol 2012; 90:546-51. [PMID: 20809905 DOI: 10.1111/j.1755-3768.2010.01988.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify symptoms potentially related to glaucomatous visual field abnormalities (VFAs) in a population-based setting, and to assess the applicability of using these symptoms to identify persons at risk of developing glaucoma. METHODS In this study, 10,214 Japanese male general workers (mean age, 45.3±8.8 years) filled out a self-administered questionnaire and underwent frequency doubling technology (FDT) perimetry testing. The questionnaire inquired about whether the participant was suffering from any of nine symptoms, with scores for each response graded on a four-item Likert scale: 0 (none), 1 (rarely), 2 (sometimes), and 3 (always). Results from the questionnaire were compared among three groups: participants without any VFAs (9767), participants with VFAs as determined by the FDT test (FDT-VFA; 447), and 227 participants (of the 447 FDT-VFA participants) with glaucomatous VFAs who were newly diagnosed by ophthalmologic examinations. RESULTS The mean summed scores for the total items were significantly (p<0.01) higher in FDT- and glaucomatous VFA groups than in normal subjects. In particular, responses citing the symptoms 'feeling of something in the front of the eye' and 'feeling of hardness to see in dark places' were significantly (p<0.05) more frequent in subjects with FDT- and glaucomatous VFAs than among normal participants. However, the respective areas under the receiver operating characteristic curve of summed scores for the nine total items and for the two items which showed significant differences for the glaucoma groups were 0.57 (95% confidence interval=0.53-0.60) and 0.58 (95% confidence interval=0.54-0.61). CONCLUSION Although the symptoms 'feeling of hardness to see in dark places' and 'feeling of something in the front of the eye' could be associated with glaucomatous VFA in a population-based setting, inquiring about symptoms is of little aid in identifying subjects with glaucomatous VFA as a strategy for public health.
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Affiliation(s)
- Masayuki Tatemichi
- Department of Hygiene and Preventive Medicine, Showa University, School of Medicine, Tokyo, Japan.
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Varma R, Wang D, Wu C, Francis BA, Nguyen BBT, Chopra V, Memarzadeh F, Torres M, Azen SP. Four-year incidence of open-angle glaucoma and ocular hypertension: the Los Angeles Latino Eye Study. Am J Ophthalmol 2012; 154:315-325.e1. [PMID: 22541649 DOI: 10.1016/j.ajo.2012.02.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 02/08/2012] [Accepted: 02/09/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To estimate the 4-year incidence of open-angle glaucoma (OAG) and ocular hypertension (OHT) among adult Latinos 40 years of age and older. DESIGN Population-based longitudinal study. METHODS Comprehensive ophthalmologic examinations including intraocular pressure, visual field testing, and stereoscopic fundus photography were performed at both baseline and the 4-year follow-up examination. Incident OAG at the 4-year follow-up examination was defined as the presence of an open angle and a glaucomatous visual field abnormality or evidence of glaucomatous optic disc damage, or both when not present at baseline. Incident OHT was defined as intraocular pressure of more than 21 mm Hg and the absence of optic disc damage or abnormal visual field results at the 4 year follow-up examination when not present at baseline. RESULTS Among the 3939 participants (mean age, 54.7 ± 10.5 years) with complete data for a diagnosis of glaucoma at both baseline and follow-up examination, incident OAG at the 4-year follow-up was identified in 87 persons (4-year incidence rate, 2.3%; 95% confidence interval, 1.8% to 2.8%). Incident OHT at the 4-year follow-up was identified in 124 persons (4-year incidence rate, 3.5%; 95% confidence interval, 2.9% to 4.1%). In participants with OAG in 1 eye, the 4-year risk of OAG developing in the fellow eye was 5 times as high as the risk for those without OAG in either eye at baseline. In participants with OHT in 1 eye, the 4-year risk of OHT developing in the fellow eye was 10 times as high as the risk for those without OHT in either eye at baseline. The incidence rates of OAG and OHT were higher in older Latinos than in younger Latinos. CONCLUSIONS Incidence of OAG in Latinos is higher than in non-Hispanic whites, but lower than in Afro-Caribbeans. The relatively high rate of incident OAG and OHT underscores the need for community screening programs in this fastest growing segment of the United States population.
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Affiliation(s)
- Rohit Varma
- Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Taylor HR, Keeffe JE. Authors' response. Br J Ophthalmol 2011; 96:1041-2. [PMID: 22180416 DOI: 10.1136/bjophthalmol-2011-301245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kemper AR, Wallace DK, Patel N, Crews JE. Preschool vision testing by health providers in the United States: findings from the 2006-2007 Medical Expenditure Panel Survey. J AAPOS 2011; 15:480-3. [PMID: 22108361 DOI: 10.1016/j.jaapos.2011.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/01/2011] [Accepted: 07/13/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Few data are available regarding the rate of preschool vision screening. The purpose of this study is to estimate the current rate of vision testing among children ages 3 through 6 years by any health care provider and to the characterize the children reported to have been tested. METHODS We conducted a cross-sectional analysis of the 4,237 children aged 3 through 6 years included in either the 2006 or 2007 Medical Expenditure Panel Survey. Household respondents were asked whether selected children ever had vision testing by a doctor or other health provider. Data were weighted to make estimates representative of the civilian noninstitutionalized population. RESULTS Overall, 64.9% (95% CI, 62.9%-66.9%) of children 3 through 6 years of age were reported to have ever had vision testing. The likelihood of previous reported testing increased with age, from 42.9% among 3-year-olds to 79.4% among 6-year-olds (P < 0.001). After adjusting for age, family income, insurance status, whether the child had a regular health care provider, and whether the child had special health care needs, we found that lower odds of testing were reported among non-Hispanic white children (odds ratio [OR], 0.73; 95% CI, 0.55-0.97) and among Hispanic children (OR, 0.62; 95% CI, 0.47-0.82) compared with non-Hispanic black children (OR, 1). CONCLUSIONS These findings highlight the gaps in the delivery of preschool vision screening. Improved population-level surveillance of children's vision and methods to track use of vision-related health services are needed to inform policy makers to develop new strategies to improve care.
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Affiliation(s)
- Alex R Kemper
- Department of Pediatrics, Duke University, Durham, NC, USA.
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Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, Gregg EW, Albright AL, Klein BEK, Klein R. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA 2010; 304:649-56. [PMID: 20699456 PMCID: PMC2945293 DOI: 10.1001/jama.2010.1111] [Citation(s) in RCA: 739] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT The prevalence of diabetes in the United States has increased. People with diabetes are at risk for diabetic retinopathy. No recent national population-based estimate of the prevalence and severity of diabetic retinopathy exists. OBJECTIVES To describe the prevalence and risk factors of diabetic retinopathy among US adults with diabetes aged 40 years and older. DESIGN, SETTING, AND PARTICIPANTS Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N = 1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A(1c) of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older. MAIN OUTCOME MEASUREMENTS Diabetic retinopathy and vision-threatening diabetic retinopathy. RESULTS The estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 21.7%-30.1%; P = .04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of diabetic retinopathy (38.8%; 95% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening diabetic retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of diabetic retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A(1c) level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 1.02-1.03). CONCLUSION In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was high, especially among Non-Hispanic black individuals.
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Affiliation(s)
- Xinzhi Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA 30341-3727, USA.
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Andersson Grönlund M, Landgren M, Strömland K, Aring E, Svensson L, Tuvemo T, Hellström A. Relationships between ophthalmological and neuropaediatric findings in children adopted from Eastern Europe. Acta Ophthalmol 2010; 88:227-34. [PMID: 19416116 DOI: 10.1111/j.1755-3768.2008.01430.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to evaluate and relate visual function, ocular dimensions and neuropaediatric findings in adoptees from Eastern Europe. METHODS We studied 72 of 99 children, born during 1990-95 and adopted from Eastern Europe to western Sweden during 1993-97. The children (mean age 7.5 years, range 4.8-10.5 years; 41 boys, 31 girls) were examined after a mean period of 5 years post-adoption by a multidisciplinary team. Correlations between ophthalmological findings and neuropaediatric data were analysed. RESULTS Bivariate and regression analyses indicate a significant positive correlation between visual acuity (VA) and perceptual organization (p < 0.001), as well as between strabismus and verbal comprehension (p < 0.02). Fetal alcohol syndrome (FAS) was correlated with low VA (p < 0.02), subnormal stereovision (p < 0.009) and small optic discs (p < 0.02). Small head circumference was related to low VA (p < 0.015) and small optic discs (p < 0.03). Furthermore, small optic discs were related to low birthweight (p < 0.005) and preterm birth (p < 0.01). Large optic cups were correlated with poorer perceptual organization (p < 0.02). CONCLUSIONS In this group of adoptees from Eastern Europe, ophthalmological findings were correlated to neuropaediatric findings, especially those arising from prenatal adverse events resulting in growth deficiency and central nervous system damage. Therefore, it is important and valuable with an ophthalmological examination in children adopted from Eastern Europe.
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Affiliation(s)
- Marita Andersson Grönlund
- Institute of Neuroscience and Physiology/Ophthalmology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
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Multi-Ethnic Pediatric Eye Disease Study Group. Prevalence of myopia and hyperopia in 6- to 72-month-old african american and Hispanic children: the multi-ethnic pediatric eye disease study. Ophthalmology 2010; 117:140-147.e3. [PMID: 19926137 DOI: 10.1016/j.ophtha.2009.06.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 06/02/2009] [Accepted: 06/08/2009] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine the age-, gender-, and ethnicity-specific prevalence of myopia and hyperopia in African American and Hispanic children aged 6 to 72 months. DESIGN Population-based cross-sectional study. PARTICIPANTS The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children aged 6 to 72 months in Los Angeles County, California. Seventy-seven percent of eligible children completed a comprehensive eye examination. This report focuses on results from 2994 African American and 3030 Hispanic children. METHODS Eligible children in 44 census tracts were identified during an in-home interview and scheduled for a comprehensive eye examination and in-clinic interview. Cycloplegic autorefraction was used to determine refractive error. MAIN OUTCOME MEASURES The proportion of children with spherical equivalent (SE) myopia </= -1.00 diopter (D) and SE hyperopia >/= +2.00 D in the worse eye. Prevalence of myopia and hyperopia is also reported using alternative threshold definitions. RESULTS Prevalence of myopia was higher in African American (6.6%) compared with Hispanic children (3.7%; P<0.001). Hispanics showed a higher prevalence of hyperopia than African American children (26.9% vs. 20.8% respectively, P<0.001). The prevalence of myopia showed a significant decreasing trend with age (P<0.001). Hyperopia prevalence reached a low point at approximately 24 months of age but increased and remained higher than that thereafter. No significant gender differences were found in the prevalence of refractive error for either ethnic group. CONCLUSIONS We observed ethnicity-related differences in both hyperopia and myopia prevalence in preschool children. The age-related decrease in myopia prevalence in preschool children could reflect early emmetropization and contrasts with the increase in myopia prevalence known to occur in older school-aged children. The limits of emmetropization are evident, however, in the persistently elevated prevalence of hyperopia beyond 24 months of age. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Ma J, Li BH, Wu SS, Song Y, Hu PJ, Zhang B. [Study on the trend of minority students' health status from 1995 to 2005 in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2009; 30:919-922. [PMID: 20193228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To reveal the trend of minority students' health from 1995 to 2005 in China. METHODS We selected 15 minority groups wtih data pertaining to students' nutritional status, poor vision and decayed tooth in 1995, 2000 and 2005. The minority groups were Mongolian, Hui, Uygur, Zhuang, Korean, Tibetan, Yao, Li, Qiang, Bouyei, Dong, Hmong, Tu, Salar and Kirgiz. RESULTS The prevalences of underweight and malnutrition in 2005 in Mongolian, Hui, Uygur, Zhuang and Korean students aged 7 - 22 years were lower than that of 1995 and 2000, indicating the nutrition status was improved. The prevalence of malnutrition in city girls was the highest. The mild malnutrition rates in 2005 decreased to 2.69%, 4.67%, 3.68%, 9.62% and 2.65% but the prevalence of overweight and obesity increased. For city boys, the rates were 5.50%, 8.12%, 2.69%, 3.69% and 13.50%. The prevalence of decayed tooth changed but with no significant differences. The prevalence rates of poor vision and myopia kept increasing. The minority students' myopia rates in 2005 were 29.5%, 39.1%, 10.1%, 42.6%, 41.1%, for boys and 45.4%, 50.0%, 15.4%, 49.7%, 46.7% for girls. CONCLUSION In order to improve the health of students in minority regions, we need to promote health education at schools.
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Affiliation(s)
- Jun Ma
- Institute of Child and Adolescent Health, Peking University, Beijing 100191, China
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Lam BL, Lee DJ, Zheng DD, Davila EP, Christ SL, Arheart KL. Disparity in prevalence of self-reported visual impairment in older adults among U.S. race-ethnic subgroups. Ophthalmic Epidemiol 2009; 16:144-50. [PMID: 19437308 PMCID: PMC4084731 DOI: 10.1080/09286580902863007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Prevalence of visual impairment (VI) in the United States (U.S.) has not been carefully examined by race-ethnic subgroups. This study examines self-reported VI prevalence in race-ethnic subgroups using data representative of the U.S. population age > or =45 years. METHODS The National Health Interview Survey (NHIS) is a population-based multipurpose and multistage area probability annual survey of the U.S. civilian non-institutionalized population conducted by the National Center for Health Statistics. Data from a total of 122,649 participants age > or =45 years from the pooled 1999-2006 National Health Interview Surveys were used. VI prevalence was based on two questions asked to participants, "Do you have any trouble seeing, even when wearing glasses or contact lenses?" (some VI), and "Are you blind or unable to see at all?" (severe VI). RESULTS For middle-aged adults age 45-64 years, race/ethnic groups with high age-adjusted rates of any self-reported VI (some or severe VI) include Native Americans, Puerto Ricans, Dominicans, and those reporting mixed race/ethnicity. Among older adults age > or =65 years, understudied race/ethnic groups with high age-adjusted rates of any self-reported VI include Native Americans, Chinese Americans, Puerto Ricans, Dominicans, and Central/South Americans. Among older adults with severe VI, the results suggest high VI prevalence in Filipinos, Chinese Americans, Dominicans, Cubans, and Puerto Ricans and those reporting mixed race/ethnicity. CONCLUSIONS Among understudied U.S. race-ethnic groups, older Native Americans, Chinese Americans, Puerto Ricans, Dominicans, and Central/South Americans generally have high rates of self-reported VI suggesting further targeted epidemiologic and intervention studies may be warranted.
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Affiliation(s)
- Byron L Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA.
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Grönlund MA, Aring E, Strömland K, Landgren M, Svensson LA, Hellström A. [Eye and visual problems common in adoptees from Eastern Europe]. Lakartidningen 2009; 106:676-678. [PMID: 19418686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Foong AWP, Fong CW, Wong TY, Saw SM, Heng D, Foster PJ. Visual Acuity and Mortality in a Chinese Population. Ophthalmology 2008; 115:802-7. [PMID: 17765312 DOI: 10.1016/j.ophtha.2007.04.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 04/30/2007] [Accepted: 04/30/2007] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the relationship between visual acuity and mortality in a Chinese population. DESIGN Population-based cohort study. PARTICIPANTS Chinese persons in Singapore ages 40 to 79 years at baseline examination. METHODS The Tanjong Pagar Study in Singapore examined 1232 persons (response rate, 71.8%) at the baseline examination in 1997 and 1998. Participants had measurements of presenting and best-corrected visual acuity (VA) using standardized protocols. Mortality data were obtained from the National Death Registry, which linked subjects who had died since the baseline examination. Cause of death was determined from the International Classification of Diseases 9 codes. Analysis was performed on 1225 (99.4%) participants with VA data. MAIN OUTCOME MEASURE All-cause mortality. RESULTS By December 31, 2004 (median follow-up, 6.8 years), 126 persons had died. Participants with presenting VA in the better eye worse than 20/40 (logarithm of the minimum angle of resolution [logMAR] score, 0.3) had a significantly higher mortality rate (hazard ratio [HR], 2.9; 95% confidence interval [CI], 1.4-6.3, adjusting for age, gender, hypertension, diabetes, smoking, heart attack, stroke, and income) as compared with participants with VA of 20/20 (logMAR, 0.0). Associations were similar for best-corrected VA in the better eye (HR, 2.7; 95% CI, 1.4-5.5). Among clinic participants with logMAR VA measurements, each 1-line difference in presenting VA (logMAR gain, 0.10) was associated with a 4-fold increased risk of mortality (HR, 4.4; 95% CI, 1.9-10.2). CONCLUSIONS In this Chinese population in Singapore, visual impairment was associated independently with an increased risk of mortality.
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Wilson CJ, Rust G, Levine R, Alema-Mensah E. Disparities in vision impairment among adults in the United States. Ethn Dis 2008; 18:S2-246. [PMID: 18646358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND This study aimed to determine the prevalence and severity of vision impairment by race in the United States by analyzing the population-based prevalence of corrected distance visual acuities in non-Hispanic Whites, Hispanics, and African Americans. METHODS This is a nationally representative, population-based, cross-sectional study. Data from the National Health and Nutrition Examination Survey (NHANES) 2001-2002 were analyzed to investigate the epidemiologic features of corrected distance visual acuities among non-Hispanic Whites (n = 3034), Hispanic Americans (n = 1532), and African Americans (n = 1183) aged 18-85 years. RESULTS Prevalence rates of overall impairment were 5.0%, 2.1%, and 1.6% for non-Hispanic Whites, Hispanic Americans, and African Americans, respectively (P = .1015). CONCLUSIONS The prevalence of vision impairment based on corrected distance visual acuity is higher in non-Hispanic Whites than in Hispanic and African Americans. The magnitude of this racial difference is not statistically significant and is less than that of previous studies that were based on comparisons of uncorrected visual acuities.
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Affiliation(s)
- Carmen J Wilson
- Clinical Research Center, Morehouse School of Medicine, Atlanta, Georgia, USA.
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Nolan MJ, Giovingo MC, Miller AM, Wertz RD, Ritch R, Liebmann JM, Allingham RR, Herndon LW, Wax MB, Smolyak R, Hasan F, Barnett EM, Samples JR, Knepper PA. Aqueous humor sCD44 concentration and visual field loss in primary open-angle glaucoma. J Glaucoma 2007; 16:419-29. [PMID: 17700283 DOI: 10.1097/ijg.0b013e318050ab4b] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To correlate aqueous humor soluble CD44 (sCD44) concentration, visual field loss, and glaucoma risk factors in primary open-angle glaucoma (POAG) patients. METHODS Aqueous samples were obtained by paracentesis from normal and glaucoma patients who were undergoing elective surgery and analyzed for sCD44 concentration by enzyme-linked immunosorbent assay. RESULTS In normal aqueous (n=124) the sCD44 concentration was 5.88+/-0.27 ng/mL, whereas in POAG aqueous (n=90) the sCD44 concentration was 12.76+/-0.66 ng/mL, a 2.2-fold increase (P<0.000001). In POAG patients with prior successful filtration surgery (n=13), the sCD44 concentration was decreased by 43% to 7.32+/-1.44 (P=0.001) in comparison with POAG patients without filtration surgery; however, the sCD44 concentration in the prior successful filtration subgroup with no medications and normal intraocular pressure was 12.62+/-3.81 (P=0.05) compared with normal. The sCD44 concentration of normal pressure glaucoma patients was 9.19+/-1.75 ng/mL, a 1.6-fold increase compared with normal (P=0.02). Race and intraocular pressure pulse amplitude were significant POAG risk factors in this cohort of patients. In both normal and POAG patients with mild and moderate visual field loss, sCD44 concentration was greater in African Americans than in whites (P=0.04). CONCLUSIONS sCD44 concentration in the aqueous of POAG patients correlated with the severity of visual field loss in all stages in white patients and in mild to moderate stages in African American patients. sCD44 concentration in aqueous is a possible protein biomarker of visual field loss in POAG.
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Affiliation(s)
- Michael J Nolan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, USA
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Hennis A, Wu SY, Nemesure B, Honkanen R, Leske MC. Awareness of Incident Open-angle Glaucoma in a Population Study. Ophthalmology 2007; 114:1816-21. [PMID: 17698198 DOI: 10.1016/j.ophtha.2007.06.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Revised: 06/05/2007] [Accepted: 06/05/2007] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate factors related to awareness of incident open-angle glaucoma (OAG) in the Barbados Eye Studies. DESIGN Cohort study with 81% to 85% response rate over 9 years. PARTICIPANTS Four thousand three hundred fourteen participants of African descent, 40 to 84 years old at baseline. METHODS Standardized study visits included an interview on demographic, medical, health care, and other factors; various ophthalmic measurements; fundus photography; and comprehensive ophthalmologic examinations for those referred. MAIN OUTCOME MEASURES Definite OAG was defined by both visual field and optic disc criteria after ophthalmologic confirmation, regardless of intraocular pressure (IOP). Definite incident participants without prior OAG diagnosis/treatment were considered unaware. Logistic regression analyses evaluated factors associated with OAG unawareness. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Over 9 years, 125 participants newly developed definite OAG, of whom 53% were previously unaware. At baseline, the unaware group had significantly lower mean IOP (OR, 0.86; 95% CI, 0.79-0.94) and more hyperopia (OR, 2.69; 95% CI, 1.08-6.69) than those aware. Most unaware and aware participants had > or =2 medical care visits in the previous year (72.7% vs. 83.1%). However, those in the unaware group sought eye care less frequently than those aware (last visit in preceding year, 33.4% vs. 64.4%); these visits were mainly for eyeglasses (71.4% vs. 12.5%), with most having glaucoma tests only during study visits (72.7% vs. 37.3%). The unaware group reported more visits to opticians/optometrists than to private ophthalmologists (OR, 4.20; 95% CI, 1.00-17.66) and fewer visits to a public ophthalmologic clinic (OR, 0.18; 95% CI, 0.04-0.86). CONCLUSIONS Over half of participants with incident OAG were unaware of their diagnosis. Unawareness was related to lower IOP, hyperopia, and eye care utilization patterns. Although persons in the unaware group had regular visits for medical care, visits for eye care and OAG testing were limited. Unawareness was 4 times more likely when opticians/optometrists were the regular eye care source, compared with private ophthalmologists, and about 80% less likely with a public ophthalmologic source. These findings highlight the high frequency of undiagnosed OAG and importance of comprehensive examinations in disease detection.
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Affiliation(s)
- Anselm Hennis
- Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Bridgetown, Barbados
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Barañano AE, Wu J, Mazhar K, Azen SP, Varma R. Visual acuity outcomes after cataract extraction in adult latinos. The Los Angeles Latino Eye Study. Ophthalmology 2007; 115:815-21. [PMID: 17826836 PMCID: PMC4864722 DOI: 10.1016/j.ophtha.2007.05.052] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 05/25/2007] [Accepted: 05/25/2007] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine prevalence, primary causes, and risk indicators of visual impairment in cataract-operated eyes. DESIGN Population-based cross-sectional study of adult Latinos. PARTICIPANTS Two hundred sixty-one participants with cataract extraction. METHODS Participants underwent an in-home interview and a comprehensive ophthalmologic examination. Visual impairment in the cataract-operated eye was defined by presenting visual acuity (PVA) of 20/40 or less or best-corrected visual acuity (BCVA) of 20/40 or less. The association of cataract extraction status (aphakic, pseudophakic) and severity of visual impairment was evaluated. Risk indicators associated with visual impairment by BCVA in the worse-seeing cataract-operated eye were evaluated. MAIN OUTCOME MEASURES Visual acuity, causes of visual impairment, and risk indicators associated with visual impairment. RESULTS Of the 261 participants with at least one cataract extraction and a complete clinical examination, 100 (38%) participants had undergone a unilateral extraction and 161 (62%) had undergone bilateral extractions. The prevalence of visual impairment was 41% (n = 107) defined by BCVA and 60.5% (n = 158) defined by PVA in the worse-seeing cataract-operated eye, and 32.2% (n = 136) defined by BCVA versus 48.1% (n = 203) defined by PVA in all cataract-operated eyes. Uncorrected refractive error, age-related macular degeneration, and diabetic retinopathy were the primary causes of visual impairment, accounting for 49% in worse-seeing cataract-operated eyes and 57% in all cataract-operated eyes. Self-reported history of glaucoma, barriers to eye care, and unmarried participants were independent risk indicators associated with visual impairment (P<0.05). CONCLUSIONS Despite cataract surgery, a significant proportion of participants had residual visual impairment. Refractive correction eliminated visual impairment in 15% to 20% of the participants, demonstrating the need for regular ophthalmologic examinations in cataract-operated patients.
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Affiliation(s)
- Anne E. Barañano
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Joanne Wu
- Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, California
| | - Kashif Mazhar
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stanley P. Azen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rohit Varma
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Chopra V, Varma R, Francis BA, Wu J, Torres M, Azen SP. Type 2 diabetes mellitus and the risk of open-angle glaucoma the Los Angeles Latino Eye Study. Ophthalmology 2007; 115:227-232.e1. [PMID: 17716734 PMCID: PMC4864602 DOI: 10.1016/j.ophtha.2007.04.049] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 04/26/2007] [Accepted: 04/30/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To examine the relationship between type 2 diabetes mellitus (T2DM) and the risk of having open-angle glaucoma (OAG) in an adult Latino population. DESIGN Population-based cross-sectional study. PARTICIPANTS Latinos 40 years and older (n = 5894) from 6 census tracts in Los Angeles, California. METHODS Participants from the Los Angeles Latino Eye Study (LALES), a large population-based study of self-identified adult Latinos, answered an interviewer-administered questionnaire and underwent a clinical and complete ocular examination, including visual field (VF) testing and stereo fundus photography. A participant was defined as having diabetes mellitus (DM) if she or he had a history of being treated for DM, the participant's glycosylated hemoglobin was measured at 7.0% or higher, or the participant had random blood glucose of 200 mg% or higher. Type 2 DM was defined if the participant was 30 years or older when diagnosed with DM. Open-angle glaucoma was defined as the presence of an open angle and a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. Logistic regression analysis was used to identify the risk of having OAG in persons with T2DM. MAIN OUTCOME MEASURE Prevalence of OAG. RESULTS Of the 5894 participants with complete data, 1157 (19.6%) had T2DM and 288 (4.9%) had OAG. The prevalence of OAG was 40% higher in participants with T2DM than in those without T2DM (age/gender/intraocular pressure-adjusted odds ratio, 1.4; 95% confidence interval, 1.03-1.8; P = 0.03). Trend analysis revealed that a longer duration of T2DM (stratified into 5-year increments) was associated with a higher prevalence of OAG (P<0.0001). CONCLUSION The presence of T2DM and a longer duration of T2DM were independently associated with a higher risk of having OAG in the LALES cohort. The high prevalences of T2DM and OAG and their association in this fastest growing segment of the United States population have significant implications for designing screening programs targeting Latinos.
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Affiliation(s)
- Vikas Chopra
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rohit Varma
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brian A. Francis
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Joanne Wu
- Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, California
| | - Mina Torres
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stanley P. Azen
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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McKean-Cowdin R, Varma R, Wu J, Hays RD, Azen SP. Severity of visual field loss and health-related quality of life. Am J Ophthalmol 2007; 143:1013-23. [PMID: 17399676 PMCID: PMC2731547 DOI: 10.1016/j.ajo.2007.02.022] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 02/05/2007] [Accepted: 02/07/2007] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the association between severity of visual field loss (VFL) and self-reported health-related quality of life (HRQOL) in a population-based sample. DESIGN Population-based cross-sectional study. METHODS Participants in the Los Angeles Latino Eye Study (LALES) underwent a comprehensive ophthalmic examination including visual field testing by the Humphrey Automated Field Analyzer II (Swedish Interactive Thresholding Algorithm [SITA] Standard 24-2) [Carl Zeiss Meditec, Dublin, California, USA]. Mean deviation (MD) scores were used to determine severity of VFL both as a continuous variable and stratified by severity: no VFL (MD >or= -2 decibels [dB]), mild VFL (-6 dB < MD < -2 dB), and moderate to severe VFL (MD < -6 dB). HRQOL was assessed by the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) and the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Linear regression analyses and analysis of covariance were used to assess the relationship between HRQOL scores and VFL. RESULTS Of the 5,213 participants included in this study, 18% had unilateral mild, 1.5% unilateral moderate to severe, 19% bilateral mild, and 6.5% bilateral moderate to severe VFL. Worse NEI-VFQ-25 and SF-12 HRQOL scores were associated with VFL in a linear manner. Four- to 5-dB differences in VFL were associated with a five-point difference in the NEI-VFQ-25 composite and most subscale scores. Persons with VFL had the greatest difficulty with driving activities, dependency, mental health, distance vision, and peripheral vision. CONCLUSIONS HRQOL is diminished even in persons with relatively mild VFL on the basis of MD scores. Prevention and management of persons with VFL may be important in preventing or reducing poor HRQOL related to difficulties in driving, distance and peripheral vision activities, and a sense of dependency.
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Affiliation(s)
- Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rohit Varma
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joanne Wu
- Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Ron D. Hays
- Department of Health Services, UCLA School of Public Health, University of California at Los Angeles, Los Angeles, CA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, CA
- RAND Corporation, Santa Monica, CA
| | - Stanley P. Azen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Abstract
PURPOSE To extract and induce rules of association for differentiating between normal and glaucomatous eyes based on the quantitative assessment of summary data reports from the StratusOCT (optical coherence tomography; Carl Zeiss Meditec, Inc., Dublin, CA) in a Taiwan Chinese population. METHODS One randomly selected eye of each of the 64 patients with glaucoma and each of the 71 normal subjects was included in the study. Measurements of glaucoma variables (retinal nerve fiber layer thickness and optic nerve head analysis results) were obtained with the StratusOCT. A self-organizing map and decision tree were applied to extract features and determine rules of association for glaucoma detection. RESULTS The average visual field mean deviation was -0.55 +/- 0.57 dB in the normal group and -4.30 +/- 3.32 dB in the glaucoma group. Vertical cup-to-disc (C/D) ratio and inferior quadrant thickness were extracted from the decision tree, and three association rules were determined for glaucoma detection. CONCLUSIONS The precise rules of association induced by a novel application of the decision tree may enhance glaucoma detection.
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Affiliation(s)
- Mei-Ling Huang
- Department of Industrial Engineering and Management, National Chin-Yi Institute of Technology, Taipei, Taichung, Taiwan
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Vistamehr S, Shelsta HN, Palmisano PC, Filardo G, Bashford K, Chaudhri K, Forster SH, Shafranov G, Bruce Shields M. Glaucoma Screening in a High-risk Population. J Glaucoma 2006; 15:534-40. [PMID: 17106368 DOI: 10.1097/01.ijg.0000212282.88347.c9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate a screening protocol for detection of individuals with a higher risk of chronic open angle glaucoma for which a complete glaucoma evaluation is indicated. PATIENTS AND METHODS African Americans over 40 years of age in New Haven, CT. In the screening phase, volunteers filled out a questionnaire and underwent measurements of visual acuity, intraocular pressure (IOP) with a Tono-Pen and visual field with Frequency Doubling Technology. Participants were categorized into "glaucoma likely" or "unlikely," but all were encouraged to follow up with a free complete glaucoma exam, which included applanation tonometry, pachymetry, visual fields with a Humphrey Visual Field Analyzer, gonioscopy, and fundoscopy. Based on the latter exam, patients were categorized into "glaucoma likely" (suspects and confirmed glaucoma) or "unlikely" groups. RESULTS One hundred eighty-four subjects completed both phases of the study and 76 of 93 patients (82%) who were classified as "glaucoma likely" in the final exam, were also classified as "glaucoma likely" in the screening. Adjusted analysis revealed family history of glaucoma in first degree relatives and screening IOP > 21 mm Hg to have statistically significant associations with the final impression of "glaucoma likely." A combination of these findings gave an overall sensitivity of 81.7% with a specificity of 55%. CONCLUSIONS In the study population, the combination of an IOP > 21 mm Hg and history of glaucoma in a first degree relative allowed the identification of a significant percentage of individuals with a higher risk of chronic open angle glaucoma, for which a complete glaucoma examination is indicated.
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Affiliation(s)
- Setareh Vistamehr
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06520, USA
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41
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Abstract
PURPOSE To examine the relationship of visual field impairment to vision-specific health-related quality of life and symptoms in a large cohort (N=345) of African Americans and Whites of non-Hispanic origin diagnosed with glaucoma. MATERIALS AND METHODS Participants consisted of persons > or =55 years of age recruited from university-affiliated ophthalmology and optometry practices in Birmingham, AL who had been diagnosed with glaucoma. Medical records were abstracted to collect information on demographics, visual acuity, and visual fields. A telephone survey was conducted to obtain information on vision-specific health-related quality of life [National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25)], glaucoma symptoms [Glaucoma Symptom Scale (GSS)], and cognitive status (Short Portable Mental Status Questionnaire). Visual fields were used to compute a visual field defect score for each eye based on the Advanced Glaucoma Intervention Study (AGIS) scoring system. RESULTS Mean NEI VFQ-25 subscale scores ranged from the 50s to 80s. Scores for African Americans and Whites did not differ except for the general health and ocular pain subscales for which African Americans had slightly higher scores. For both African Americans and Whites, as the AGIS score became worse in the better and/or worse eye, there was a decrease in VFQ subscale score for most VFQ subscales including general vision, distance vision, near vision, social functioning, color vision, and peripheral vision (P<0.05). AGIS scores were unrelated to the GSS subscales in African Americans; for Whites, the visual but not the nonvisual subscale was related to AGIS score. CONCLUSIONS Scores on most subscales of the NEI VFQ-25 and the 2 subscales of the GSS are highly similar in African Americans and Whites of non-Hispanic origin who have been diagnosed with glaucoma. In addition, for both African Americans and Whites, the VFQ subscales for the most part demonstrated good construct validity with respect to the extent of visual field impairment. Results imply that the NEI VFQ-25 and the GSS are appropriate instruments for studying the personal burden of glaucoma in studies whose samples involve both African American and White adults.
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Affiliation(s)
- Lillian Ringsdorf
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294-0009, USA
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42
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Girkin CA, DeLeon-Ortega JE, Xie A, McGwin G, Arthur SN, Monheit BE. Comparison of the Moorfields classification using confocal scanning laser ophthalmoscopy and subjective optic disc classification in detecting glaucoma in blacks and whites. Ophthalmology 2006; 113:2144-9. [PMID: 16996609 DOI: 10.1016/j.ophtha.2006.06.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 06/10/2006] [Accepted: 06/12/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To compare the diagnostic accuracy of the Moorfields regression classification (MRC) and subjective optic disc evaluation in discriminating early to moderate glaucomatous from nonglaucomatous eyes. DESIGN Cross-sectional observational study. PARTICIPANTS Two hundred thirty-three patients with glaucoma and 216 normal subjects were included in the analysis. Racial groups were defined by self-description. METHODS All subjects underwent confocal scanning laser ophthalmoscopy, stereophotography, and standard perimetry. Glaucoma was defined by visual field defect alone and confirmed with a second visual field test. Stereo photographs were graded as either normal or glaucomatous appearing in a masked fashion by 2 independent graders and adjudicated by a third grader in cases of disagreement. Mean disc area was compared between patients correctly and incorrectly diagnosed with either technique. MAIN OUTCOME MEASURES Sensitivity and specificity of MRC and subjective evaluation of stereophotographs in the detection of glaucomatous visual field loss. RESULTS With the MRC, the sensitivity and specificity were higher using the 95% cutoff than using the 99.9% cutoff. Classification based on subjective photo assessment had a greater agreement with the diagnosis of glaucoma than the MRC for blacks (MRC, sensitivity = 62.5%, specificity = 93.2%; Photo, sensitivity = 76.5%, specificity = 91.5%) and whites (MRC, sensitivity = 67.0%, specificity = 92.2%; photo, sensitivity = 78.4%, specificity = 91.9%). Disc area was significantly larger in patients incorrectly diagnosed with the MRC (P = 0.0289). CONCLUSIONS Subjective optic disc grading by glaucoma specialists outperformed the MRC with the HRT II in both black and white subjects. Both subjective and objective diagnostic methods were associated with similar sensitivity and specificity between racial groups. The MRC was more likely to provide an incorrect diagnosis in subjects with larger optic discs.
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Affiliation(s)
- Christopher A Girkin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
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43
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Abstract
PURPOSE To evaluate whether iris colour influences size and shape of the optic nerve head and risk for glaucoma progression. METHODS The hospital-based observational study included 1973 eyes of 1012 Caucasian subjects with ocular hypertension or chronic open-angle glaucoma. For all patients, colour stereo optic disc photographs were evaluated, and corneal pachymetry and achromatic perimetry were performed. Main outcome measures were optic nerve head parameters, the development or progression of visual field defects and iris colour. RESULTS In most of the study groups, size of the optic disc, neuroretinal rim, alpha zone and beta zone of parapapillary atrophy, retinal vessel diameter and central corneal thickness did not differ significantly between eyes with blue, green, brown and mixed iris colour. In the normal-pressure glaucoma group, neuroretinal rim area was smallest in the population with mixed-coloured eyes and largest in the group of eyes with brown irides (P = 0.001 after correction for inter-eye dependency and multiple testing). For the ocular hypertensive subjects and glaucoma patients with follow-up examinations, the rate of development or progression of glaucomatous visual field loss was not significantly associated with iris colour (P = 0.060). CONCLUSIONS In Caucasian subjects, iris colour does not have a major association with the size of the optic nerve head structures, central corneal thickness and retinal arterial diameter. In Caucasian patients with ocular hypertension or chronic open-angle glaucoma, an influence of iris colour on the risk for development or progression of glaucomatous visual field defects could not be confirmed.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
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44
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Varma R, Wu J, Chong K, Azen SP, Hays RD. Impact of severity and bilaterality of visual impairment on health-related quality of life. Ophthalmology 2006; 113:1846-53. [PMID: 16889831 DOI: 10.1016/j.ophtha.2006.04.028] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 04/05/2006] [Accepted: 04/06/2006] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To assess the impact of unilateral and bilateral visual impairment (VI) and its severity on health-related quality of life (HRQOL) in Latinos 40 years and older. DESIGN A cross-sectional population-based study, the Los Angeles Latino Eye Study (LALES). PARTICIPANTS Five thousand three hundred seventy-seven LALES participants. METHODS Health-related quality of life was measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). Visual acuity (VA) was measured by a standardized protocol. Based on the presenting VA, VI was classified as unilateral or bilateral impairment and as either mild (20/40-20/63) or moderate/severe (20/80 or worse). MAIN OUTCOME MEASURES National Eye Institute VFQ-25 and SF-12 composite and subscale scores. RESULTS The NEI VFQ mean composite score decreased from no VI (86) to bilateral moderate/severe VI (66) (P<0.006). Relative to participants with no VI, those with unilateral or bilateral VI at any severity level had significantly lower NEI VFQ-25 scores for 10 of the 12 subscales (P<0.05). The largest mean score differences between participants with and without VI were observed for subscales related to driving difficulties (42.5 points), vision-related dependency (29.1 points), distance vision (27.0 points), and vision-related mental health (24.5 points). No differences in SF-12 scores were found between participants with and without VI (P>0.05). CONCLUSION Relative to persons with no VI, persons with bilateral mild and unilateral or bilateral moderate/severe VI report greater difficulties in performing most vision-dependent daily activities and experience vision-related dependency and poorer vision-related mental health. Because most visual function subscale scores were significantly lower in persons with bilateral mild and/or unilateral/bilateral moderate/severe VI, health care providers should consider intervention in these persons. Our findings provide further insight into the relationship between severity level, bilaterality of VI, and self-reported visual function. These data can be used to refine the determination of visual disability in persons with VI.
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Affiliation(s)
- Rohit Varma
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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45
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Jonas JB, Xu L, Zhang L, Wang Y, Wang Y. Optic disk size in chronic glaucoma: the Beijing eye study. Am J Ophthalmol 2006; 142:168-70. [PMID: 16815273 DOI: 10.1016/j.ajo.2006.01.068] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Revised: 01/19/2006] [Accepted: 01/20/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate whether eyes with chronic glaucoma have a larger or smaller optic disk than normal eyes. DESIGN Population-based, cross-sectional cohort study. METHODS The study included 4439 subjects out of 5324 subjects invited to participate with an age of 40+ years. Color optic disk photographs (45 degrees ) were morphometrically examined. RESULTS After exclusion of aphakic eyes, pseudophakic eyes, and highly myopic eyes, data of 3989 subjects entered the statistical analysis. The mean optic disk area did not vary significantly (P > .05) between the nonglaucomatous group (2.61 +/- 0.50 mm(2)), eyes with glaucomatous appearance of the optic disk (2.69 +/- 0.63 mm(2)), eyes with glaucomatous optic disks and visual field defects (2.66 +/- 0.70 mm(2)), and eyes with elevated intraocular pressure (2.63 +/- 0.49 mm(2)). CONCLUSIONS In adult Chinese, optic disk size may not markedly differ between normal eyes and eyes with chronic glaucoma.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
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46
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Abstract
PURPOSE The purpose of this study was to examine the prevalence of astigmatism and poor visual acuity and rate of eyeglass wear in grade school children who are members of a Native American tribe reported to have a high prevalence of large amounts of astigmatism. METHODS Vision screening was conducted on 1,327 first through eighth grade children attending school on the Tohono O'odham Reservation. Noncycloplegic autorefraction was conducted on the right and left eye of each child using the Nikon Retinomax K+ autorefractor, and monocular recognition acuity was tested using ETDRS logarithm of the minimum angle of resolution (logMAR) letter charts. RESULTS Tohono O'odham children had a high prevalence of high astigmatism (42% had > or = 1.00 D in the right or left eye) and the axis of astigmatism was uniformly with-the-rule. However, only a small percentage of children arrived at the vision screening wearing glasses, and the prevalence of poor visual acuity (20/40 or worse in either eye) was high (35%). There was a significant relation between amount of astigmatism and uncorrected visual acuity with each additional diopter of astigmatism resulting in an additional 1 logMAR line reduction in visual acuity. CONCLUSIONS Uncorrected astigmatism and poor visual acuity are prevalent among Tohono O'odham children. The results highlight the importance of improving glasses-wearing compliance, determining barriers to receiving eye care, and initiating public education programs regarding the importance of early identification and correction of astigmatism in Tohono O'odham children.
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Affiliation(s)
- Erin M Harvey
- The University of Arizona Department of Ophthalmology and Vision Science, Tucson, Arizona 85711, USA.
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47
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Abstract
OBJECTIVE To compare the uptake of cataract surgery in nursing homes in which assistance was provided in obtaining services with that in control homes. METHODS The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) project is a randomized clinical trial studying the effect of a comprehensive vision restoration-rehabilitation program, including the provision of cataract surgery services when needed. Twenty-eight nursing homes in the Eastern Shore area of Maryland and Delaware were matched in pairs by size and payment type. Nursing homes within each pair were randomized to usual care or targeted intervention. Persons with cataract causing visual acuity in the better eye to be worse than 20/40 were informed of the possible benefit of cataract surgery. For those in intervention homes, additional support was provided in obtaining cataract surgery. RESULTS Of residents with vision-impairing cataract in intervention homes, 31% underwent cataract surgery vs 2% in usual-care facilities. Residents with cataract compared with all residents without visual impairment, regardless of nursing home assignment, tended to be older (mean age, 86.7 vs 82.1 years; P<.001), were more likely to be black (age-adjusted P<.001), had lower Mini-Mental State Examination scores (mean, 11.7 vs 16.2; age-adjusted P<.001), and longer length of stay (mean, 42.3 vs 24.4 months; P<.001). Furthermore, cataract was associated with significant visual impairment and with functional limitations, with 20% of those recommended for surgery having a visual acuity of 20/100 or worse in the better-seeing eye. CONCLUSIONS Screening for and identifying cataracts as a cause of vision loss rarely results in uptake of cataract surgery services in nursing homes. The addition of a support system to facilitate the process of scheduling surgery and getting to and from the hospital dramatically increases uptake rates.
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Affiliation(s)
- David S Friedman
- Dana Center for Preventive Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Caban AJ, Lee DJ, Gómez-Marín O, Lam BL, Zheng DD. Prevalence of concurrent hearing and visual impairment in US adults: The National Health Interview Survey, 1997-2002. Am J Public Health 2005; 95:1940-2. [PMID: 16195516 PMCID: PMC1449463 DOI: 10.2105/ajph.2004.056671] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Analysis of data from a nationally representative sample of US adults (n=195801) showed that concurrent hearing and visual impairment prevalence rates were highest for participants older than 79 years of age (16.6%); a 3-fold increase in age-adjusted rates of reported hearing and visual impairment was observed for Native Americans compared with Asian Americans. Research on preventing concurrent hearing and visual impairment and countering its consequences is warranted, especially in population subgroups, such as Native and older Americans.
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Affiliation(s)
- Alberto J Caban
- Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
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Globe DR, Varma R, Torres M, Wu J, Klein R, Azen SP. Self-reported comorbidities and visual function in a population-based study: the Los Angeles Latino Eye Study. ACTA ACUST UNITED AC 2005; 123:815-21. [PMID: 15955983 DOI: 10.1001/archopht.123.6.815] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the association of self-reported systemic and ocular comorbid disease and visual function in Latino subjects. METHODS National Eye Institute 25-item Visual Function Questionnaire (NEI-VFQ-25) and eye examination data were obtained from 5380 participants in the Los Angeles Latino Eye Study, a population-based prevalence study of eye disease in Latino subjects 40 years and older. We developed and contrasted 5 comorbidity measures. One-way analysis of variance was used to assess the association between comorbidity and visual impairment and self-reported visual function. Regression analyses determined the association of sociodemographic variables, clinical variables, and the best measure of comorbidity with the NEI-VFQ-25 composite score. The main outcome measure was self-reported visual function as assessed by the NEI-VFQ-25 composite score. RESULTS On average, visual function subscale scores were lowest for those participants with the most systemic comorbid conditions (P<.05). This was more evident in participants with moderate or severe visual impairment compared with those with mild or no visual impairment (P<.05). CONCLUSIONS Self-reported systemic comorbidities were associated with self-reported visual function. This association was greater at more severe levels of visual impairment. Of the 5 comorbidity measures assessed, the measure that summed the number of self-reported systemic comorbidities correlated most with self-reported visual function.
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Affiliation(s)
- Denise R Globe
- Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, USA
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50
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Abstract
AIMS To evaluate ophthalmological findings in children adopted from eastern Europe. METHODS A prospective study on 72/99 children, born 1990-5 and adopted from eastern Europe to western Sweden during 1993-7 was performed. The children (41 boys; mean age 7.5 years) were compared with an age and sex matched reference group ("ref") of Swedish children. RESULTS 78% of the adopted children had abnormal ocular findings. 26% (ref 4%) had visual acuity (VA) of the better eye < or = 0.5 (> or = 0.3 logMAR) (p = 0.0001) and 8% (ref 0%) were visually impaired (p = 0.01). Amblyopia was found in 15% (ref 2%) (p = 0.005). 22% (ref 10%) were hyperopic (> or = 2.0 D SE) (NS) and 10% (ref 1%) were myopic (> or = 0.5 D SE) (p = 0.03). Astigmatism (> or = 0.75 D) was found in 51% (ref 23%) (p = 0.004). 32% (ref 2%) had strabismus (p<0.0001), mostly esotropia. Four cases had bilateral optic nerve hypoplasia, in three of whom a history of suspected prenatal alcohol exposure was documented. One child had congenital glaucoma. Signs of visuoperceptual problems were recorded in 37% (ref 1%) (p<0.0001). CONCLUSION In this study, children adopted from eastern Europe had a high frequency of ophthalmological findings. Consequently, it is strongly recommended that an ophthalmological examination be performed in these children after arrival in their new home country.
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Affiliation(s)
- M A Grönlund
- Institute of Clinical Neuroscience, The Sahlgrenska Academy at Göteborg University, Sweden.
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