Impact of unilateral and bilateral vision loss on quality of life

A Prospective Association Between Sensory Impairment and Cognitive Performance Among Older Community-Dwelling Adults: The Role of Depressive Symptoms

We examined whether vision impairment (VI) and hearing impairment (HI) and dual sensory impairment (DSI) affect cognitive performance and whether depression mediates that effect. We examined 55,340 participants from the Survey of Health, Aging and Retirement in Europe, which assessed 32,325 participants in 2011 (baseline, Time 1), 2015 (follow-up, Time 2), sociodemographic data and health factors, self-reported VI, HI, and DSI at baseline, depression, and cognitive performance after four years. A multiple mediator model was tested using bootstrapping and resampling. At baseline, 22.9% had VI, 10.2% HI, and 10.4% had DSI. We found a significant negative association between VI (b = -0.023, p = .001) and DSI (b = -0.083, p = .001) and cognitive performance; both were also associated with depression, which was linked with poor cognition. VI or DSI among older adults are associated with poor cognitive function directly and indirectly by increasing depression symptoms.

Prevalence and Risk Factors of Blindness Among Primary Angle Closure Glaucoma Patients in the United States: An IRIS Registry Analysis

PURPOSE

To assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States.

DESIGN

Retrospective cross-sectional study.

METHODS

Eligible patients from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); and 3) no history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤20/200) at first diagnosis of PACG.

RESULTS

Among 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (odds ratios [ORs] 1.42 and 1.21, respectively; P < .001) and bilateral (ORs 2.04 and 1.53, respectively; P < .001) blindness compared with non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred a higher risk of blindness (OR > 1.28; P ≤ .01).

CONCLUSIONS

Blindness affects 1 of 9 patients with newly diagnosed PACG in the IRIS Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among patients with PACG and the need for improved disease awareness and detection methods.

The association between visual impairment and mental disorders

To determine the association between visual impairment (VI) and some mental disorders using the general health questionnaire (GHQ) in individuals aged 60 years and above in Tehran, Iran. The present population-based cross-sectional study was conducted on people aged 60 and older in Tehran, Iran using multi-stage cluster sampling. After selecting the samples, examinations including visual acuity measurement, refraction, and slit-lamp biomicroscopy were performed for all participants. The GHQ was used to examine mental disorders. Simple and multiple linear regressions were used to investigate the association between VI and mental disorders. Of the 3740 invitees, 3310 participated in the study (response rate: 88.50%). After applying the exclusion criteria, 2789 individuals were analyzed for this report. Mean score of physical, anxiety, social and depression disorders in people with and without VI was 3.74 ± 2.03, 5.81 ± 2.79, 7.56 ± 1.91, 1.32 ± 1.90, and 3.14 ± 1.76, 4.93 ± 2.71, 8.09 ± 1.99, 0.91 ± 1.38, respectively. The total score of GHQ in participants with and without VI was 18.43 ± 4.75 and 17.07 ± 4.19, respectively. The association between GHQ subscales and total GHQ score with VI by multiple linear regression showed that VI had a statistically significant direct association with physical symptoms (β = 0.37; 95% CI 0.12 to 0.62) and anxiety (β = 0.48; 95% CI 0.16 to 0.81). Nevertheless, depression had a borderline association with VI (β = 0.21; 95% CI - 0.03 to 0.45) and social dysfunction did not have a statistically significant association with VI in the final linear regression model and did not remain in the model. Total GHQ score had a statistically significant association with VI (β = 1.02; 95% CI 0.39 to 1.64) in the presence of covariates. Regarding the association between VI and GHQ components, the physical symptoms had the highest R2 (R2 = 0.159). Patients with VI suffer more from anxiety, depression, and physical symptoms regardless of age, sex, education, and other effective variables. The coincidence of aging with VI and the association of VI with mental disorders emphasizes the importance of a broader view of the elderly and the aging process.

The Aerial Guide Dog: A Low-Cognitive-Load Indoor Electronic Travel Aid for Visually Impaired Individuals

Most navigation aids for visually impaired individuals require users to pay close attention and actively understand the instructions or feedback of guidance, which impose considerable cognitive loads in long-term usage. To tackle the issue, this study proposes a cognitive burden-free electronic travel aid for individuals with visual impairments. Utilizing human instinctive compliance in response to external force, we introduce the "Aerial Guide Dog", a helium balloon aerostat drone designed for indoor guidance, which leverages gentle tugs in real time for directional guidance, ensuring a seamless and intuitive guiding experience. The introduced Aerial Guide Dog has been evaluated in terms of directional guidance and path following in the pilot study, focusing on assessing its accuracy in orientation and the overall performance in navigation. Preliminary results show that the Aerial Guide Dog, utilizing Ultra-Wideband (UWB) spatial positioning and Measurement Unit (IMU) angle sensors, consistently maintained minimal deviation from the targeting direction and designated path, while imposing negligible cognitive burdens on users while completing the guidance tasks.

Age-related macular degeneration and cardiovascular disease in US population: an observational study

BACKGROUND

As far as we know, age-related macular degeneration (AMD) has become one of the predominant causes of visual impairments. Previous studies have revealed that AMD and many cardiovascular diseases (CVDs) share the same pathologic and genotypic factors, making the connection between AMD and CVD a hot topic. However, the conclusions of the available studies on the relationship between them are somewhat divergent.

METHODS

We screened 5523 eligible participants from the National Health and Nutrition Examination Survey (NHANES) database from 2005 through 2008 for an observational clinical study design. Binary logistic regression modelling was used to estimate the relations between AMD and various CVDs with and without adjustment for demographics, health status, and behaviours related to health.

RESULTS

Binary logistic regression analyses showed that AMD was able to increase the risk of CVDs in patients both unadjusted and after adjusting for confounding variables.

CONCLUSIONS

Within this study, preventing the development of AMD might cut down the incidence of several CVDs, in particular, significantly lowering the stroke risk. These findings indicate that interventions to prevent AMD may also help to prevent CVDs. In general, late AMD has a more severe impact on the risk of CVDs compared with early AMD. These results could help clinical ophthalmology and cardiovascular medicine in their clinical education and interventions.

Intelligent Head-Mounted Obstacle Avoidance Wearable for the Blind and Visually Impaired

Individuals who are Blind and Visually Impaired (BVI) take significant risks and dangers on obstacles, particularly when they are unaccompanied. We propose an intelligent head-mount device to assist BVI people with this challenge. The objective of this study is to develop a computationally efficient mechanism that can effectively detect obstacles in real time and provide warnings. The learned model aims to be both reliable and compact so that it can be integrated into a wearable device with a small size. Additionally, it should be capable of handling natural head turns, which can generally impact the accuracy of readings from the device's sensors. Over thirty models with different hyper-parameters were explored and their key metrics were compared to identify the most suitable model that strikes a balance between accuracy and real-time performance. Our study demonstrates the feasibility of a highly efficient wearable device that can assist BVI individuals in avoiding obstacles with a high level of accuracy.

Impact of vision on generic health-related quality of life - A systematic review

The aim of the study was to provide an overview on the relation between vision and generic health-related quality of life (HRQoL) in general populations worldwide. We conducted a systematic review to identify articles that have evaluated the relation of binocularly measured distance visual acuity (VA) and HRQoL in adults at population level around the world. Used search terms were related to visual acuity, vision loss, visual impairment and HRQoL. We identified 780 articles, of which 12 satisfied the eligibility criteria. The studies were conducted in the USA, Europe, Asia and Australia. Generic HRQoL was measured using EQ-5D, 15D, SF-36, SF-12 and/or WHOQoL. Nine studies reported a trend between decreasing VA and deteriorating HRQoL of at least some degree. Vision loss was mostly associated with dimensions related to physical health and capability, including self-care, mobility and usual activities. Mental dimensions - vitality and social functioning in particular - were also affected, although the results were inconsistent. Six studies compared the impact of different medical conditions on HRQoL, all of which reported that the impact of visual impairment was equal or stronger compared with other major medical conditions. In conclusion, generic HRQoL instruments are sensitive to detect the relation between vision and HRQoL, as they cover dimensions influenced by vision. Declining vision is associated with reduced functioning, which leads to dependence and isolation - both major factors in an individual's well-being. This phenomenon showed surprising similarity around the world and therefore emphasises the global burden of vision loss at both individual and societal level and encourages its prevention and treatment.

Long-Term Burden of Pain and Reduced Visual Acuity after Gunshot Wounds to the Orbit

PURPOSE

To characterize the clinical presentation, surgical management, long-term complications and outcomes of Gunshot Wounds(GSW) to the orbit.

METHODS

An extended case series with retrospective chart-review was conducted on all cases (1985-2020) of traumatic ocular injuries secondary to GSWs at an academic institution with a level 1 trauma center. Predictors included demographic information, clinical and radiologic examination findings, and surgical intervention at time of presentation. Outcomes included long-term lid malposition, visual acuity, pain, and secondary surgery. Descriptive statistics and tests of association were performed, including Fishers exact tests for categorical data, Kruskal-Wallis rank sum tests, analysis of variance, and, in the case of repeated measures, generalized estimating equations.

RESULTS

88 patients with GSW involving the orbit were included with average age of 32.6 years (sd = 15.7). Patients were 85.2% male, 75% African-American, 25.0% Caucasian, and 5.7% Hispanic. Median follow up was 43.3 months (4.6, 136.4). The injuries at presentation were 53.4% intracranial, 21.6% open globe, 80.7% orbital fracture, 89.8% lid laceration. Visual acuity did not significantly improve over time. Long-term complications included abnormal lid or globe position in 26.1% of patients, reduced visual acuity in 55.2%, and persistent pain in 50.6%.

CONCLUSION

To our knowledge, this represents the first and largest clinical epidemiologic study with insight into the clinical presentation, surgical intervention, and long-term outcomes of GSW to the orbit. The results demonstrate a long-term burden of persistent pain and reduced visual acuity in patients who suffer from GSW to the globe and orbit. This study may guide patient management and communications.

A new era in posterior segment ocular drug delivery: Translation of systemic, cell-targeted, dendrimer-based therapies

Vision impairment and loss due to posterior segment ocular disorders, including age-related macular degeneration and diabetic retinopathy, are a rapidly growing cause of disability globally. Current treatments consist primarily of intravitreal injections aimed at preventing disease progression and characterized by high cost and repeated clinic visits. Nanotechnology provides a promising platform for drug delivery to the eye, with potential to overcome anatomical and physiological barriers to provide safe, effective, and sustained treatment modalities. However, there are few nanomedicines approved for posterior segment disorders, and fewer that target specific cells or that are compatible with systemic administration. Targeting cell types that mediate these disorders via systemic administration may unlock transformative opportunities for nanomedicine and significantly improve patient access, acceptability, and outcomes. We highlight the development of hydroxyl polyamidoamine dendrimer-based therapeutics that demonstrate ligand-free cell targeting via systemic administration and are under clinical investigation for treatment of wet age-related macular degeneration.

Remarkable Improvements After Cataract Surgery in a Presumed "End-Stage" Glaucoma Patient: A Case Report

Predicting the visual outcome after cataract extraction can be challenging in glaucoma patients who develop cataracts. Here, we demonstrate the case of a patient with advanced glaucoma and a mild-to-moderate cataract at initial presentation, who demonstrated remarkable improvement in visual acuity following a period of controlled intraocular pressure (IOP) and the removal of a matured cataract at the time of surgery. A 64-year-old Haitian woman with severe mixed-mechanism glaucoma and hand motion vision in both eyes (OU) presented with intraocular pressures of 38 mmHg OD (oculus dexter/right eye) and 41 mmHg OS (oculus sinister/left eye) while on three IOP-lowering agents. Her medications were escalated to six IOP-lowering medications, and she underwent bilateral transscleral laser cyclophotocoagulation with both micropulse and continuous wave probes simultaneously. Postoperatively, IOPs dropped to 7 and 9 mmHg in the right and left eyes, respectively, and remained at or below target on three topical agents for the remainder of her follow-up. Contrastingly, the patient's cataract had progressed, and the decision was made to undergo cataract extraction OU sequentially. The subsequent clinical course demonstrated progressive visual improvement with 20/80 best-corrected visual acuity OU and increased independence with activities of daily living. This case illustrates the potential for visual improvement in an advanced glaucoma patient after removing a matured cataract despite limited prior expectations. Ocular comorbidities complicate but do not necessarily preclude appropriate interventions that may improve patients' vision-related quality of life.

A large-scale analysis of refractive errors in students attending public primary schools in Mexico

A cross-sectional, retrospective study was conducted from September 2013 through July 2014 to determine the prevalence of refractive errors among students attending public primary schools in Mexico. Among 3,861,156 students at 14,566 public primary schools in all 32 states of Mexico, teachers identified reduced visual acuity in 1,253,589 (32.5%) using visual acuity measurement. Optometrists confirmed 391,498 [31.2%, mean (SD) age: 8.8 (1.9) years; 204,110 girls (52.9%)] had refractive errors using visual acuity measurement and noncycloplegic static retinoscopy. Among 288,537 (72.4%) of children with previous eyeglasses usage data reported, 241,505 (83.7%) had uncorrected refractive errors. Before prescription eyeglasses were provided, 281,891 students (72%) had logMAR visual acuity ≤ 0.2; eyeglasses corrected vision loss in 85.6% (n = 241,352) of them. Simple myopic astigmatism was the most frequent refractive error (25.7%, n = 100,545). Astigmatism > - 1.00 diopters was present in 54.6% of all students with ametropia. The anisometropia rate based on spherical equivalent difference between right and left eye ≥ 1.50 diopters was 3.9% (n = 15,402). Uncorrected refractive errors are an important issue in primary school students in Mexico. An updated study is needed to analyze the evolving trends over the past decade.

The Incidence, Time to Development, and Risk Factors for Fellow Eye Retinal Vein Occlusions

BACKGROUND AND OBJECTIVE

Little is known about factors affecting risk or time to development of fellow eye retinal vein occlusion (RVO). The purpose of this study was to examine the incidence and risk factors for fellow eye RVO.

PATIENTS AND METHODS

This was a retrospective case-control study comparing unilateral and fellow eye RVO patients. This study was exempt by the Cleveland Clinic Institutional Review Board.

RESULTS

Out of 1,083 patients, fellow eye RVO had a cumulative incidence of 3.6% (95% CI 2.61, 4.94) with a median time to development of 18 months (95% CI 6.0, 28.0). Fellow eye disease was associated with multiple characteristics including chronic kidney disease (odds ratio [OR] 3.78, 95% CI 1.89 to 7.55) and diabetic retinopathy (3.18, 1.57 to 6.44).

CONCLUSION

While fellow eye RVO is relatively rare, it typically occurs within the first few years following initial diagnosis. Multiple characteristics were associated with fellow eye disease and time to onset. [Ophthalmic Surg Lasers Imaging Retina 2023;54:471-476.].

Complement inhibitors for age-related macular degeneration

BACKGROUND

Age-related macular degeneration (AMD) is a common eye disease and leading cause of sight loss worldwide. Despite its high prevalence and increasing incidence as populations age, AMD remains incurable and there are no treatments for most patients. Mounting genetic and molecular evidence implicates complement system overactivity as a key driver of AMD development and progression. The last decade has seen the development of several novel therapeutics targeting complement in the eye for the treatment of AMD. This review update encompasses the results of the first randomised controlled trials in this field.

OBJECTIVES

To assess the effects and safety of complement inhibitors in the prevention or treatment of AMD.

SEARCH METHODS

We searched CENTRAL on the Cochrane Library, MEDLINE, Embase, LILACS, Web of Science, ISRCTN registry, ClinicalTrials.gov, and the WHO ICTRP to 29 June 2022 with no language restrictions. We also contacted companies running clinical trials for unpublished data.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) with parallel groups and comparator arms that studied complement inhibition for advanced AMD prevention/treatment.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed search results and resolved discrepancies through discussion. Outcome measures evaluated at one year included change in best-corrected visual acuity (BCVA), untransformed and square root-transformed geographic atrophy (GA) lesion size progression, development of macular neovascularisation (MNV) or exudative AMD, development of endophthalmitis, loss of ≥ 15 letters of BCVA, change in low luminance visual acuity, and change in quality of life. We assessed risk of bias and evidence certainty using Cochrane risk of bias and GRADE tools.

MAIN RESULTS

Ten RCTs with 4052 participants and eyes with GA were included. Nine evaluated intravitreal (IVT) administrations against sham, and one investigated an intravenous agent against placebo. Seven studies excluded patients with prior MNV in the non-study eye, whereas the three pegcetacoplan studies did not. The risk of bias in the included studies was low overall. We also synthesised results of two intravitreal agents (lampalizumab, pegcetacoplan) at monthly and every-other-month (EOM) dosing intervals. Efficacy and safety of IVT lampalizumab versus sham for GA For 1932 participants in three studies, lampalizumab did not meaningfully change BCVA given monthly (+1.03 letters, 95% confidence interval (CI) -0.19 to 2.25) or EOM (+0.22 letters, 95% CI -1.00 to 1.44) (high-certainty evidence). For 1920 participants, lampalizumab did not meaningfully change GA lesion growth given monthly (+0.07 mm², 95% CI -0.09 to 0.23; moderate-certainty due to imprecision) or EOM (+0.07 mm², 95% CI -0.05 to 0.19; high-certainty). For 2000 participants, lampalizumab may have also increased MNV risk given monthly (RR 1.77, 95% CI 0.73 to 4.30) and EOM (RR 1.70, 95% CI 0.67 to 4.28), based on low-certainty evidence. The incidence of endophthalmitis in patients treated with monthly and EOM lampalizumab was 4 per 1000 (0 to 87) and 3 per 1000 (0 to 62), respectively, based on moderate-certainty evidence. Efficacy and safety of IVT pegcetacoplan versus sham for GA For 242 participants in one study, pegcetacoplan probably did not meaningfully change BCVA given monthly (+1.05 letters, 95% CI -2.71 to 4.81) or EOM (-1.42 letters, 95% CI -5.25 to 2.41), as supported by moderate-certainty evidence. In contrast, for 1208 participants across three studies, pegcetacoplan meaningfully reduced GA lesion growth when given monthly (-0.38 mm², 95% CI -0.57 to -0.19) and EOM (-0.29 mm², 95% CI -0.44 to -0.13), with high certainty. These reductions correspond to 19.2% and 14.8% versus sham, respectively. A post hoc analysis showed possibly greater benefits in 446 participants with extrafoveal GA given monthly (-0.67 mm², 95% CI -0.98 to -0.36) and EOM (-0.60 mm², 95% CI -0.91 to -0.30), representing 26.1% and 23.3% reductions, respectively. However, we did not have data on subfoveal GA growth to undertake a formal subgroup analysis. In 1502 participants, there is low-certainty evidence that pegcetacoplan may have increased MNV risk when given monthly (RR 4.47, 95% CI 0.41 to 48.98) or EOM (RR 2.29, 95% CI 0.46 to 11.35). The incidence of endophthalmitis in patients treated with monthly and EOM pegcetacoplan was 6 per 1000 (1 to 53) and 8 per 1000 (1 to 70) respectively, based on moderate-certainty evidence. Efficacy and safety of IVT avacincaptad pegol versus sham for GA In a study of 260 participants with extrafoveal or juxtafoveal GA, monthly avacincaptad pegol probably did not result in a clinically meaningful change in BCVA at 2 mg (+1.39 letters, 95% CI -5.89 to 8.67) or 4 mg (-0.28 letters, 95% CI -8.74 to 8.18), based on moderate-certainty evidence. Despite this, the drug was still found to have probably reduced GA lesion growth, with estimates of 30.5% reduction at 2 mg (-0.70 mm², 95% CI -1.99 to 0.59) and 25.6% reduction at 4 mg (-0.71 mm², 95% CI -1.92 to 0.51), based on moderate-certainty evidence. Avacincaptad pegol may have also increased the risk of developing MNV (RR 3.13, 95% CI 0.93 to 10.55), although this evidence is of low certainty. There were no cases of endophthalmitis reported in this study.

AUTHORS' CONCLUSIONS

Despite confirmation of the negative findings of intravitreal lampalizumab across all endpoints, local complement inhibition with intravitreal pegcetacoplan meaningfully reduces GA lesion growth relative to sham at one year. Inhibition of complement C5 with intravitreal avacincaptad pegol is also an emerging therapy with probable benefits on anatomical endpoints in the extrafoveal or juxtafoveal GA population. However, there is currently no evidence that complement inhibition with any agent improves functional endpoints in advanced AMD; further results from the phase 3 studies of pegcetacoplan and avacincaptad pegol are eagerly awaited. Progression to MNV or exudative AMD is a possible emergent adverse event of complement inhibition, requiring careful consideration should these agents be used clinically. Intravitreal administration of complement inhibitors is probably associated with a small risk of endophthalmitis, which may be higher than that of other intravitreal therapies. Further research is likely to have an important impact on our confidence in the estimates of adverse effects and may change these. The optimal dosing regimens, treatment duration, and cost-effectiveness of such therapies are yet to be established.

Unilateral Vision Loss in Elderly People in Residential Care: Prevalence, Causes and Impact on Visual Functioning: The Hyderabad Ocular Morbidity in Elderly Study (HOMES)

PURPOSE

To investigate the prevalence, causes and impact of unilateral visual impairment (UVI) on visual function in the elderly in 'home for the aged' in Hyderabad, India.

METHODS

Participants aged ≥60 years were recruited from 41 'homes for the aged'. All participants had complete eye examinations including visual acuity assessment, refraction, slit-lamp and fundus examination. Unilateral visual impairment (UVI) was defined as presenting VA worse than 6/18 in one eye and presenting VA 6/18 or better in the other eye. Indian Vision Function Questionnaire (INDVFQ) was used for assessing visual functioning.

RESULTS

Of the total 1,513 elderly participants enumerated, 1,182 (78.1%) were examined. After excluding 356 participants with VI in the better eye, data were analysed for the remaining 826 participants. The mean age (standard deviation) of these participants was 74.4 ± 8.4 years; 525 (63.6%) were women, and 111 (13.4%) had no schooling. The prevalence of unilateral VI was 38.1% (95% CI: 34.8-41.5; n = 315). Cataract (37.5%; n = 118) was the leading cause of UVI followed by Uncorrected Refractive Error (22.2%; n = 70) and posterior capsular opacification (18.4%; n = 58). The overall INDVFQ score was higher among those with UVI than those without UVI (37.7 versus 34.5; p < .01) suggestive of poor visual functioning.

CONCLUSIONS

UVI was common and largely due to avoidable causes among the elderly in residential care with an adverse impact on visual functioning. Screening for vision loss in 'homes for the aged' and the provision of appropriate services should become a routine practice to achieve the goal of healthy aging in India.

Age-Related Macular Degeneration With Visual Disability Is Associated With Cardiovascular Disease Risk in the Korean Nationwide Cohort

Background Age-related macular degeneration (AMD) is the leading cause of visual disability. AMD shares some risk factors with the pathogenesis of cardiovascular disease (CVD). However, previous studies examining the association between AMD and the risk of CVD provide conflicting results. Hence, we investigated the association between AMD, visual disability, and the risk of CVD. Methods and Results This is a nationwide cohort study using data from the Korean National Health Insurance System database (2009-2019) on subjects who underwent a national health screening program in 2009. A total of 3 789 963 subjects were categorized by the presence of AMD and visual disability. Visual disability was defined as a best-corrected visual acuity of ≤20/100 by validated documentation from a specialist physician. Cox regression hazard model was used to examine the hazard ratios (HRs) of CVD, including myocardial infarction and ischemic stroke, after adjusting for potential confounders. During a mean 9.77 years of follow-up, AMD was associated with a 5% higher risk of myocardial infarction (adjusted HR [aHR], 1.05 [95% CI, 1.01-1.10]) but not associated with increased risk of overall CVD (aHR, 1.02 [95% CI, 1.00-1.05]) or ischemic stroke (aHR, 1.02 [95% CI, 0.98-1.06]). However, when AMD was accompanied by visual disability, there was increased risk of CVD (aHR, 1.17 [95% CI, 1.06-1.29]), myocardial infarction (aHR, 1.18 [95% CI, 1.01-1.37]), and ischemic stroke (aHR, 1.20 [95% CI, 1.06-1.35]). These trends were more evident in women and subjects with cardiometabolic comorbidities. Conclusions AMD with visual disability, but not all AMD, was associated with an increased risk of CVD. Patients with AMD who have visual disability should be targeted for CVD prevention.

Cross-sectional associations of dietary intake with hearing and vision capacities and potential mediation effect of inflammation in older adults: the COGFRAIL study

BACKGROUND

Considering their prevalence and burden, information on the sensory impairment etiology is essential. Links between nutrition and sensory impairment through inflammation have been suggested. Although the decline in sensory capacities is age-related, few research included a geriatric population.

AIMS

Exploring the associations of nutrition with sensory capacities and test inflammation as a mediator among cognitively and physically impaired older adults.

METHODS

Cross-sectional data from the COGFRAIL cohort, including 164 participants with no hearing aid and 20 participants wearing no visual aid. Hearing was evaluated using the Hearing Handicap Inventory for the Elderly-screening version (on 40 points, the lower the better), and the Monoyer chart (one to ten out of ten points, the higher the better), and the Parinaud scale (from 1.5, the best, to 28 points, the worst) assessed distant and near vision, respectively. Dietary intake was assessed through a diet history interview and inflammation was measured by the C-Reactive Protein level. Multivariate linear regressions were performed and Structural Equation Modeling (SEM) framework was used to explore the potential mediation effect of inflammation on the diet-hearing relationships.

RESULTS

None of the nutrients was significantly associated with hearing acuity in the regressions or the SEM model. Regarding vision, a higher intake of saturated fatty acids was related to lower long-distance visual acuity, and greater Omega-3 consumption was associated with better near-vision capacity.

DISCUSSION

No nutrient was associated with hearing capacity and relationships between fatty acids quality and vision acuity were suggested.

CONCLUSION

These exploratory results require further investigations.

A Smart Service System for Spatial Intelligence and Onboard Navigation for Individuals with Visual Impairment (VIS4ION Thailand): study protocol of a randomized controlled trial of visually impaired students at the Ratchasuda College, Thailand

BACKGROUND

Blind/low vision (BLV) severely limits information about our three-dimensional world, leading to poor spatial cognition and impaired navigation. BLV engenders mobility losses, debility, illness, and premature mortality. These mobility losses have been associated with unemployment and severe compromises in quality of life. VI not only eviscerates mobility and safety but also, creates barriers to inclusive higher education. Although true in almost every high-income country, these startling facts are even more severe in low- and middle-income countries, such as Thailand. We aim to use VIS⁴ION (Visually Impaired Smart Service System for Spatial Intelligence and Onboard Navigation), an advanced wearable technology, to enable real-time access to microservices, providing a potential solution to close this gap and deliver consistent and reliable access to critical spatial information needed for mobility and orientation during navigation.

METHODS

We are leveraging 3D reconstruction and semantic segmentation techniques to create a digital twin of the campus that houses Mahidol University's disability college. We will do cross-over randomization, and two groups of randomized VI students will deploy this augmented platform in two phases: a passive phase, during which the wearable will only record location, and an active phase, in which end users receive orientation cueing during location recording. A group will perform the active phase first, then the passive, and the other group will experiment reciprocally. We will assess for acceptability, appropriateness, and feasibility, focusing on experiences with VIS⁴ION. In addition, we will test another cohort of students for navigational, health, and well-being improvements, comparing weeks 1 to 4. We will also conduct a process evaluation according to the Saunders Framework. Finally, we will extend our computer vision and digital twinning technique to a 12-block spatial grid in Bangkok, providing aid in a more complex environment.

DISCUSSION

Although electronic navigation aids seem like an attractive solution, there are several barriers to their use; chief among them is their dependence on either environmental (sensor-based) infrastructure or WiFi/cell "connectivity" infrastructure or both. These barriers limit their widespread adoption, particularly in low-and-middle-income countries. Here we propose a navigation solution that operates independently of both environmental and Wi-Fi/cell infrastructure. We predict the proposed platform supports spatial cognition in BLV populations, augmenting personal freedom and agency, and promoting health and well-being.

TRIAL REGISTRATION

ClinicalTrials.gov under the identifier: NCT03174314, Registered 2017.06.02.

A Review of Design and Evaluation Practices in Mobile Text Entry for Visually Impaired and Blind Persons

Millions of people with vision impairment or vision loss face considerable barriers in using mobile technology and services due to the difficulty of text entry. In this paper, we review related studies involving the design and evaluation of novel prototypes for mobile text entry for persons with vision loss or impairment. We identify the practices and standards of the research community and compare them against the practices in research for non-impaired persons. We find that there are significant shortcomings in the methodological and result-reporting practices in both population types. In highlighting these issues, we hope to inspire more and better quality research in the domain of mobile text entry for persons with and without vision impairment.

Dynamics of the accommodative response and facility with dual-focus soft contact lenses for myopia control

OBJECTIVE

To assess the impact of using dual-focus soft contact lenses for myopia control on the dynamics of the accommodative response and facility.

METHODS

24 young adult myopes were fitted with dual-focus soft contact lenses for myopia control (MiSight®) and single-vision soft contact lenses (Proclear®). The WAM-5500 open-field autorefractor was used to measure the dynamics of the accommodative response (magnitude and variability) in binocular conditions, with accommodative data being gathered from the dominant eye, at three viewing distances (500 cm, 40 cm, and 20 cm) during 90 s. Also, the binocular accommodative facility was assessed with the WAM-5500 autorefractor. All participants performed the same experimental protocol with the dual-focus (MiSight) and single-vision (Proclear) soft contact lenses, with both experimental sessions being carried in two different days and following a counterbalanced order.

RESULTS

This study showed greater lags of accommodation with the MiSight than the Proclear lenses at near distances (40 cm: 1.27 ± 0.77 vs. 0.68 ± 0.37 D, corrected p-value = 0.002, Cohen-d = 0.90; and 20 cm: 1.47 ± 0.84 vs. 1.01 ± 0.52 D, corrected p-value = 0.007, Cohen-d = 0.75), whereas a higher variability of accommodation was observed with the dual-focus than the single-vision lenses at 500 cm (0.53 ± 0.11 vs. 0.23 ± 0.10 D), 40 cm (0.82 ± 0.31 vs. 0.68 ± 0.37 D), and 20 cm (1.50 ± 0.56 vs. 1.15 ± 0.39 D) (corrected p-value < 0.001 in all cases, and Cohen-ds = 0.67-2.33). Also, a worse quantitative (27.75 ± 8.79 vs. 34.29 ± 10.08 cycles per minute, p = 0.029, Cohen-d = 0.48) and qualitative (23.68 ± 7.12 vs. 28.43 ± 7.97 score, p = 0.039, Cohen-d = 0.45) performance was observed with the MiSight when compared to the Proclear lenses.

CONCLUSIONS

The use of dual-focus soft contact lenses for myopia control alters the dynamics of accommodative response and facility in the short-term. Although this optical design has demonstrated its effectiveness for myopia control, eye care specialists should be aware of the acute effects of these lenses on accommodation performance.

Increased end-stage renal disease risk in age-related macular degeneration: a nationwide cohort study with 10-year follow-up

Common etiologies between age-related macular degeneration (AMD) and kidney disease advocate a close link between AMD and end-stage renal disease (ESRD). However, the risk of ESRD in people with AMD was not reported. Here, we investigated the association between AMD and the risk of ESRD by using a nationwide, population-based cohort data in Korea. 4,206,862 participants aged 50 years or older were categorized by presence of AMD and visual disability. Risk of ESRD was the primary outcome. Cox regression hazard model was used to examine the hazard ratios (HRs) with adjustment for potential confounders. Stratified analyses by age, sex, baseline kidney function, and cardiometabolic comorbidities were performed. During the mean 9.95 years of follow-up, there were 21,759 incident ESRD events (0.52%). AMD was associated with 33% increased risk of ESRD (adjusted HR [aHR] 1.33, 95% confidence interval [CI] 1.24-1.44), and the risk was even higher when accompanied by visual disability (aHR 2.05, 95% CI 1.68-2.50) than when not (aHR 1.26, 95% CI 1.17-1.37). Age, baseline kidney function, and cardiometabolic comorbidities significantly interact between AMD and the risk of ESRD. Our findings have clinical implications on disease prevention and risk factor management of ESRD in patients with AMD.

Comparison of three health-related quality of life instruments in relation to visual acuity: EQ-5D, 15D, and EUROHIS-QOL8

PURPOSE

To compare three health-related quality of life (HRQoL) instruments in detecting the effect of distance visual acuity (VA) on generic HRQoL in an adult population.

METHODS

We used cross-sectional, population-based data from a nationwide health survey conducted in Finland in 2011-2012. It included three self-reported HRQoL instruments, EuroQol-5 Dimension (EQ-5D), 15D, and EUROHIS-QOL8, and a health examination in which habitual distance VA was measured binocularly. We assessed 3764 survey participants aged 30 years and older with information available on these parameters. The comparability and sensitivity of the instruments were evaluated using Pearson correlation coefficients and multivariable linear regression in different VA groups.

RESULTS

EQ-5D and 15D index scores showed strong positive correlation (0.65-0.74) with each other regardless of distance VA, whereas EUROHIS-QOL8 index score showed moderate-to-strong correlation (0.46-0.79) with EQ-5D and 15D. All three instruments showed a negative trend with deteriorating VA, although EQ-5D and 15D showed better sensitivity than EUROHIS-QOL8. When adjusted for age, gender, and co-morbidities, adequate vision (VA 0.63-0.8), weak vision (VA 0.32-0.5), and impaired vision or worse (VA ≤ 0.25) were independently associated with declined EQ-5D and 15D, whereas declined EUROHIS-QOL8 was associated only with adequate and weak vision.

CONCLUSION

All three instruments can be viable tools in evaluating the relation between vision and HRQoL. While 15D is preferred due to its wide coverage of dimensions, EQ-5D can be an equal alternative, as it has less respondent burden. The feasibility of EUROHIS-QOL8 on detecting differences between lower VA levels may require further evidence.

Prime Editing for the Installation and Correction of Mutations Causing Inherited Retinal Disease: A Brief Methodology

Inherited retinal diseases (IRDs) encompass a large heterogeneous group of rare blinding disorders whose etiology originates from mutations in the 280 genes identified to date. Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated (Cas) systems represent a promising avenue for the treatment of IRDs, as exemplified by FDA clinical trial approval of EDIT-101 (AGN-151587), which removes a deep intronic variant in the CEP290 gene that causes Leber congenital amaurosis (LCA) type 10. Prime editing is a novel double-strand break (DSB) independent CRISPR/Cas system which has the potential to correct all 12 possible transition and transversion mutations in addition to small deletions and insertions. Here, as a proof-of-concept study, we describe a methodology using prime editing for the in vitro installation and correction of the classical Pde6b^rd10 c.1678C > T (p.Arg560Cys) mutation which causes autosomal recessive retinitis pigmentosa (RP) in mice.

Inequities and Research Gaps in Ophthalmology: A Scoping Review

Importance

Deficient ophthalmologic care is costly to patients, making the identification of groups not receiving adequate care of vital importance. The current landscape of equity in ophthalmic care has yet to be thoroughly investigated and is important to ensure inclusivity and patient-centered care.

Objective

To perform a scoping review of the literature pertaining to health care inequities in the field of ophthalmology.

Evidence Review

A comprehensive database search using MEDLINE (via PubMed) and Ovid Embase was done in July 2022. English-language articles published from 2016 to 2021 were included and encompassed all article types except commentaries or correspondence. The search modeled the National Institutes of Health list of designated US health inequity populations, which includes income, education level, occupational status, rural and underresourced area, sex and gender, lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity, and race and ethnicity. A total of 8170 abstracts and titles were screened by 2 independent investigators, and 189 studies were assessed in full text for eligibility. For inclusion, articles needed to be an ophthalmic study discussing health inequities. In a masked, duplicate fashion, 2 independent investigators screened 75 full-text studies for data extraction using a pilot-tested form. Data extraction included general publication characteristics and health inequity data based on the National Institutes of Health's defined inequity groups.

Findings

A total of 75 publications were included. Notable inequities were found among Black and Hispanic patients associated with negative ophthalmic outcomes and mixed associations regarding sex or gender. Overall, lower-income patients were more likely to have vision impairment, use eye care services less, and have lower adherence to eye examinations. No articles within our sample examined LGBTQ inequities among ophthalmology patients since the 2016 National Institutes of Health classification of sexual and gender minority populations. Substantial research gaps were observed within the ophthalmic literature pertaining to the LGBTQ community, race and ethnicity, and rural and underresourced areas.

Conclusions and Relevance

This scoping review found substantial findings associated with the LGBTQ community, race and ethnicity, and the role of telemedicine in rural and underresourced areas. Because of the importance of ophthalmic care in overall patient health, it is vital to understand the various inequities present and strive to improve the current gaps in the literature. Future studies should (1) examine barriers to clinical study and medical trainee recruitment as well as patient values and preference studies and (2) investigate the implementation of telemedicine in underresourced areas.

When one partner can no longer see: Exploring the lived experiences of romantic partners in the context of vision loss

This qualitative descriptive study aims to explore the lived experience of the adjustment process of couples who face vision loss, investigating the impact of such loss on daily life and the adjustments and adaptations that ensue. To undertake such an exploration, the application of an occupational perspective is relevant where the meaning and purpose partners ascribe to their everyday activities can be investigated. A total of 16 couples living in Western Switzerland were interviewed between January and June 2020. Data collection was carried out with semi-structured face-to-face interview. Three themes emerge from the thematic analysis of transcripts. The first theme emphasizes that either separate or joint everyday activities of partners can be shared within couples, which all give sense to the partnership; the second one shows that vision loss disrupts the engagement of partners in such shared everyday activities. The third theme highlights partners’ efforts to reshape their engagement in their shared everyday activities in order to maintain a sense of couple’s we-ness. While navigating vision loss requires both partners to jointly engage in this process of reshaping, couples described tension that arises because of the partners with vision loss’ growing dependence on the other partner. One’s sense of control when navigating vision loss is critical to adjust to a changing and changed daily life. Further research is needed that focuses on how romantic partners ascribe a shared meaning and purpose to their engagement in everyday activities, separate or joint, and how such meaning and purpose are impacted by the onset or aggravation of one partner’s vision loss.

The impact of COVID-19 on the everyday life of blind and sighted individuals

The COVID-19 pandemic caused unexpected and unavoidable changes in daily life worldwide. Governments and communities found ways to mitigate the impact of these changes, but many solutions were inaccessible to people with visual impairments. This work aimed to investigate how blind individuals subjectively experienced the restrictions and isolation caused by the COVID-19 pandemic. To this end, a group of twenty-seven blind and seventeen sighted people took part in a survey addressing how COVID-19 impacted life practically and psychologically, how it affected their daily habits, and how it changed their experiences of themselves and others. Results demonstrated that both sighted and blind individuals had a hard time adapting to the new situation. However, while sighted people struggled more with personal and social aspects, the frustration of the blind population derived mostly from more practical and logistical issues. Likely as consequences, results showed that blind people engaged more in their inner life and experienced fear and anger as main emotions. This study suggests that changes in life associated with COVID-19 have been subjectively experienced differently based on the presence or not of blindness, and that tailored future interventions should be considered to take care of the different needs of blind individuals.

Suprachoroidal Injection of Triamcinolone Acetonide Injectable Suspension for the Treatment of Macular Edema Associated With Uveitis in the United States: A Cost-Effectiveness Analysis

OBJECTIVES

Suprachoroidal injection of triamcinolone acetonide is the first Food and Drug Administration-approved treatment for macular edema associated with uveitis. A cost-effectiveness analysis was performed comparing this treatment with best supportive care (BSC) for the management of this indication from US Medicare and commercial payer perspectives.

METHODS

A patient-level simulation was developed per the patient characteristics and changes in best-corrected visual acuity letter scores observed in a phase III study of triamcinolone acetonide (PEACHTREE). The wholesale acquisition cost of triamcinolone acetonide was $1650/injection; suprachoroidal injection cost was assumed at $200/injection. Healthcare costs were informed by a US claims-based analysis. Mortality risk associated with severe vision loss and blindness was modeled by applying a hazard ratio to all-cause mortality rates of the US general population. Health-related quality of life weights, obtained from a regression model fitted to the Visual Function Questionnaire-25 data from PEACHTREE, were applied based on the best-corrected visual acuity scores of both eyes. Costs (2020 US dollar) and benefits were discounted at 3% annually. Incremental cost-effectiveness ratios were estimated over a 10-year horizon.

RESULTS

In the base-case, the incremental cost-effectiveness ratio comparing triamcinolone acetonide with BSC was $28 479 per quality-adjusted life-year gained. The wholesale acquisition cost for triamcinolone acetonide for suprachoroidal use was ∼68%, ∼56%, and ∼27% below the willingness-to-pay thresholds of $150 000, $100 000, and $50 000 per quality-adjusted life-year gained, respectively. Results were robust in sensitivity and scenario analyses.

CONCLUSIONS

Triamcinolone acetonide for suprachoroidal use is cost-effective compared with BSC for patients with macular edema associated with uveitis.

Association between Age-Related Macular Degeneration and the Risk of Diabetes Mellitus: A Nationwide Cohort Study

Age-related macular degeneration (AMD) is a degenerative and progressive disease of the macula, the part of the retina that is responsible for central vision. AMD shares some risk factors with diabetes mellitus (DM), but little is known about the risk of DM in individuals with AMD. With the goal of establishing novel perspectives, this study aimed to investigate the association between AMD and the risk of DM using the Korean Nationwide Health Insurance Database. Individuals aged ≥ 50 years who underwent a national health screening program in 2009 were enrolled. Participants were categorized by the presence of AMD and visual disability (VD). The Cox hazard regression model was used to examine hazard ratios (HRs) of DM with adjustment for potential confounders. Stratified analyses by age, sex, and comorbidities (hypertension or dyslipidemia) were also performed. During a mean follow-up of 8.61 years, there were 403,367 (11.76%) DM incidences among the final 3,430,532 participants. The crude HR (95% confidence interval (CI)) was 1.16 (1.13–1.20) for AMD. After adjusting for potential confounders, AMD was associated with a 3% decreased risk of DM (aHR 0.97, 95% CI 0.95–1.00), but no significant association with the risk of DM was found in AMD with VD (aHR 1.03, 95% CI 0.93–1.14). In summary, we did not find an increased risk of DM in individuals with AMD. A 3% decreased risk of DM in patients with AMD is not clinically meaningful. Our study suggests that the association between AMD and the risk of DM is weak, considering the potential confounders. Further studies examining this association are needed to extend our knowledge.

A review of risk factors for retinal vein occlusions

INTRODUCTION

Risk factors for retinal vein occlusion have been extensively studied, with varying population sizes. Smaller populations result in less certain measures of associations. The present review included studies with a relevant population size to identify clinically relevant risk factors for retinal vein occlusion. Understanding the risk factors of retinal vein occlusion is important for the management of these patients.

AREAS COVERED

A comprehensive literature review was conducted through a systematic literature search in PubMed and Embase. Additional studies were selected from cross references in the assessed studies. Weighted effect measures were calculated for all included risk factors.Risk factors associated with retinal vein occlusion included cardiovascular diseases, eye diseases, systemic diseases, medical interventions, and sociodemographic factors.

EXPERT OPINION

This review provided an extensive overview of a wide variety of risk factors increasing the risk of developing retinal vein occlusion. The severity of the identified risk factors indicated that these patients have been in contact with the health care system before their retinal vein occlusion event. Therefore, the clinical course for patients with retinal vein occlusion may benefit from a multidisciplinary collaboration between ophthalmologists and especially cardiologists.

Health-related quality of life among adult patients with visual impairments in Yazd, Iran

BACKGROUND

Visual impairment (VI) is one of the major public health problems that cause suffering, disability, loss of productivity, and reduced quality of life (QoL). This study aimed to evaluate the health-related QoL (HRQoL) among adults with visual problems in 2021.

MATERIALS AND METHODS

This analytical cross-sectional study was conducted on 300 patients with VIs referring to ophthalmology centers in Yazd, Iran. Data were collected through face-to-face interviews using EQ-5D, visual analog scale (VAS), and demographic information questionnaires. The results were analyzed using independent sample t-test, one-way analysis of variance, Pearson correlation coefficient, and adjusted limited dependent variable mixture model (ALDVMM) model by STATA, and SPSS.

RESULTS

The mean and standard deviation of EQ-5D-5 L index and EQ-VAS score in the studied patients were 0.68 ± 0.25 and 72.46 ± 19.36, respectively. Most problems at unable/extreme level were related to the mobility dimension (12%) and the usual activities dimension (9%). Factors related to HRQoL scores using ALDVMM model showed that divorced or widow marital status, age over 50, having strabismus, and acuter visual problems had significant negative effects on EQ-5D-5 L index values (P < 0.05).

CONCLUSIONS

The results showed that HRQoL was moderate in patients with VIs and reduced in patients with high disease severity, old age, lack of a spouse, retirement, and nonuniversity education. As a result, socioeconomic and demographic characteristics were required to be considered in visual health policies.

Towards a national pre-school vision screening programme

The aim of the study is to examine common approaches to pre-school vision screening, including the current New South Wales model which is known as Statewide Eyesight Preschooler Screening (StEPS) to determine whether the criteria set by the World Health Organization are fulfilled by StEPS, and therefore, whether there is sufficient justification to deploy a similar model nationally. A literature review was conducted to answer four key questions related to vision screening. The authors sought to review (i) the justification for vision screening of a pre-school population; (ii) the principles and best approaches to vision screening such as how, where and who should conduct vision screening; (iii) the conditions that are targeted in vision screening; and (iv) the acceptable pass/fail vision screening criteria. The StEPS vision screening model is an accurate, reliable and economical way of screening for reduced vision at a time when neural plasticity allows improvement in vision following intervention. It fulfils World Health Organization criteria for a successful screening programme. StEPS has very high participation rates compared to other screening methods in Australia due to its unique model whereby screeners utilise early childhood settings to recruit and screen 4-year-old children. Due consideration should be given to deploying the StEPS vision screening model nationally.

The clinical features and the factors affecting visual prognosis in pediatric open-globe ınjuries

PURPOSE

To investigate clinical features and factors affecting visual prognosis after pediatric open-globe injuries.

METHODS

Retrospective study of 223 children with open-globe injury was conducted. Children with final logMAR visual acuity (LVA) > 0.70 were determined as poor-vision group (group 1, n = 108) and those with final LVA ≤ 0.70 as good-vision group (group 2, n = 115). Demographic characteristics (age, gender, and damaged eye), time between trauma and surgery, ocular trauma score (OTS), follow-up time, injury size, initial and final visual acuity levels, injury type (penetrating injury, globe rupture, perforating injury, and intraocular foreign body injury), injury localization (zone 1 = within the corneal and/or limbal area, zone 2 = within the scleral area extending 5 mm back from the limbus, and zone 3 = within the area posterior to zone 2), injury cause [metal objects (fork, knife, needle), broken glass, blunt objects (ball, punch), pen-pencil, and unidentified objects], and accompanying ocular findings of the groups were detected, and comparisons were done. Additionally, effects of age, time between trauma and surgery, OTS, injury size, follow-up time, initial LVA, injury type, and injury zone on final LVA were analyzed in both groups.

RESULTS

Mean age was 9.1 ± 2.0 years. There were 151 males and 72 females. Compared to group 1, group 2 had better initial and final visions (1.21 ± 0.26 vs 0.60 ± 0.28, p < 0.001 for initial LVA; 1.00 ± 0.32 vs 0.30 ± 0.13, p < 0.001 for final LVA), greater OTS (1.72 ± 0.53 vs 3.73 ± 0.61, p = 0.025), and smaller injury size (10.4 ± 3.5 vs 5.8 ± 2.4 mm, p = 0.002). Globe rupture (p = 0.015) and relative afferent pupillary defect (RAPD) (p = 0.037) were higher in group 1, while penetrating injury (p = 0.044), zone 1 involvement (p = 0.038), and metal object injury (p = 0.041) were higher in group 2. Based on multivariate analysis, the presences of globe rupture (p = 0.024) and RAPD (p = 0.035), the involvement without zone 1 (p = 0.042), and the injury without metal object (fork, knife, needle) (p = 0.046) were associated with poor final vision. Final LVA (for group 1 and group 2) was negatively correlated with OTS (r =  - 0.398, p = 0.037; r =  - 0.369, p = 0.040), while positively correlated with injury size (r = 0.412, p = 0.031; r = 0.318, p = 0.046) and initial LVA (r = 0.335, p = 0.043; r = 0.402, p = 0.034).

CONCLUSION

In our study, poor prognostic factors affecting final vision were low OTS, poor initial vision, the presences of globe rupture and RAPD, the large injury size, the involvement without zone 1, and the injury without metal object (fork, knife, needle).

Predictors of vision-related quality of life in patients with macular oedema receiving intra-vitreal anti-VEGF treatment

PURPOSE

To determine which demographic and clinical characteristics are predictive of vision-related quality of life (VrQoL) and quality of life (QoL) in patients with macular oedema receiving intravitreal anti-vascular endothelial growth factor (VEGF) treatment.

METHODS

Vision-related quality of life (VrQoL) and quality of life (QoL) were measured in 712 patients with retinal exudative disease receiving anti-VEGF treatment at baseline, 6 and 12 months. VrQoL was measured using an item-response theory based 47-question item bank (EyeQ), whereas QoL was measured using the EuroQol Five Dimensions (EQ-5D) questionnaire. The EQ-5D score was dichotomized into a perfect score of 1 and a suboptimal score of <1. Demographic and clinical patient characteristics were considered as possible predictors of (Vr)QoL. Prediction models for (Vr)QoL were created with linear mixed models and generalised estimating equations, using a forward selection procedure.

RESULTS

A worse VrQoL was predicted by poorer LogMAR visual acuity of the better eye, female sex, single civil status, older age, longer length of anti-VEGF treatment at baseline and the presence of non-ocular and ocular comorbidities. Suboptimal EQ-5D scores were predicted by poorer LogMAR visual acuity of the better eye, female sex, single civil status, older age, the presence of non-ocular comorbidities and a lower educational background.

CONCLUSIONS

Along with visual acuity of the better eye, which is the main factor used in clinical decision making, other patient characteristics should also be considered for the risk assessment of (Vr)QoL, such as sex, age, civil status, comorbidities and length of anti-VEGF treatment.

Longitudinal association between visual disability and cognitive function among middle-aged and older adults in China

BACKGROUND/AIMS

To determine the associations between visual disability and cognitive decline in Chinese middle-aged and older adults.

METHODS

A total of 6748 subjects were enrolled into this longitudinal, population-based, nationally representative study from two waves of the China Health and Retirement Longitudinal Study. Lagged dependent variable regression was used to model the independent associations between self-reported visual disability and cognitive function including memory and mental status.

RESULTS

The mean age of the 6748 individuals was 56.33 years, and 3350 (49.6%) were women. The prevalence of visual disability was 3.8%, which increased with age (p<0.001). Both memory and mental status score worsened over time (all p<0.001). After controlling for covariates, lagged dependent variable regression models showed that visual disability at baseline was significantly associated with memory decline after 7 years (β=-0.252, p=0.046). After stratifying by age groups, this association was only significant in the 55-64 age group (β=-0.372, p=0.033). In addition, both memory and mental status in 2011 predicted memory decline over 7 years (p=0.024 and p=0.045, respectively).

CONCLUSIONS

Our results suggest that visual disability may be a risk factor of memory decline, but not mental status among middle-aged and elderly adults in China. Future studies are needed to further corroborate the association between visual disability and cognitive decline and to determine whether interventions to preserve good visual function can prevent cognitive decline.

Retinal Organoids and Retinal Prostheses: An Overview

Despite the progress of modern medicine in the last decades, millions of people diagnosed with retinal dystrophies (RDs), such as retinitis pigmentosa, or age-related diseases, such as age-related macular degeneration, are suffering from severe visual impairment or even legal blindness. On the one hand, the reprogramming of somatic cells into induced pluripotent stem cells (iPSCs) and the progress of three-dimensional (3D) retinal organoids (ROs) technology provide a great opportunity to study, understand, and even treat retinal diseases. On the other hand, research advances in the field of electronic retinal prosthesis using inorganic photovoltaic polymers and the emergence of organic semiconductors represent an encouraging therapeutical strategy to restore vision to patients at the late onset of the disease. This review will provide an overview of the latest advancement in both fields. We first describe the retina and the photoreceptors, briefly mention the most used RD animal models, then focus on the latest RO differentiation protocols, carry out an overview of the current technology on inorganic and organic retinal prostheses to restore vision, and finally summarize the potential utility and applications of ROs.

Unmet Needs of Individuals With Acute Traumatic Eye Injury

Introduction: Although traumatic eye injuries can have a far-reaching impact on an individual and society, traumatic eye injury has not been a focus of research. The purpose of this study is to examine individuals’ experiences after traumatic vision loss and identify their needs. Methods: We used a qualitative approach to conduct semi-structured interviews with individuals who experienced traumatic vision loss and were treated at a specialty eye hospital in an urban setting. Participants also completed a demographic survey and the National Eye Institute Visual Functioning Questionnaire–25 (VFQ-25). Content analysis was used to analyze qualitative data and descriptive statistics were used to summarize quantitative data. Results: Interviews with 26 participants resulted in three categories of patient needs: informational, functional, and psychosocial. Participants wanted more information from providers about what to expect over time and identified driving as a significant challenge that affected their daily lives. Participants offered suggestions for addressing their functional needs including assistance with transportation to appointments, physical therapy, and occupational therapy. Participants also discussed how vision loss affected their livelihood and finances, with a subset of participants experiencing significant mental health distress. Some participants suggested that a recovery coach, peer support, support groups, and mental health services would be beneficial for addressing their psychosocial needs. Discussion: Our findings point to a significant gap in services available to meet the needs of individuals with traumatic eye injuries. Future research is needed to test the effect of an integrated-care model that includes routine offering of psychosocial and functional services for patients with acute vision loss to determine the effect on outcomes. Implications for Practitioners: This work has far-reaching implications for providers, since it supports the need for the development and delivery of integrated interventions that emphasize addressing psychosocial and functional aspects of recovery.

Central retinal artery occlusion: a retrospective study of disease presentation, treatment, and outcomes

OBJECTIVE

A central retinal artery occlusion (CRAO) represents a form of ocular stroke with poor visual prognosis. CRAO shares a common pathophysiology with cerebral ischemic stroke but presents unique diagnostic and management challenges leading to variability in clinical practice. This study aims to assess the presentation, treatment, and outcomes of CRAO at a tertiary care centre in Canada over 2 years and elucidate potential areas for improvement in the care of these patients.

METHODS

Single-institution retrospective review including 27 patients diagnosed with CRAO from March 2018 to March 2020 in Edmonton, Alberta.

RESULTS

Most patients with CRAO presented to eye care providers (14 of 27); others presented to the emergency department (10 of 27) or family physicians (2 of 27). Three patients (11.1%) presented within 4.5 hours of symptom onset. At presentation, 81% of patients had visual acuity of 20/400 or worse in the affected eye. No patients received thrombolysis. The majority of CRAO cases had a nonarteritic etiology (92.6%). All patients had at least one pre-existing vascular risk factor. Forty-eight percent of patients received escalated medical therapy. Ipsilateral carotid stenosis was identified in 5 patients (18.5%); 3 patients required carotid endarterectomy. Two patients were diagnosed with atrial fibrillation. Two patients experienced symptomatic cerebral ischemia within 6 weeks of CRAO.

CONCLUSIONS

The majority of patients with CRAO presented to eye care providers, and few present within the potential window for thrombolysis of 4.5 hours, highlighting the need for public awareness strategies. Our cohort highlights the significant rate of systemic comorbidity that exists in these patients.

The Refractive Error and Vision Impairment Estimation with Spectacle Data Study

Purpose

To investigate whether spectacle lens sales data can be used to estimate the population distribution of refractive error among patients with ametropia and hence to estimate the current and future risk of vision impairment.

Design

Cross-sectional study.

Participants

A total of 141 547 436 spectacle lens sales records from an international European lens manufacturer between 1998 and 2016.

Methods

Anonymized patient spectacle lens sales data, including refractive error information, was provided by a major European spectacle lens manufacturer. Data from the Gutenberg Health Survey was digitized to allow comparison of a representative, population-based sample with the spectacle lens sales data. A bootstrap analysis was completed to assess the comparability of both datasets. The expected level of vision impairment resulting from myopia at 75 years of age was calculated for both datasets using a previously published risk estimation equation combined with a saturation function.

Main Outcome Measures

Comparability of spectacle lens sales data on refractive error with typical population surveys of refractive error and its potential usefulness to predict vision impairment resulting from refractive error.

Results

Equivalent estimates of the population distribution of spherical equivalent refraction can be provided from spectacle lens data within limits. For myopia, the population distribution was equivalent to the Gutenberg Health Survey (≤ 5% deviation) for levels of –2.0 diopters (D) or less, whereas for hyperopia, the distribution was equivalent (≤ 5% deviation) for levels of +3.0 D or more. The estimated rates of vision impairment resulting from myopia were not statistically significantly different (chi-square, 182; degrees of freedom, 169; P = 0.234) between the spectacle lens dataset and Gutenberg Health Survey dataset.

Conclusions

The distribution of refractive error and hence the risk of vision impairment resulting from refractive error within a population can be determined using spectacle lens sales data. Pooling this type of data from multiple industry sources could provide a cost-effective, timely, and globally representative mechanism for monitoring the evolving epidemiologic features of refractive error and associated vision impairment.

Psychological aspects of living with an artificial eye

PURPOSE

Artificial eye clinics address physical and aesthetic aspects of orbital prostheses, but psychological effects may not be formally addressed. In general, without effective coping mechanisms, stress can lead to anxiety and depression. This study aims to determine, in the context of having an artificial eye, whether coping strategies, as well as perception of illness and other demographic and clinical variables are associated with anxiety or depression.

METHODS

Consecutive patients attending two artificial eye clinics were invited to participate in this audit. Participants completed questionnaires: HADS, Brief IPQ and Brief COPE. Variables with a correlation coefficient of ≥0.2 with anxiety or depression were included in regression modeling. The extent to which the participants' emotional and cognitive representations of their artificial eye related to feelings of anxiety and depression was determined.

RESULTS

In the cohort of 208, clinically significant anxiety was present in 29.5% and clinically significant depression was present in 8.4%. Perceptions of the impact of the artificial eye and self-blame as a coping strategy were correlated with anxiety. Depression levels were higher when participants believed that their artificial eye had a greater impact on their life, when they lived alone, and when they used substances as a coping strategy.

CONCLUSION

Significant levels of anxiety exist in those living with artificial eyes, with various coping strategies used. Addressing this and offering alternative coping strategies may improve patient well being and overall satisfaction.

Altered Spontaneous Brain Activity and Network Property in Patients With Congenital Monocular Blindness

Individuals with congenital monocular blindness may have specific brain changes since the brain is prenatally deprived of half the normal visual input. To explore characteristic brain functional changes of congenital monocular blindness, we analyzed resting-state functional MRI (rs-fMRI) data of 16 patients with unilateral congenital microphthalmia and 16 healthy subjects with normal vision to compare intergroup differences of amplitude of low frequency fluctuations (ALFFs), functional connectivity (FC), and network topolgoical properties. Compared with controls, patients with microphthalmia exhibited significantly lower ALFF values in the left inferior occipital and temporal gyri, superior temporal gyrus, inferior parietal lobe and post-central gyrus, whereas higher ALFF in the right middle and inferior temporal gyri, middle and superior frontal gyri, left superior frontal, and temporal gyri, such as angular gyrus. Meanwhile, FC between left medial superior frontal gyrus and angular gyrus, FC between left superior temporal gyrus and inferior parietal lobe and post-central gyrus decreased in the patients with congenital microphthalmia. In addition, a graph theory-analysis revealed increased regional network metrics (degree centrality and nodal efficiency) in the middle and inferior temporal gyri and middle and superior frontal gyri, while decreased values in the inferior occipital and temporal gyri, inferior parietal lobule, post-central gyrus, and angular gyrus. Taken together, patients with congenital microphthalmia had widespread abnormal activities within neural networks involving the vision and language and language-related regions played dominant roles in their brain networks. These findings may provide clues for functional reorganization of vision and language networks induced by the congenital monocular blindness.

Psychological changes among working-age adults with acquired vision impairment: The need for psychological intervention?

This study investigates the psychological impacts of acquiring a vision impairment during working-age phase of adulthood and the potential negative effect on participation in community activities were highlighted. Adopting a qualitative and interpretive phenomenological approach, eight semi-structured in-depth interviews were conducted with eight adult users of vision rehabilitation services. Three broad themes were identified: (1) reduced participation in education, employment, and community activities, (2) feelings of hopelessness and depression from vision loss, and (3) psychological adjustment to vision loss over time. Findings are discussed in the context of the international literature, and recommendations that may enhance the vision rehabilitation services are made.

Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section

BACKGROUND

The optimal management of clinoidal meningiomas (CMs) continues to be debated.

METHODS

We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of these tumors. The data from the literature along with contemporary practice patterns were discussed within the task force to generate consensual recommendations.

RESULTS AND CONCLUSION

This article represents the consensus opinion of the task force regarding pre-operative evaluations, patient's counselling, surgical classification, and optimal surgical strategy. Although this analysis yielded only Class B evidence and expert opinions, it should guide practitioners in the management of patients with clinoidal meningiomas and might form the basis for future clinical trials.

Multimodal sensing and intuitive steering assistance improve navigation and mobility for people with impaired vision

Globally, more than 250 million people have impaired vision and face challenges navigating outside their homes, affecting their independence, mental health, and physical health. Navigating unfamiliar routes is challenging for people with impaired vision because it may require avoiding obstacles, recognizing objects, and wayfinding indoors and outdoors. Existing approaches such as white canes, guide dogs, and electronic travel aids only tackle some of these challenges. Here, we present the Augmented Cane, a white cane with a comprehensive set of sensors and an intuitive feedback method to steer the user, which addresses navigation challenges and improves mobility for people with impaired vision. We compared the Augmented Cane with a white cane by having sighted and visually impaired participants complete navigation challenges while blindfolded: walking along hallways, avoiding obstacles, and following outdoor waypoints. Across all experiments, the Augmented Cane increased the walking speed for participants with impaired vision by 18 ± 7% and sighted participants by 35 ± 12% compared with a white cane. The increase in walking speed may be due to accurate steering assistance, reduced cognitive load, fewer contacts with the environment, and higher participant confidence. We also demonstrate advanced navigation capabilities of the Augmented Cane: indoor wayfinding, recognizing and steering the participant to a key object, and navigating a sequence of indoor and outdoor challenges. The open-source and low-cost design of the Augmented Cane provides a platform that may improve the mobility and quality of life of people with impaired vision.

Glaucoma Screening Using an iPad-Based Visual Field Test in a West African Population

PURPOSE

To investigate the performance of the Melbourne Rapid Fields (MRF) for use in clinic-based visual field testing in a low-resource setting.

DESIGN

Prospective cross-sectional study.

PARTICIPANTS

One hundred and three participants (66 patients with glaucoma and 37 control participants) attending a clinical appointment at the Tema Eye Center, Tema, Ghana.

METHODS

Patients with glaucoma and control participants underwent MRF and Humphrey Field Analyzer (HFA) testing.

MAIN OUTCOME MEASURES

Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, sensitivity, specificity, and area under the receiver operating characteristic curve.

RESULTS

Mean MD was less negative and mean PSD was more positive on the MRF than the HFA in both groups (all P < 0.001). False-positive and false-negative rates were comparable between methods (P = 0.09 and P = 0.35, respectively). In patients with glaucoma, MD and PSD from the 2 devices were correlated strongly (r = 0.84; P < 0.001) and moderately (r = 0.61; P < 0.001), respectively. Agreement analysis revealed that MRF tended to generate significantly higher MD (bias, 3.3 ± 4.1 dB; P = 0.03) and PSD (bias, 1.9 ± 2.8 dB; P = 0.03) with wide limits of agreement. For detecting moderate to advanced glaucoma, the sensitivity was 60.9% for the MRF and 78.3% for the HFA (P = 0.10); respective specificities were 86.5% and 83.8% (P = 0.76).

CONCLUSIONS

The MRF underestimated MD and overestimated PSD values compared with the HFA. Agreement biases were significant, suggesting a weak agreement between the 2 devices. However, the MRF showed potential for screening in a low-resource setting, particularly for detecting moderate to advanced glaucoma.

Visual Performance and Cortical Atrophy in Vision-Related Brain Regions Differ Between Older Adults with (or at Risk for) Alzheimer's Disease

BACKGROUND

Visual impairment is associated with deficits in cognitive function and risk for cognitive decline and Alzheimer's disease (AD).

OBJECTIVE

The purpose of this study was to characterize the degree of visual impairment and explore the association thereof with cortical atrophy in brain regions associated with visual processing in individuals with (or at risk for) AD.

METHODS

Using the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) dataset, we analyzed vision and brain imaging data from three diagnostic groups: individuals with subjective cognitive decline (SCD; N = 35), mild cognitive impairment (MCI; N = 74), and mild AD (N = 30). We used ANCOVAs to determine whether performance on reading acuity and contrast sensitivity tests differed across diagnostic groups. Hierarchical regression analyses were applied to determine whether visual performance predicted gray matter volume for vision-related regions of interest above and beyond group membership.

RESULTS

The AD group performed significantly worse on reading acuity (F(2,138) = 4.12, p <  0.01, ω 2 = 0.04) compared to the SCD group and on contrast sensitivity (F(2,138) = 7.6, p <  0.01, ω 2 = 0.09) compared to the SCD and MCI groups, which did not differ from each other. Visual performance was associated with volume in some vision-related structures beyond clinical diagnosis.

CONCLUSION

Our findings demonstrate poor visual performance in AD and that both group membership and visual performance are predictors of cortical pathology, consistent with the idea that atrophy in visual areas and pathways contributes to the functional vision deficits observed in AD.

Thrombolysis for Central Retinal Artery Occlusion in 2020: Time Is Vision!

BACKGROUND

Acute nonarteritic central retinal artery occlusion (CRAO) is an eye stroke with poor visual prognosis and no proven effective therapies. Given advances in acute stroke care, thrombolysis in CRAO merits critical re-examination. We review the evidence for intravenous (IV) and intra-arterial (IA) tissue plasminogen activator (tPA) in CRAO management.

EVIDENCE ACQUISITION

MEDLINE, Scopus, and Cochrane online databases were systematically searched from 1960 to present, for reports of acute IV or IA therapy with alteplase or tenecteplase in nonarteritic CRAO patients. English language case reports, case series, interventional studies, or randomized controlled trials were included. The study type, age and number of subjects, the regimen administered, the time since symptoms' onset, visual outcome, and safety reports were noted.

RESULTS

Use of IV thrombolysis with alteplase was reported in 7 articles encompassing 111 patients, with 54% of them receiving IV tPA within 4.5 hours of symptom onset, and none developing symptomatic intracranial or ocular hemorrhage. Six studies described IA alteplase administration, with only 18 of a total of 134 patients (13.4%) treated within the first 6 hours after visual loss. The reported adverse events were minimal. Visual outcomes post-IV and IA thrombolysis were heterogeneously reported; however, most studies demonstrated benefit of the respective reperfusion therapies when administered very early. We found no reports of tenecteplase administration in CRAO.

CONCLUSIONS

In 2020, nonarteritic CRAO patients should theoretically receive the same thrombolytic therapies, in the same time window, as patients with acute cerebral ischemia. Eye stroke and teleeye stroke code encounters must include an expert ophthalmologic evaluation to confirm the correct diagnosis and to evaluate for ocular signs that may help guide IV tPA administration or IA management. Future research should focus on developing feasible retinal penumbra imaging studies that, similar to cerebral tissue viability or perfusion imaging, can be incorporated into the thrombolysis decision-making algorithm.

Prevalence, Causes, and Factors Associated with Visual Impairment in a Chinese Elderly Population: The Rugao Longevity and Aging Study

Purpose

This study aimed to explore the current prevalence, causes, and factors associated with visual impairment in a Chinese elderly population.

Methods

A random sample of 2164 candidates aged ≥70 years was selected. Among them, 1914 participants (response rate: 88.4%) underwent comprehensive eye examinations. The prevalence and causes of visual impairment were estimated, and the associated factors were identified.

Results

The standardized prevalence of mild visual impairment (<6/12 to ≥6/18), moderate to severe visual impairment (MSVI) (<6/18 to ≥3/60), and blindness (<3/60) in the better eye were 20.5%, 25.8%, and 3.4%, respectively. The leading cause of visual impairment was cataract (49.7%), followed by uncorrected refractive error (26.5%), myopic maculopathy (5.8%), and posterior capsular opacification (5.5%). Optical coherence tomography revealed that vitreoretinal interface abnormalities were the third most common cause of monocular mild visual impairment (2.2%) and MSVI (4.4%) in the elderly population. A large number of patients with visual impairment (81.7%) were amenable to undergo the interventions. Visual impairment was associated with advanced age (odds ratio [OR], 1.09 per year; p<0.001), female sex (OR, 1.59; p=0.003), self-reported visual impairment (OR, 1.91; p<0.001), cognitive impairment (OR, 1.40, p=0.005), and high educational level (OR, 0.75; primary, p=0.045; and OR, 0.53, secondary or higher; p<0.001).

Conclusion

Visual impairment was common in the Chinese elderly population and a severe health and social problem. Practicable policies are urgently needed to popularize eye health knowledge and promote treatments for visual impairment in elderly people in rural China.

Smartphone usage among people living with severe visual impairment and blindness

Low vision care and rehabilitation is often limited by access to assistive devices, especially in low-resourced countries, due to their high cost and unavailability. Smartphones have the potential to serve as an alternative assistive device for people living with severe visual impairment and blindness (SVIB). This study aims to investigate the use of smartphones among people living with SVIB. The study was a cross-sectional study of 166 people living with SVIB in a low resourced setting. The participants were recruited from two tertiary institutions and four eye care facilities. A questionnaire was administered to all respondents and for those who could not read prints they were read out to them and their responses recorded. The majority of respondents (n = 88, 53.1%) either had no phone or used a basic phone. The prevalence of smartphone usage among people living with SVIB was found to be 46.90% (n = 78). Most respondents use their smartphones to interact on social media [n = 75 (96%)] and web browsing [n = 69,92%]. The most frequently demanded [n = 22 (44%)] smartphone functionality by the respondents was the image and color description feature. Most participants were unaware that 90% of their functionality demands already existed and were compatible with current smartphones. A significant number of people living with SVIB in this study used smartphones; however, most users are unaware of its full functionality and assistive capabilities.