Visual acuity and the ability of the visually impaired to read medication instructions

Luciole, a new font for people with low vision

Low vision affects the ability to read and can be a major barrier to educational success and insertion into the workplace. We designed a new font (Luciole) to improve the readability and comfort for people with low vision. In this study, we analyze the effect of the font type on readability. Luciole was compared to five other fonts (Arial, OpenDyslexic, Verdana, Eido and Frutiger) in 145 French readers (73 with low vision, and 72 normal sighted), aged 6 to 35 years old and divided into four reading expertise groups. Participants completed two tasks, first reading texts on paper and then reading false-words on screen using eye tracking. About half of the participants with low vision had a subjective preference for Luciole when reading on paper and on the screen; lower preference is noted for participants with normal vision. Other readability criteria show a slight advantage of the Luciole font over some fonts (e.g., Eido and OpenDyslexic) in both groups. The results obtained when taking into consideration the level of reading expertise confirm this trend.

In search of disambiguation: development of eye drop bottle sleeves to aid in identification and survey among possible users. A cross-sectional study

BACKGROUND

Considerable numbers of individuals present low vision, blindness, illiteracy and other conditions that could possibly impair their identification of medications, such as eye drops. Through helping these individuals to identify their eye drops, they can achieve greater autonomy. Misidentification can be avoided through use of multisensory sleeves that can be adapted to most eye drop bottles. Correct use of eye drops is important for preventing progression of diseases like glaucoma that could potentially lead to blindness.

OBJECTIVE

To develop bottle sleeves to aid in identification of eye drops and then interview a group of possible users to evaluate the acceptance of the solution.

DESIGN AND SETTING

Cross-sectional survey performed at an ophthalmological clinic in São Paulo (SP), Brazil.

METHODS

We describe the development of multisensory sleeves to assist in identification of eye drops. To assess the acceptance of this solution, we interviewed 18 patients who were currently using three or more types of eye drops.

RESULTS

We developed four prototypes for eye drop bottle sleeves and conducted an acceptance test on them. Most of the patients who answered the survey about the sleeves were elderly. Most (95%) reported believing that the sleeves would help reduce the risk of mixing up eye drops with other medications that also dispense drops. They also believed that these would increase their autonomy in using eye drops.

CONCLUSION

The solution presented was well accepted and may help increase safety in using eye drops through preventing misidentification.

Visual acuity, literacy, and unintentional misuse of nonprescription medications

PURPOSE

Results of a study of associations between visual acuity and the risk of misuse of nonprescription acetaminophen products in a sample of community-dwelling adults are reported.

METHODS

In a study involving English-speaking adults at 4 primary care clinics, the potential for misuse of nonprescription acetaminophen products was measured via a functional assessment of product self-dosing and by testing patients' understanding of the risks of concomitant use (i.e., taking 2 products at the same time when contraindicated). Vision was assessed using the Rosenbaum vision chart and dichotomized as normal (visual acuity of 20/20-20/25) or low (acuity of 20/30-20/100). Bivariable and multivariable analyses were performed to determine the impact of visual acuity on medication misuse outcomes.

RESULTS

Among the study participants (n = 500), 39% had limited literacy, and 54% were categorized as having low vision. After controlling for age, race, and prior acetaminophen use, low vision was independently associated with an increased risk of self-dosing errors (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.25-2.21; p < 0.001) and misunderstanding of concomitant-use risks (OR, 1.41; 95% CI, 1.00-2.00; p = 0.05). Limited literacy was an independent risk factor for incorrect dosing (OR, 1.71; 95% CI, 1.25-2.35; p = 0.001) and unawareness of concomitant use instructions (OR, 4.14; 95% CI, 2.80-6.12; p < 0.001).

CONCLUSION

Misunderstanding of nonprescription acetaminophen product information was common among study participants and independently associated with both impaired visual acuity and low literacy skills.

The Legibility of Typefaces for Readers with Low Vision: A Research Review

This article presents a systematic review of the research evidence on the effects of the characteristics of typefaces on the legibility of text for adult readers with low vision. The review revealed that research has not produced consistent findings and thus that there is a need to develop standards and guidelines that are informed by evidence.

"We're really not ready for this": A qualitative exploration of community pharmacy personnel's perspectives on the pharmaceutical care of older people with sensory impairment

Background

In most developed countries there is an increasing ageing population living in the community with long-term conditions and sensory impairment (sight; hearing; dual impairment). Community pharmacy personnel are key providers of pharmaceutical care to this patient population.

Objective

This study explored community pharmacy personnel's experiences with providing pharmaceutical care for older people with sensory impairment.

Methods

Semi-structured telephone interviews were conducted with community pharmacy personnel across Scotland between 2015 and 2016.

Results

Thirty interviews were completed with community pharmacists (n = 17) and other pharmacy personnel (n = 13). Two overarching themes emerged: safety and communication. Interviewees reported patients' reluctance to disclose their impairment “patients are very good at hiding it” and had considerable safety concerns “it's a fear that they're going to take too much … accidentally taking the same medicine twice”. Difficulties in communication were cited “no matter what you do or how you label things, leaflets and telling people, things can go wrong”. Additionally, interviewees identified training needs to increase their disability awareness and to identify strategies to provide safe and reliable pharmaceutical care to this vulnerable group “We don't specifically have anything in place to deal with anyone with impairments of that kind”.

Conclusions

This is the first in-depth exploration of providing pharmaceutical care to older people with sensory impairment from the perspective of community pharmacy personnel. Strategies are needed to encourage older people to disclose their sensory impairment. Education and training are also needed to optimise the provision of pharmaceutical care to this vulnerable population.

Consumer Comprehension of OTC Medication Labels and the Scope for Improvement in Font Size

Background:

On March 17, 1999, the FDA mandated a new standardized format called “Drug Facts” and a minimum font size of 6 points for the labeling of over-the-counter (OTC) medications. Yet, some text legibility studies report consumer preference for font sizes of at least 10 points. The possibility therefore exists that the minimum font size mandated by the FDA might be too small for certain consumers to read.

Objective:

To compare the effectiveness of 3 labeling formats—old, new, and simulated labels (SLs)—using the OTC medication Label Evaluation Process Model (LEPM).

Methods:

A within-subjects experimental design was used. SLs designed for this study contained similar information as the new labels plus a larger font size. English-speaking consumers viewed these label formats and completed a questionnaire that requested consumer demographic information and measured their responses on 5 domains of the LEPM: ease of use, product knowledge, attitude toward product label, product evaluation, and purchase intention. These 5 domains were the dependent variables for this study. The independent variable was the label format. Data were analyzed using the SAS 9.1 software. A multivariate analysis of variance (ANOVA) followed by a univariate ANOVA determined the effect of label format on the dependent variables.

Results:

Each label format differed significantly from the others in terms of ease of use, attitude, product evaluation, and purchase intention, with the highest mean scores reported for SLs. SLs were the only label format that significantly improved consumers' product knowledge.

Conclusions:

Although the new standardized OTC labels are an improvement from the old unstandardized label format, there is a need for further improvement in OTC medication labeling, especially regarding the font size on these labels.

Aging: a predisposition to dry eyes

Dry eye syndrome is a disease of the ocular surface and tear film that is prevalent in older adults. Even though the degree of visual acuity loss in dry eye patients is commonly mild-to-moderate, in the aging population, this minimal change in visual status can lead to a significant decrease in visual function and quality of life. A healthy ocular surface is maintained by appropriate tear production and tear drainage, and deficiencies in this delicate balance can lead to dryness. In the aging eye, risk factors such as polypharmacy, androgen deficiency, decreased blink rates, and oxidative stress can predispose the patient to developing dry eye that is frequently more severe, has higher economic costs, and leads to worse consequences to the well-being of the patient. Understanding why elderly patients are at higher risk for developing dry eyes can provide insights into the diagnosis and management of the growing number of older adults struggling with dry eye and minimize the burden of disease on our aging population.

Telepresence as an Aid for Medication Self-Management

The goal of this article is to explore ways to keep elderly individuals independent longer and able to remain in their own homes. Caregivers – whether professionals, family, or friends – are an integral facet in enabling elderly persons to be independent. One of the most challenging aspects of maintaining independence is the complex issue of medication self-management. The main focus of this study considers how the addition of telepresence to a new and as-yet-undeveloped dynamic automated medication-dispensing device could help individuals self-medicate. Through telepresence, patients could easily be connected to a variety of caregivers.

Design and test of preference for a new prescription medication label

OBJECTIVE

This study measured preference for newly designed prescription labels in comparison with two existing labels from the perspective of patients, pharmacists and physicians, based on three parameters: content, convenience and cosmetic appearance.

SETTING

Participants were interviewed at pharmacies (patients) and at professional meetings (physicians and pharmacists) regarding their preference for the labels.

METHOD

Two new labels (A and B) were designed using Publisher® Software version 2007 based on literature and results from our previous study. New features focusing on content, convenience and cosmetic appearance (3Cs) included a time table for medication administration, indication of medication and warnings, on a redesigned label. These labels were initially tested on a small sample and then revised. A survey instrument was developed to compare currently used labels and modified labels A and B, on the 3Cs.

MAIN OUTCOME MEASURE

The preference of three groups of stakeholders (patients, pharmacists and physicians) were measured for newly designed labels in comparison with two existing labels.

RESULTS

Complete data obtained with 444 patients, 115 pharmacists and 69 physicians indicated that the median age range of participants was between 51 and 64 years. The patient and physician samples consisted of a higher percentage of women. Pharmacists working in chain pharmacies and family practitioners comprised majority of our sample in professional groups. Mean years of experience in pharmacy and physician groups was 18.2 and 26.8 years, respectively. Most patients (94.4%) in the sample had at least high school education. Majority of patients (82.8%) preferred new labels over existing ones and 55.2% preferred label B on all three parameters. Close to two thirds of pharmacists (76.4%) and physicians (75.3%) preferred new labels with 55.3 and 57.9% preferring label B, respectively. Participants cited all the added modifications as reasons for their preference.

CONCLUSION

New prescription labels were favored over existing labels by all stakeholders, for content, convenience and cosmetic appearance. The results may help in making labels more user-friendly and addressing problem areas in labels.

Prevalence and predictors of ocular manifestations of RA: is there a need for routine screening?

BACKGROUND

People with rheumatoid arthritis (RA) have an increased risk for eye problems caused by associated conditions or medication side-effects. Consequent visual impairment may increase the risk of falls or difficulties self-administering medications.

AIMS

The aim of the present study was to estimate the prevalence and predictors of ocular manifestations and visual impairment in a local sample of people with RA. The Visual Functioning Questionnaire (VFQ-25) was evaluated as a screening tool in people with RA.

METHODS

Seventy-five participants with RA attended a visual screening clinic. Demographic, medication and disease characteristics were recorded, a full ophthalmological assessment was performed by an expert ophthalmologist and the VFQ-25, Health Assessment Questionnaire and Self-administered Comorbidity Questionnaire were completed.

RESULTS

Twenty-nine participants (38.7%) had impaired visual acuity; this was correctable by appropriate refraction in 93.1%. The prevalence of cataracts was 22.7% and this was predicted by older age and steroid use. An abnormal Schirmer's test, suggesting dry eyes, was seen in 70.7% of participants but only 12.0% were using artificial tears. Answers to the VFQ-25 suggested misinterpretation of questions as relating to disability attributed to arthritis rather than caused by visual impairment.

CONCLUSIONS

Visual impairment does not appear to be particularly prevalent in RA, obviating the need for a screening programme. Utilization of the VFQ-25 as a screening tool in RA requires further consideration. The high prevalence of cataracts in participants on steroids emphasizes the need to prescribe the minimum required dose. The high prevalence of dry eyes suggests that a Schirmer's test should be performed regularly, with prescription of artificial tears if required.