Unilateral visual impairment and health related quality of life: the Blue Mountains Eye Study

Factors associated with health-related quality of life among people with visual impairments living in nursing homes in Armenia: a cross-sectional study

PURPOSE

The study aimed to examine the effect of visual impairment (VI), eye diseases, and other risk factors on health-related quality of life (HRQoL) in nursing home residents in Armenia.

METHODS

This cross-sectional study administered an interviewer-administered structured questionnaire to collect information about socio-demographics, chronic diseases, HRQoL, smoking, receiving and giving instrumental/emotional social support, and sleeping disorders among 313 nursing home residents. An ophthalmic examination of the participants was conducted.

RESULTS

The mean age was 72.5 years, ranging from 45.5 to 91.4. Women constituted 50% of the sample. The prevalence of normal vision by presenting visual acuity with available correction was 55.3%, while VI and blindness were present in 40.8% and 3.9%, respectively. Uncorrected refractive error (URE) was found in 20% of participants. The mean HRQoL score was 51.3, ranging from 7.9 to 95.0. In the adjusted analysis, having at least one chronic non-communicable disease, sleeping disorders, eye diseases, URE, VI, blindness, and giving instrumental social support were associated with HRQoL.

CONCLUSIONS

Regular eye care services could improve the eye health and HRQoL of nursing home residents. Interventions addressing vision loss and chronic non-communicable diseases could enhance the functioning and overall well-being of the target population.

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.

Prevalence of Reduced Vision among UK Elderly Drivers: The Bridlington Eye Assessment Project (BEAP)—A Cross-Sectional Study

Self-assessment of driving fitness is mandatory in the United Kingdom. A paucity of data on visual function among drivers exists. We report prevalence of elderly drivers below legal visual acuity (VA) standard from a population study (The Bridlington Eye Assessment Project (BEAP)) conducted from 2002 to 2006. All residents aged ≥65 years were invited, 3459 undergoing structured interviews/ophthalmic examinations. Driving status was recorded, VA measured, and visual field (VF) testing performed. Outcomes were prevalence and characteristics of drivers below VA legal standard and prevalence of bilateral VF defects. Conditions causing reduced VA were explored and those with treatable conditions allowing visual improvement identified. Duration since last optometry review was recorded. Associations were explored using unpaired t-tests for continuous and chi-squared for discrete variables. Logistic regression was used for multivariate analysis and to determine odd ratios in the final adjusted model. Statistical analysis was performed using Stata 14.0 (Stata Corp, Tx). Within this sample, 7.1% (95% CI 6.0–8.3) of drivers fell below the VA legal driving standard (6/12) in their better eye, with 20% not having seen an optometrist for 2 years, including 8.2% who had not attended for over 5 years. The percentage of drivers falling below the VA minimum increases with age reaching 22.8% (95% CI 13.7–35.3) among those aged 85–89 years. 7.2% (95% CI 6.2–8.6) of drivers had bilateral visual field defects. 93% of drivers with reduced VA below legal standard had a cataract, refractive error or both in at least one eye. Significant numbers of elderly drive with VA below legal standard, most having easily correctable causes. Poor attendance with optometrists appears commonplace. Public education raised awareness of legal driving standards and encouraged compliance are required. Regular eye tests, appropriate refractive correction, and cataract surgery when needed should be encouraged.

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.

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.

Surgical Decompression or Corticosteroid Treatment of Indirect Traumatic Optic Neuropathy: A Randomized Controlled Trial

BACKGROUND

Traumatic optic neuropathy (TON) is a rare cause of severe permanent visual impairment after injury. Traumatic optic neuropathy may occur due to sharp trauma (direct injury) that damages the optic nerve directly or due to damage from the transmitted forces after a concussive blow to the head or orbit (indirect injury). The management of indirect TON remains controversial. Either surgical decompression or mega dose corticosteroid is used for managing indirect TON. However, no consensus exists regarding the definitive treatment.

MATERIALS AND METHODS

We designed a randomized controlled trial study to investigate this issue. Only patients with indirect TON and normal vision before the injury were enrolled. The patients' data were recorded, and fine cut facial computed tomography scan was performed to exclude those with retrobulbar hematoma. All the study subjects were randomly allocated to either the mega dose steroid (30 mg/kg stat and 15 mg/kg every 6 hours for 3 days) group or the surgical decompression group. The patients were followed up at 1 week, 1 month, 3 months, 6 months, and 9 months. During each follow-up, the Snellen visual acuity (VA), visual field, color change, fundus findings, and intraocular pressure were evaluated. These data were compared and analyzed using the Mann-Whitney U test and odds ratio. The short form questionnaire was used to analyze the lift quality difference between the two groups.

RESULTS

Thirty patients were enrolled, 12 in the surgical group and 18 in the steroid treatment group. There were no significant differences in the improvement rate, improvement degree, and life quality between the groups. However, the odds ratios are 5, 10, 2.5, and nonavailable in the cutoff points of no light perception (NLP), light perception (LP), hand movement, and counting finger in surgery group. In steroid group, they are 1, 1, 1, 1.83 in each cutoff points. Patients with better VA than NLP had better life quality than those with NLP VA (P = 0.005). Other cutoff point groups had no significant difference.

CONCLUSIONS

Patients with worse initial VA (eg, NLP and LP) had a higher chance of benefiting from surgical treatment and experiencing improvements in the life quality.

Prevalence and 11-year incidence of common eye diseases and their relation to health-related quality of life, mental health, and visual impairment

Purpose

To study the prevalence and incidence of the most common eye diseases and their relation to health-related quality of life (HRQoL), depression, psychological distress, and visual impairment in the aging population of Finland.

Methods

Our study was based on two nationwide health surveys conducted in 2000 and 2011. Eye disease status data were obtained from 7379 and 5710 individuals aged 30 + years, of whom 4620 partook in both time points. Both surveys included identical indicators of HRQoL (EuroQol-5 Dimension [EQ-5D], 15D), depression (Beck Depression Inventory [BDI]), psychological distress (General Health Questionnaire-12 [GHQ-12]), visual acuity, and self-reported eye diseases. We assessed the impact of known eye diseases on these factors, adjusted for age, gender, and co-morbidities.

Results

Prevalence of self-reported eye diseases was 3.1/2.7% for glaucoma, 8.1/11.4% for cataract, and 3.4/3.8% for retinal degeneration in 2000 and 2011, and the average incidence between 2000 and 2011 was 22, 109, and 35 /year/10,000 individuals, respectively. These eye diseases were associated with a significant decrease in EQ-5D and 15D index scores in both time points. BDI and GHQ-12 scores were also worsened, with some variation between different eye diseases. Impaired vision was, however, the strongest determinant of declined HRQoL. During the 11-year follow-up the effect of eye diseases on HRQoL and mental health diminished.

Conclusion

Declined HRQoL associated with eye diseases is more related to impaired vision than the awareness of the disease itself, and this declining effect diminished during the follow-up. Therefore, information directed to the public on the risks and prevention of blindness can and should be strengthened to prevent the deleterious effects of visual impairment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02817-1.

Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association

PURPOSE

Central retinal artery occlusion (CRAO) is a form of acute ischemic stroke that causes severe visual loss and is a harbinger of further cerebrovascular and cardiovascular events. There is a paucity of scientific information on the appropriate management of CRAO, with most strategies based on observational literature and expert opinion. In this scientific statement, we critically appraise the literature on CRAO and provide a framework within which to consider acute treatment and secondary prevention.

METHODS

We performed a literature review of randomized controlled clinical trials, prospective and retrospective cohort studies, case-control studies, case reports, clinical guidelines, review articles, basic science articles, and editorials concerning the management of CRAO. We assembled a panel comprising experts in the fields of vascular neurology, neuro-ophthalmology, vitreo-retinal surgery, immunology, endovascular neurosurgery, and cardiology, and document sections were divided among the writing group members. Each member received an assignment to perform a literature review, synthesize the data, and offer considerations for practice. Multiple drafts were circulated among the group until consensus was achieved.

RESULTS

Acute CRAO is a medical emergency. Systems of care should evolve to prioritize early recognition and triage of CRAO to emergency medical attention. There is considerable variability in management patterns among practitioners, institutions, and subspecialty groups. The current literature suggests that treatment with intravenous tissue plasminogen activator may be effective. Patients should undergo urgent screening and treatment of vascular risk factors. There is a need for high-quality, randomized clinical trials in this field.

Sociodemographic, behavioral, and medical risk factors associated with visual impairment among older adults: a community-based pilot survey in Southern District of Hong Kong

Background

The last visual survey of older adults in Hong Kong was a district-level study in 2002, with no assessment of behavioral and medical risk factors for visual impairment (VI). Our objectives were to determine the latest VI prevalence among older adults, significance of any spatial and temporal differences on the prevalence, and any associations of sociodemographic, behavioral and medical risk factors with VI from a multi-perspective analysis.

Methods

Community-based pilot survey of residents from a suburb of Hong Kong, aged ≥50, using a standardized questionnaire, was conducted in 2016.

Results

Of the 222 subjects, crude rates of bilateral and unilateral VI were 9.46 and 32.88%, respectively, or corresponding age-and-gender-adjusted rates of 6.89 and 30.5%. Older age and lower educational were associated with higher risk for unilateral VI, while older age, temporary housing, obesity and hyperlipidemia were associated with higher risk for bilateral VI. Smoking and alcohol-drinking status were not associated with unilateral or bilateral VI. Relative changes in ORs of hypertension or educational level on unilateral or bilateral VI were >  10% after adjusting for age. Interaction term between hyperlipidemia and gender or obesity was significant for unilateral VI. Gender, hypertension and cataract were not associated with unilateral or bilateral VI in general population of pooled analysis but were identified as risk factors in specific subgroups of stratified analysis. Refractive error (myopia or hyperopia) was significantly associated with VI in the eye-level analysis after adjusting the inter-eye correlation.

Conclusions

Sociodemographic and medical risk factors contributed to VI, but behavioral risk factors did not. Sociodemographic disparities of visual health existed. Age was the confounders of the VI-hypertension or VI-educational level relationships. Gender and obesity were more likely to have multiplicative effect on unilateral VI when combined with hyperlipidemia. Stratified analysis should be conducted to provide further insight into the risk factors for VI in specific populations. Uncorrected refractive error remains a significant cause of impaired vision. The spatial and temporal differences in bilateral VI prevalence from the previous local study indicates a territory-wide survey is needed to assess regional differences and overall prevalence of VI in Hong Kong.

Visual impairment and ten-year mortality: the Liwan Eye Study

OBJECTIVES

To explore associations between visual impairment (VI) and mortality in an adult population in urban China.

METHODS

The Liwan Eye Study was a population-based prevalence survey conducted in Guangzhou, Southern China. The baseline examination was carried out in 2003. All baseline participants were invited for the 10-year follow-up visit. VI was defined as the visual acuity of 20/40 or worse in the better-seeing eye with habitual correction if worn. Correctable VI was defined as the VI correctable to 20/40 or better by subjective refraction, and non-correctable VI was defined as the VI correctable to worse than 20/40. Mortality rates were compared using the log-rank test and Cox proportional hazards regression models.

RESULTS

Of the 1399 participants (mean age: 65.3 ± 9.93 years; 56.4% female) with available baseline visual acuity measurement, 320 participants (22.9%) had VI. After 10 years, 314 (22.4%) participants died. Visually impaired participants had a significantly increased 10-year mortality compared with those without VI (40.0% vs. 17.2%, P < 0.05). After adjusting for age, gender, income, educational attainment, BMI, history of diabetes and hypertension, both VI (HR, 1.55; 95% CI, 1.14-2.11) and non-correctable VI (HR, 2.72; 95% CI, 1.86-3.98) were significantly associated with poorer survival, while correctable VI (HR, 0.99; 95% CI, 0.66-1.49) was not an independent risk factor for 10-year mortality.

CONCLUSIONS

Our findings that VI, particularly non-correctable VI, predicting poorer survival may imply the underlying mechanism behind VI-mortality association and reinforce the importance of preventing and treating disabling ocular diseases to prevent premature mortality in the elderly.

Influence of cataract surgery for the first or second eye on vision-related quality of life (VR-QOL) and the predictive factors of VR-QOL improvement

PURPOSE

To assess improvements in vision-related quality of life (VR-QOL) in patients undergoing their first or second eye cataract surgery, as well as clinical factors related to VR-QOL.

STUDY DESIGN

Prospective case series.

METHODS

We examined 282 patients undergoing their first (222) or second (60) eye cataract surgery. VR-QOL was evaluated before and after surgery using the 25-item National Eye Institute visual function questionnaire (VFQ-25), along with the best-corrected visual acuity (BCVA), uncorrected visual acuity, and the lens opacities classification system III (LOCSIII). The resulting VFQ-25 subscale scores were compared between patients undergoing their first or second eye cataract surgery, including multiple regression analysis.

RESULTS

The mean VFQ-25 composite score (CS) was 71.5 ± 14.2 before and 84.0 ± 10.2 after the first eye cataract surgery and 73.5 ± 12.7 before and 85.4 ± 10.2 after the second eye cataract surgery. VFQ-25 scores improved significantly, with reduced disparity among patients after surgery in both groups. Preoperative CS was related to the preoperative sum of the BCVA (standardized partial regression coefficient (β) =  - 0.254, P < 0.001). Improvement in the CS was related to a preoperative poor BCVA (β = 0.203, P < 0.001), low CS (β =  - 0.693, P < 0.001), and high general health score (β = 0.118, P = 0.025).

CONCLUSIONS

VR-QOL improved after the first and second eye surgery. Many VFQ-25 subscales were related to the BCVA or LOCSIII scores. Low preoperative VR-QOL and BCVA were related to an improved postoperative VR-QOL.

Epidemiological factors associated with health knowledge of three common eye diseases: A community-based pilot survey in Hong Kong

Objectives

To assess the proportions of respondents in the general community having heard or awareness, and their knowledge level, of three common eye diseases: age-related macular degeneration, cataract, and glaucoma. We also attempted to assess for risk factors that may be associated with any variations, which will help identify the areas of inadequate knowledge and demographics of potential audiences for focused health education.

Methods

We conducted a community-based pilot survey for the residents from a southern suburb of Hong Kong in early 2016, by inviting all aged 50 or above to complete a standardized questionnaire in the local community hall.

Results

Most of the 222 respondents have heard, or awareness, of cataract (92.79% or 81.98%, respectively), followed by glaucoma (86.94% or 52.70%, respectively), and age-related macular degeneration (51.35% or 29.28%, respectively). The results of Cronbach's alpha (α > 0.7) and Spearman's correlation coefficient (p < 0.01) suggested that the internal consistency, convergent and discriminant validities of the questionnaire were acceptable for the study population. Compared to a previous Hong Kong survey in 2002, the proportions of having heard of the three eye diseases were greater, but the overall knowledge remained limited. From a maximum knowledge score of 29, the median scores for age-related macular degeneration, cataract, and glaucoma were 9, 13, and 14, respectively. Except for the treatment of cataract, the knowledge level in most areas was low. Sociodemographic factors and medical history, rather than behavioral factors, were more likely to be associated with having a higher knowledge level. Subjects with family or friends with a history of glaucoma or age-related macular degeneration were more aware and knowledgeable, but not for subjects who were current and past smokers or alcohol drinkers. For age-related macular degeneration, gender modified the effect between age and knowledge level, while age was a confounder of having medical history, and having heard or awareness, of the disease.

Conclusion

Despite a larger proportion of the community having heard or awareness since 15 years ago, much effort remains for improving health knowledge of these three eye diseases in Hong Kong. We recommend targeting respondents with higher lifestyle risks, such as current and past smokers or alcohol drinkers, as a focused audience, and utilizing family members, relatives, or friends as another way of distributing health information.

Central retinal venous occlusion in a child with hyperhomocysteinemia: A case report

RATIONALE

To report a rare case of 8-year-old girl patient with central retinal venous occlusion (CRVO) with hyperhomocysteinemia.

PATIENT CONCERNS

The patient had a 2-year history on painless visual loss in the left eye.

DIAGNOSES

All examination results were within normal limits except plasma homocysteine (HCY). Fluorescein angiography (FA) confirmed peripheral capillary non-perfusion (CNP) in the left eye, and OCT showed macular edema. The girl patient was diagnosed as CRVO.

INTERVENTIONS

Based on all of the test results, laser photocoagulation was performed at peripheral capillary non-perfusion (NP). Ranibizumab was injected into virtreous cavity to reduce the macular edema. Oral folic acid, vitamin B12, and vitamin B6 were performed to the girl.

OUTCOMES

After 13 months, the girl visual acuity recovered to 20/100 in the left eye.

LESSONS

All eye examinations should be performed in young patients, and they should undergo treatments immediately after is diagnosed as CRVO.

Impact of cataract on health-related quality of life in a longitudinal Japanese chronic obstructive pulmonary cohort

Cigarette smoking increases the risk of developing both cataract and chronic obstructive pulmonary disease (COPD). The prevalence of cataract and the clinical characteristics of COPD patients with cataract were retrospectively investigated in a 2-year observational COPD cohort. We analyzed 395 patients with complete data on ophthalmologic evaluation (319 subjects with COPD and 76 subjects at risk of COPD). There was no difference in the prevalence of cataract between COPD patients and those at risk (47.0% vs. 42.1%, p = 0.44). Age ≥ 75 years, low body mass index, and hypertension were independently associated with cataract as a comorbidity in COPD. The incidence of exacerbation within 2 years was significantly higher in COPD patients with cataract than those without cataract (36.6% vs. 18.3%, p = 0.0019). COPD patients with cataract exhibited significantly higher COPD assessment test score compared to those without cataract (13.7 ± 8.9 vs. 11.5 ± 7.2, p = 0.0240). Overall St George's Respiratory Questionnaire score and each component were significantly worse in COPD patients with cataract compared to those without cataract. COPD patients with cataract exhibited poor health-related quality of life and frequent exacerbations. The association between cataract and exacerbations of COPD deserves further attention.

Prevalence and causes of visual impairment amongst older adults in a rural area of North India: a cross-sectional study

OBJECTIVES

To determine the prevalence, causes and associated factors for visual impairment (VI) in rural population of Jhajjar district, Haryana, north India.

METHODS

A community-based, cross-sectional study was conducted in two blocks of Jhajjar district. A total of 34 villages were selected using probability proportionate to size sampling method. Adults aged 50 years and above were selected using compact segment cluster sampling approach. Presenting visual acuity using LogMAR E chart was measured along with collection of other demographic details as part of the house-to-house survey. Subjective refraction and torch light examination were performed at a clinic site within the village to ascertain VI and its cause. VI was considered when presenting visual acuity was less than 6/18 in the better eye. Common causes of VI viz uncorrected refractive errors, cataract, central corneal opacity and others were noted by optometrists. Descriptive analysis was undertaken. Multivariate logistic regression analysis was performed for determining associated factors with VI.

RESULTS

Out of 2025 enumerated adults, 1690 (83.5%) were examined at the household level and 1575 (78%) completed all study procedures. The prevalence of VI was found to be 24.5% (95% CI 21.1 to 26.3) and blindness was 5% (95% CI 3.9 to 6.1). The most common causes of VI were uncorrected refractive errors (50%) and cataract (37%). The VI in study participants was found to be associated with age, gender, marital and educational status.

CONCLUSIONS

VI is still a public health problem in rural population of Jhajjar district, Haryana. Provision of spectacles and cataract surgical services are simple interventions to address this issue.

Prevalence and Causes of Unilateral Vision Impairment and Unilateral Blindness in Australia: The National Eye Health Survey

Importance

This study determines the prevalence of unilateral vision impairment (VI) and unilateral blindness to assist in policy formulation for eye health care services.

Objective

To determine the prevalence and causes of unilateral VI and unilateral blindness in Australia.

Design, Setting, and Participants

This cross-sectional population-based survey was conducted from March 2015 to April 2016 at 30 randomly selected sites across all strata of geographic remoteness in Australia. A total of 1738 indigenous Australians 40 years or older and 3098 nonindigenous Australians 50 years or older were included.

Main Outcomes and Measures

The prevalence and causes of unilateral vision impairment and blindness, defined as presenting visual acuity worse than 6/12 and 6/60, respectively, in the worse eye, and 6/12 or better in the better eye.

Results

Of the 1738 indigenous Australians, mean (SD) age was 55.0 (10.0) years, and 1024 participants (58.9%) were female. Among the 3098 nonindigenous Australians, mean (SD) age was 66.6 (9.7) years, and 1661 participants (53.6%) were female. The weighted prevalence of unilateral VI in indigenous Australians was 12.5% (95% CI, 11.0%-14.2%) and the prevalence of unilateral blindness was 2.4% (95% CI, 1.7%-3.3%), respectively. In nonindigenous Australians, the prevalence of unilateral VI was 14.6% (95% CI, 13.1%-16.3%) and unilateral blindness was found in 1.4% (95% CI, 1.0%-1.8%). The age-adjusted and sex-adjusted prevalence of unilateral vision loss was higher in indigenous Australians than nonindigenous Australians (VI: 18.7% vs 14.5%; P = .02; blindness: 2.9% vs 1.3%; P = .02). Risk factors for unilateral vision loss included older age (odds ratio [OR], 1.60 for each decade of age for indigenous Australians; 95% CI, 1.39-1.86; OR, 1.65 per decade for nonindigenous Australians; 95% CI, 1.38-1.96), very remote residence (OR, 1.65; 95% CI, 1.01-2.74) and self-reported diabetes (OR, 1.52; 95% CI, 1.12-2.07) for indigenous Australians, and having not undergone an eye examination in the past 2 years for nonindigenous Australians (OR, 1.54; 95% CI, 1.04-2.27). Uncorrected refractive error and cataract were leading causes of unilateral VI in both populations (70%-75%). Corneal pathology (16.7%) and cataract (13.9%) were leading causes of unilateral blindness in indigenous Australians, while amblyopia (18.8%), trauma (16.7%), and age-related macular degeneration (10.4%) were major causes of unilateral blindness in nonindigenous Australians.

Conclusions and Relevance

Unilateral vision loss is prevalent in indigenous and nonindigenous Australians; however, most cases are avoidable. As those with unilateral vision loss caused by cataract and posterior segment diseases may be at great risk of progressing to bilateral blindness, national blindness prevention programs may benefit from prioritizing examination and treatment of those with unilateral vision loss.

Long-term visual outcomes of craniopharyngioma in children

Visual function is a critical factor in the diagnosis, monitoring, and prognosis of craniopharyngiomas in children. The aim of this study was to report the long-term visual outcomes in a cohort of pediatric patients with craniopharyngioma. The study design is a retrospective chart review of craniopharyngioma patients from a single tertiary-care pediatric hospital. 59 patients were included in the study. Mean age at presentation was 9.4 years old (range 0.7-18.0 years old). The most common presenting features were headache (76%), nausea/vomiting (32%), and vision loss (31%). Median follow-up was 5.2 years (range 1.0-17.2 years). During follow-up, visual decline occurred in 17 patients (29%). On Kaplan Meier survival analysis, 47% of the cases of visual decline occurred within 4 months of diagnosis, with the remaining cases occurring sporadically during follow-up (up to 8 years after diagnosis). In terms of risk factors, younger age at diagnosis, optic nerve edema at presentation, and tumor recurrence were found to have statistically significant associations with visual decline. At final follow-up, 58% of the patients had visual impairment in at least one eye but only 10% were legally blind in both eyes (visual acuity 20/200 or worse or < 20° of visual field). Vision loss is a common presenting symptom of craniopharyngiomas in children. After diagnosis, monitoring vision is important as about 30% of patients will experience significant visual decline. Long-term vision loss occurs in the majority of patients, but severe binocular visual impairment is uncommon.

Five-year visual outcome among people with correctable visual impairment: the Liwan Eye Study

IMPORTANCE

Longitudinal data on visual outcome of correctable visual impairments (VI) are of paramount importance for decision-maker to estimate burden and demand to treat avoidable VI.

BACKGROUND

To assess the 5-year visual outcome among participants with correctable VI and to identify associated risk factors.

DESIGN

Population-based longitudinal cohort study.

PARTICIPANTS

Participants with correctable VI at baseline attended the 5-year follow-up visit of the Liwan Eye Study.

METHODS

Presenting visual acuity (PVA) with habitual refractive correction was assessed using an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Then participants with PVA <6/12 in either eye underwent further non-cycloplegic subjective refraction to obtain their best-corrected visual acuity. Correctable VI was defined as having a PVA of <6/12 in the better eye which could be improved to ≥6/12 after refractive correction.

MAIN OUTCOME MEASURES

The 5-year visual outcome among participants with correctable VI.

RESULTS

Among 1405 participants at baseline examination, 188 (13.4%) had correctable VI, of whom 118 (62.8%) were re-examined at the 5-year follow-up, including 39 (33.9%) who progressed to non-correctable VI, 43 (37.4%) who had persistent correctable VI and 33 (28.7%) who were converted to normal vision. In multivariate logistic regression, compared with participants who were no longer visual impaired, significant risk factors for participants with persistent VI were older, had income <1000 RMB/month, and more myopia spherical equivalent.

CONCLUSIONS AND RELEVANCE

Over two of three participants with correctable VI remained to have VI after 5 years, among whom 50% are correctable by spectacles, highlighting the need to improve the refractive care accessibility to treat avoidable VI in China.

Utilization of eye care services among those with unilateral visual impairment in rural South India: Andhra Pradesh Eye Disease Study (APEDS)

AIM

To report on the utilization of eye care services and its associated factors among those with unilateral visual impairment (VI) in a rural South Indian population.

METHODS

A population based cross-sectional study was conducted in three districts (Adilabad, Mahbubnagar and West Godavari) in the state of Andhra Pradesh, India. A detailed interview and a comprehensive eye examination were conducted. Those with unilateral VI were asked questions about noticing any change in vision and on utilization of eye care services. The most important reason reported by the participant for not utilizing the services was used for the analysis. Multiple logistic regression models were used to examine the association between noticing a change in vision and socio-demographic variables such as age, gender, education and area of residence, severity and causes of VI.

RESULTS

Among the 4456 participants aged ≥16y who were administered the questionnaire, 53.2% were women, and 54.7% had no education. Of the 489 (11%; 95% CI: 10.1-11.9) people with unilateral VI, 399 (81.6%) participants reported noticing a change in their vision over the last five years but only 136 (34.1%) participants had sought eye care consultation. Those who had any education (OR: 1.9; 95% CI: 1.1-3.2), had blindness (OR: 2.7; 95% CI: 1.4-5.2), and cataract (OR: 2.1; 95% CI: 1.0-4.3) as a cause of unilateral VI were more like to seek eye care consultations. The most commonly reported reasons for not seeking eye care services were "do not have money for eye checkup" in 30.7% of the participants followed by "do not have a serious problem" (30.0%).

CONCLUSION

A large proportion of rural population though noticed a change in their vision did not seek eye care due to financial and person-related reasons. Eye care service providers need to address these barriers to enhance the uptake of eye care services among those with unilateral VI.

Prevalence and causes of visual impairment among Saudi adults

Objective:

To evaluate the prevalence and causes of visual impairment (VI) among Saudi adults in Arar City, the capital of Northern Border Region of Saudi Arabia.

Methods:

This population-based cross-sectional study was conducted on 705 Saudi adults aged 18 years and older. All participants underwent ophthalmic examination including visual acuity (VA) testing, auto refraction, intraocular pressure (IOP) measurement and fundus examination.

Results:

In the present study 166 cases (23.5%) were found to have VI, while only 12 cases (1.7%) were considered as blind following the WHO definitions. Cataract was found to be the main cause of VI [51 cases (30.7%)] followed by refractive error (RE) [41 cases (24.7%)] and diabetic retinopathy (DR) [22 cases (13.2%)]. Seventy one cases of the studied subjects (10.07 %) had shown unilateral VI, while 13 cases (1.8%) had shown unilateral blindness with the other eye normal (VA ≥ 20/20).

Conclusion:

Visual impairment is highly prevalent among Saudi adults in Arar city. Cataract, refractive error and diabetic retinopathy are the main 3 leading causes. Better plans for diagnosis and treatment should be considered to decrease the magnitude of the problem.

Health Outcomes Associated with Self-Reported Vision Impairment in Older Adults

Introduction

To compare the health status of older adults with and without vision impairment, this study employed a disability framework consisting of four stages, progressing from risk factors; through pathology and impairments that result in declining functioning; and eventually to disability.

Methods

Data from five rounds (1999 to 2008) of the National Health and Nutrition Examination Study were analyzed. Binary and multinomial logistic regression were used to estimate odds ratios, with 95% confidence intervals reflecting the likelihood of negative health outcomes among persons with self-reported fair and poor vision relative to persons with good vision.

Results

Fair and poor vision status were associated with negative health outcomes across the four health dimensions.

Discussion

Disparities in health among vision status groups may originate as a result of limitations in daily activities that could lead to changes in diet, health maintenance, and activity levels. Alternatively, disparities may reflect primary pathologies and conditions that are secondarily related to poor vision status. Longitudinal research is suggested in order to assess the order of key events, and to make a more powerful assertion of causality.

Implications for practitioners

Comparisons of health outcomes by vision status are important because of the potential to identify points in the disability framework where effective interventions could prevent progression to later stages in the disability process.

Assessment of quality of life in patients with visual impairments using a new visual function questionnaire: the VFQ-J11

Background

The purpose of the present study was to assess the vision-related quality of life (QOL) of visually impaired patients using the Japanese 11-item National Eye Institute Visual Function Questionnaire (VFQ-J11). Comparisons with the 25-item version (VFQ-25) and the EuroQoL Index using a large group of patients with various degrees of impairments and various causative diseases were performed.

Methods

A total of 232 visually impaired Japanese patients were recruited from six ophthalmology departments in Japan. Information on ophthalmic findings and patient backgrounds was collected, and information on QOL and utility assessments was collected from the patients by means of survey questionnaires.

Results

The average age of patients was 69.6±14.3 years. Both the vision-related QOL scores (VFQ-25 composite and VFQ-J11) were significantly associated with better and worse visual acuity (VA) in visually impaired subjects (all P<0.01). VFQ-J11 was comparable to VFQ-25 regardless of causative diseases. VFQ-25 composite and the VFQ-J11 scores were concurrently associated with a range of systemic medical disorders. EuroQoL Index had a significant association with better eye VA (P<0.01), but not with worse eye VA, or any systemic disorders.

Conclusion

VFQ-J11 provides valid data on vision-related QOL and is less of a burden for patients with vision problems.

An updated estimate of costs of endophthalmitis following cataract surgery among Medicare patients: 2010-2014

BACKGROUND

Endophthalmitis, which can occur after ophthalmic surgery, is an inflammation of the intraocular cavity and causes temporary or permanent vision impairment. However, little is known about the cost of treatment. The objective of this analysis was to update and expand upon the results of a previously published report that estimated the direct medical cost of treatment for endophthalmitis.

METHODS

Retrospective data analysis using 2010 through 2014 United States Medicare Limited Data Sets. Procedure codes were used to identify beneficiaries who underwent cataract surgery; demographic and clinical characteristics at the time of diagnosis were determined. Patients were stratified into cases (those who developed endophthalmitis) and controls (those who did not develop endophthalmitis) in the 3 months following surgery. Claims (ie, charges) and reimbursements (ie, costs) for cases and controls in the 6 months following cataract surgery were identified and compared. Results are presented in 2015 US dollars.

RESULTS

Of a total of 153,860 cataract surgery patients, 181 were diagnosed with endophthalmitis following cataract surgery, at a rate of 1.2 per 1,000. Cases were more likely to be male and less likely to be white than controls; age was similar. Total medical claims and reimbursements as well as ophthalmic claims and reimbursements were significantly higher for cases compared with controls. Total reimbursements, adjusted for age, sex, and region, were $4,893 higher (83% greater) and adjusted ophthalmic reimbursements were $3,002 higher (156% greater) for cases than for controls. Claims and reimbursements were significantly higher across all types of Medicare cost components.

CONCLUSION

Postcataract surgery endophthalmitis is associated with a substantial cost. Successful prophylaxis with antibiotic agents would reduce the significant costs associated with treating endophthalmitis.

Unilateral visual impairment in rural south India-Andhra Pradesh Eye Disease Study (APEDS)

AIM

To report the prevalence and causes of unilateral visual impairment (UVI) in rural population of all ages in rural Andhra Pradesh, India.

METHODS

A population-based cross sectional study using a multi-stage cluster sampling methodology was carried out in West Godavari, Adilabad and Mahbubnagar districts in south India. A comprehensive eye examination that included presenting and best corrected visual acuity and dilated fundus examination was conducted by trained professionals. UVI is defined as presenting visual acuity <6/18 in one eye but ≥6/18 in other eye. Multiple logistic regression analysis was used to test association of UVI with socio-demographic risk factors.

RESULTS

Data were analyzed for 6634/7771 participants after excluding those with bilateral visual impairment. The mean age of the participants was 27.4y (standard deviation: 17.9y), 51.9% were women and 49.1% were educated. The prevalence of UVI was 7.8% (95% CI: 7.2%-8.5%). Uncorrected refractive error (60.8%), cataract (17.4%) and retinal causes (6.6%) were the leading causes of UVI. On multiple logistic regression analyses, older age, not having education, living in well-off district had significantly higher odds of being associated with UVI. UVI was not associated with gender.

CONCLUSION

UVI is common in rural south India. Most of it is due to cataract and refractive errors, both of which can be addressed at primary and secondary levels of eye care. Burden of UVI should also be considered in planning eye care services.

Can patients with visual impairment follow a normal school?

AIM

To highlight the needs for socio-professional orientation of patients with visual impairment.

MATERIAL AND METHODS

Prospective observational study on 69 patients (47 boys and 22 girls), with a mean age of 15,99±3,4235 years, evaluated in the Ophthalmology Clinic of "Sf. Spiridon" Hospital Iaşi, in order to obtain a medical certificate. Clinical parameters: slit lamp examination, fundoscopy, visual acuity, intraocular pressure, orthoptic exam, ocular ultrasound, or corneal pachymetry (in selected cases). A questionnaire for the age group of 12-18 years was applied. Data were statistically analyzed by using the Student's t-test.

RESULTS

Sixteen patients had ocular prosthesis or visual acuity 0 in one eye and 31 patients had a low vision. Patient's diagnosis: anterior segment diseases (23,18%), posterior segment diseases (52,17%), other diagnoses (24,63%). The pathology was congenital in 60,86% of the cases. 13,04% of the patients (3 school children and 6 students) asked for the integration into normal school/ university. Frequent answers: lack of special means of assistance in schools/ universities, need for additional schooling, people's reluctance which led to situations of ridicule, dependence on others to perform daily activities, need for professional help.

CONCLUSIONS

Children with eye deficiencies can be scholarized in normal an educational system, according to the level of intelligence. Adolescents with eye disorders may attend University courses if proper aids are provided. Socio-professional orientation should be performed as early as possible to increase the quality of life in sighted patients. Aids for low-vision patients are insufficiently used in Romania.

Comparing the Impact of Refractive and Nonrefractive Vision Loss on Functioning and Disability: The Salisbury Eye Evaluation

PURPOSE

To compare the effects of uncorrected refractive error (URE) and nonrefractive visual impairment (VI) on performance and disability measures.

DESIGN

Cross-sectional, population-based study.

PARTICIPANTS

A total of 2469 individuals with binocular presenting visual acuity (PVA) of ≥ 20/80 who participated in the first round of the Salisbury Eye Evaluation study.

METHODS

The URE was defined as binocular PVA of ≤ 20/30, improving to >20/30 with subjective refraction. The VI was defined as post-refraction binocular best-corrected visual acuity (BCVA) of ≤ 20/30. The visual acuity decrement due to VI was calculated as the difference between BCVA and 20/30, whereas visual acuity due to URE was taken as the difference between PVA and BCVA. Multivariable regression analyses were used to assess the disability impact of (1) vision status (VI, URE, or normal vision) using the group with normal vision as reference and (2) a 1-line decrement in acuity due to VI or URE.

MAIN OUTCOME MEASURES

Objective measures of visual function were obtained from timed performance of mobility and near vision tasks, self-reported driving cessation, and self-reported visual difficulty measured by the Activities of Daily Vision (ADV) scale. The ADV responses were analyzed using Rasch analysis to determine visual ability.

RESULTS

Compared with individuals with normal vision, subjects with VI (n = 191) had significantly poorer objective and subjective visual functioning in all metrics examined (P < 0.05), whereas subjects with URE (n = 132) demonstrated slower walking speeds, slower near task performance, more frequent driving cessation, and lower ADV scores (P < 0.05), but did not demonstrate slower stair climbing or descent speed. For all functional metrics evaluated, the impact of VI was greater than the impact of URE. The impact of a 1-line VA decrement due to VI was associated with greater deficits in mobility measures and driving cessation when compared with a 1-line VA decrement due to URE.

CONCLUSIONS

Visual impairment is associated with greater disability than URE across a wide variety of functional measures, even in analyses adjusting for the severity of vision loss. Refractive and nonrefractive vision loss should be distinguished in studies evaluating visual disability and be understood to have differing consequences.

Psycho-social impact of visual impairment on health-related quality of life among nursing home residents

BACKGROUND

Visual impairment (VI) affects physical, psychological, and emotional well-being, and social life as well. The purpose of this exploratory study was to assess the psycho-social impact of VI on health-related quality of life (HRQoL) among nursing home residents.

METHODS

This cross-sectional study involved 272 residents of 60 years or older residing in seven nursing homes of the Kathmandu Valley, Nepal. Comprehensive ocular examinations, including near and distance vision assessment and refractions were carried out. VI was defined as visual acuity (VA) less than 6/18 in the better eye. Residents were divided into two groups: one group did not have VI (in whom VA was greater than or equal to 6/18 in the better eye), and the other had VI (in whom VA was worse than 6/18 in the better eye).Face-to-face interviews were conducted filling out a 36-item The Medical Outcomes Study Short-Form (SF-36) questionnaire. The SF-36 questionnaire was scored according to the scoring algorithm SF-36 subscales.

RESULTS

The mean age of residents was 74.68 ± 8.19 years (range, 60-99 years) and the majority were female (78.68%). The mean composite score of SF-36 was 46.98 ± 13.08. VI detrimentally affected scores of both the physical and the mental components, but the impact of VI was slightly greater for the physical component than that for the mental component. There was a trend towards a lower composite score as well as each subscale score of the SF-36 in participants with VI than in those without VI.

CONCLUSION

VI has a negative effect on HRQoL. HRQoL is reduced among nursing home residents and the reduction in the HRQoL bears a positive association with VI.

Visual impairment and multimorbidity in a representative sample of the Spanish population

BACKGROUND

In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning.

METHODS

Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity.

RESULTS

The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning.

CONCLUSIONS

Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.

Health burden associated with visual impairment in Singapore: the Singapore epidemiology of eye disease study

OBJECTIVE

To assess the impact of visual impairment (VI) on health-related quality of life and to compare the health burden of VI and other health conditions in Singapore.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

We studied the 10 009 adults (3353 Chinese, 3397 Indians, and 3259 Malays) who underwent a comprehensive eye assessment and completed the European Quality of Life-5 Dimensions (EQ-5D) questionnaire in the Singapore Epidemiology of Eye Disease Study.

METHODS

We estimated the effects of VI, obesity, hypertension, diabetes, and hyperlipidemia on the EQ-5D index score using linear regression models and the association between VI and self-reported EQ-5D health problems using logistic regression models. We compared prevalence-based quality-adjusted life-year (QALY) loss associated with VI and other health conditions. For each condition, QALY loss was calculated for 100 000 persons in 1 year using associated reduction in EQ-5D index score estimated in regression analysis as disutility.

MAIN OUTCOME MEASURES

The EQ-5D index score and annual QALY loss.

RESULTS

The EQ-5D index score decreased with increasing VI severity in all 3 ethnicities. For example, after adjusting for sociodemographic characteristics, the difference in EQ-5D index score between adults with bilateral severe VI and those without VI was -0.044 (95% confidence interval [CI], -0.089 to 0.001) in Chinese, -0.127 (95% CI, -0.237 to -0.017) in Indians, and -0.085 (95% CI, -0.148 to -0.022) in Malays. In all 3 ethnicities, VI was associated with reporting of problems in mobility (e.g., odds ratio [OR], 3.69 for Chinese with bilateral severe VI; 95% CI, 1.21-12.13) and usual activities (e.g., OR, 6.51 for Chinese with bilateral severe VI; 95% CI, 1.59-26.58). In Indians, VI was also associated with anxiety or depression (e.g., OR, 2.68 for bilateral severe VI; 95% CI, 1.11-6.50). The annual QALY loss associated with VI was 511.8 in Chinese, 608.8 in Indians, and 706.7 in Malays, greater than that associated with other health conditions examined in this study.

CONCLUSIONS

Visual impairment is associated with substantial health burden among Asians in Singapore. The relatively high burden of VI highlights the importance of VI prevention. The ethnic difference exhibited in this burden warrants further study.

Comparative effectiveness of treatment options for pediatric craniopharyngiomas

OBJECT

No clear treatment guidelines for pediatric craniopharyngiomas exist. The authors developed a decision analytical model to evaluate outcomes of 4 surgical approaches for craniopharyngiomas in children, including attempted gross-total resection (GTR), planned subtotal removal plus radiotherapy, biopsy plus radiotherapy, and endoscopic resections of all kinds.

METHODS

Pooled data, including the authors' own experience, were used to create evidence tables, from which incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) were calculated for the 4 management strategies.

RESULTS

Quality-adjusted life years at the 5-year follow-up were 2.3 ± 0.1 for attempted GTR, 2.9 ± 0.2 for planned subtotal removal plus radiotherapy, 3.9 ± 0.2 for biopsy plus radiotherapy, and 3.7 ± 0.2 for endoscopic resection (F = 17,150, p < 0.001). Similarly, QALYs at 10-year follow-up were 4.5 ± 0.2 for attempted GTR, 5.7 ± 0.5 for planned subtotal removal plus radiotherapy, and 7.8 ± 0.5 for biopsy plus radiotherapy (F = 6,173, p < 0.001). On post hoc pairwise comparisons, the differences between all pairs compared were also highly significant (p < 0.001). Since follow-up data at 10 years are lacking for endoscopic cases, this category was excluded from 10-year comparisons.

CONCLUSIONS

Biopsy with subsequent radiotherapy is the preferred approach with respect to improved overall quality of life. While endoscopic approaches also show promise in preserving quality of life at five-year follow-up, there are not sufficient data to draw conclusions about this comparison at 10 years.

Degree, duration, and causes of visual impairment in eyes affected with ocular tuberculosis

Background

Ocular tuberculosis (TB) can affect nearly every ocular tissue, leading to a variety of vision-threatening clinical manifestations. The goal of this study is to estimate the degree, duration, and causes of visual impairment in eyes affected by ocular TB.

Results

This was a retrospective study of patients diagnosed as ocular TB based on polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex. We applied the World Health Organization definition of visual impairment (VI) to affected eye(s), instead of better-seeing eye. Best-corrected visual acuity (BCVA) of <6/18 and ≥6/60 in the affected eye was classified as moderate VI and <6/60 and ≥3/60 as severe VI. Data collected included presenting and final BCVA of affected eyes and the worst BCVA during the study period. Sixty-one eyes of 40 patients were analyzed. Twenty-five patients (52.1%) had bilateral disease. The mean worst BCVA and mean final BCVA (logMAR) were 1.26 ± 0.87 and 0.61 ± 0.85, respectively, and their difference was highly significant (p < 0.0001, Friedman test). The median worst and final BCVA results were 1.30 (range 0.0 to 3.0) and 0.20 (range 0.0 to 3.0), respectively. The mean duration of follow-up was 98.34 ± 81.81 weeks. Moderate and severe VIs were seen in 14 (22.9%) and 12 (19.7%) eyes, respectively, during the course of follow up. Twenty eyes (32.8%) had BCVA of <3/60. Moderate VI or worse was most commonly seen in eyes with multifocal serpiginoid choroiditis (n = 6; 100%), retinal vasculitis (n = 25; 80.6%), and panuveitis (n = 12; 80%). The mean duration of visual loss was 25.2 ± 42.37 weeks (median 6.43 weeks, range 0 to 206.42 weeks). Vitreous hemorrhage, complicated cataract, and macular scarring were the common causes of VI.

Conclusion

Ocular TB can result in prolonged visual impairment, more commonly in patients with posterior uveitis or panuveitis.

Patterns and costs associated with progression of age-related macular degeneration

PURPOSE

To evaluate patterns of disease progression among individuals with age-related macular degeneration (AMD) and to compare costs over time.

DESIGN

Retrospective data analysis using 5% Medicare claims data from 1997 through 2009.

METHODS

Beneficiaries were included if they had no diagnosis of AMD in 1997, were 65 years of age or older, had data through 2009, and had no major ophthalmic conditions. Two cohorts were identified: those who had dry AMD in 1998 (cases) and matched controls who never had AMD.

RESULTS

There were 52,607 beneficiaries who never had AMD and 1184 who were diagnosed with dry AMD in 1998. Among beneficiaries with dry AMD, the disease progressed in 20.4% to the wet form by 2009. From 1999 to 2009, average annual Medicare expenditures increased from $11,265 to $24,494 (cases whose disease did not progress) and from $11,712 to $34,308 (cases whose disease progressed). Among beneficiaries without AMD, expenditures also increased over time (from $4736 in 1999 to $17,473 in 2009), but consistently were lower than cases' expenditures. Considering ophthalmic expenditures, the pattern was more pronounced: beneficiaries without AMD had annual expenditures less than $100, those with dry AMD had expenditures at least 3 times more, and wet AMD beneficiaries' costs were at least 5-fold more than that of those with dry disease. A subgroup analysis of beneficiaries without hypertension revealed similar patterns, although expenditures were lower than in the general population.

CONCLUSIONS

AMD progression seems to be associated with increased annual Medicare expenditures. Findings suggest that halting or slowing disease progression using proven treatment such as Age-Related Eye Disease Study-endorsed vitamins or novel technologies could have a substantial positive impact by lowering public health expenditures.

Quality of life of eye amputated patients

PURPOSE

To evaluate eye-amputated patients' health-related quality of life, perceived stress, self-rated health, job separation because of illness or disability and socioeconomic position.

METHODS

Patients were recruited from a tertiary referral centre situated in Copenhagen. Inclusion criteria were eye amputation, i.e. evisceration, enucleation, orbital exenteration or secondary implantation of an orbital implant during the period 1996-2003, and participation in a previous investigation (2005). In total, 159 eye-amputated patients were included, and completed a self-administered questionnaire containing health-related quality of life (SF-36), the perceived stress scale and answered questions about self-rated health, job changes because of illness or disability and socioeconomic status. These results were compared with findings from the Danish Health Interview Survey 2005.

RESULTS

The eye-amputated patients had significantly (p < 0.05) lower scores (poorer health) on all SF-36 subscales and more perceived stress compared to the general population. In all, 43.3% of the patients rated their health as excellent or very good compared to 52.1% of the general population. In total, 25% of the study population has retired or changed to a part-time job because of eye disease. The percentage of eye amputated patients, who were divorced or separated, was twice as high as in the general population.

CONCLUSION

The impact of an eye amputation is considerable. The quality of life, perceived stress and self-rated health of many eye-amputated patients are drastically changed. Eye amputation has a marked negative influence on job separation because of illness or disability and on socioeconomic position.

Trends in self-reported visual impairment in the United States: 1984 to 2010

OBJECTIVE

To explore trends in the prevalence of self-reported visual impairment in the noninstitutionalized adult US population during the 27-year period from 1984 to 2010.

DESIGN

Data obtained from the National Health Interview Survey (NHIS) and the Survey of Income and Program Participation (SIPP) were used to analyze trends in the prevalence of self-reported visual impairment in the United States.

PARTICIPANTS

Representative, population-based samples of between 45 000 and 92 000 adults (NHIS) and between 37 000 and 71 000 adults (SIPP) during each year of data collection.

METHODS

Survey results were age-adjusted to a standard (2010) population. Sampling weights were used throughout the analysis using strata and primary sampling unit variables provided in the public use datasets to appropriately take into account the complex design of the surveys. The statistical significance of trends was estimated by computing the difference in chi-squares of a fit to a linear trendline and a fit without a trend.

MAIN OUTCOME MEASURES

The trends and percent change in the prevalence of visual impairment from 1984 to 1996 and from 1997 to 2010 for NHIS and 1984 to 2010 for SIPP.

RESULTS

On the basis of NHIS data, the prevalence of activity-limiting visual impairment among persons aged ≥65 years declined by 51.7% (P < 0.001), from 3.5% in 1984 to 1.7% in 1996, and by 45.8% (P < 0.001), from 3.1% in 1997 to 1.7% in 2010. On the basis of SIPP data, the prevalence of functional visual impairment in the same age category declined by 58.3% (P < 0.001), from 23.3% in 1984 to 9.7% in 2010, whereas the prevalence of severe functional impairment declined by 47.1% (P < 0.001), from 5.1% to 2.7%.

CONCLUSIONS

There was a marked reduction in the prevalence of self-reported visual impairment in the noninstitutionalized adult US population during the period from 1984 to 2010.

Vision-related quality of life assessment using the NEI-VFQ-25 in adolescents and young adults with a history of congenital cataract

PURPOSE

To assess vision-specific health-related quality of life in adolescents and young adults with a history of congenital cataract using the National Eye Institute 25-item Visual Function Questionnaire (NEI-VFQ-25).

METHODS

A retrospective chart review was performed for patients who underwent surgery aged younger than 24 months. Those 13 years or older at follow-up were selected for inclusion. Educational attainment was determined. A control group of healthy individuals of similar age with no visual complaints also completed the questionnaire.

RESULTS

Sixteen patients with a history of unilateral cataract (mean age: 17.8 ± 2.8 years), 22 with bilateral cataract (19.5 ± 4.6 years), and 15 controls (17.9 ± 2.5 years) were included in the study. The bilateral cataract group had greater difficulty with near and distance activities compared with the unilateral group, and had significantly lower vision-specific social functioning, role difficulties, mental health, and composite scores. Comparing the unilateral cataract and control groups, there was no significant difference in ocular pain, vision-specific social functioning, role difficulties, and dependency scores between both groups.

CONCLUSION

Patients with unilateral cataract had fewer difficulties performing near and distance activities and certain vision-specific tasks than the bilateral group, but both groups were comparable in terms of general vision scores. The control group had better scores than the unilateral group in some, but not all, categories and better than the bilateral group in most. Educational achievements were high in both cataract groups. All attended main stream school and many attended university.

Biological risk of older adults with visual impairments

OBJECTIVES

To investigate whether biological markers of health differ among older adults with visual impairment compared to those with normal vision.

DESIGN

We use data from the National Health and Nutrition Examination Survey (1999 - 2006) to investigate clinically defined at-risk levels for 10 biological markers.

SETTING

Survey participants were non-institutionalized.

PARTICIPANTS

Nationally representative (U.S.) sample of older adults age 65 and older, categorized as having blindness (20/200 or worse), low vision (20/40 to 20/100) or normal vision (better than 20/40).

INTERVENTION

Separate binary logistic regressions (one for each biomarker, with two at-risk cut points for BMI: obese and underweight) were computed to determine the odds of having at-risk levels of each biomarker.

MEASUREMENTS

Biomarkers included: systolic and diastolic blood pressure, high-density lipoprotein, low-density lipoprotein (LDL) cholesterol, total cholesterol, glycated hemoglobin, body mass index (BMI), fasting triglycerides, C-reactive protein, and plasma homocysteine.

RESULTS

Older adults who were blind were more likely to have high-risk levels of LDL cholesterol, homocysteine, and to be underweight (BMI>18.5). Similarly, older adults with LV were more likely to have high-risk levels of homocysteine compared to older adults with normal vision.

CONCLUSION

As several of the high-risk biomarkers associated with visual impairment were diet-related, our results suggest the importance of nutrition and diet programs aimed towards educating older people who are visually impaired.

Is the pediatric quality of life inventory valid for use in preschool children with refractive errors?

PURPOSE

To determine the psychometric validity of the pediatric quality of life inventory (PedsQL 4.0) in assessing the impact of refractive errors on health-related quality of life (HRQoL) in preschool children in Singapore.

METHODS

Parents of toddlers (aged 25 to 48 months) and young children (49 to 72 months) completed the PedsQL 4.0, an HRQoL scale as part of population-based trial in Singapore. The outcome measures were the overall score, and the "physical"; "emotional"; "social"; and "school" functioning subscales. Rasch analysis was used to validate the PedsQL 4.0.

RESULTS

Parents of 939 (48.9%) toddlers and 982 (51.1%) young children completed the PedsQL 4.0 survey. The overall mean (±standard deviation) spherical equivalence for the right eye was 0.47 ± 1.13 diopter (D) for toddlers and 0.74 ± 1.22 D for young children. One hundred forty-nine (15.9%) toddlers and 90 (9.2%) young children were considered myopic (≥-0.50 D). Most participants (n = 1286, 89.6%) had presenting visual acuity 6/9 or better. Rasch analysis showed evidence of disordered category thresholds and poor person-item targeting for both groups. The separation reliability was 0.00 for toddlers and 0.03 for young children, indicating there was no variance in both samples. The PedsQL 4.0 overall and subscale scores displayed substantial multidimensionality as the variance values explained by the measures was <25% in both groups. A minimum value of 60% is usually considering acceptable.

CONCLUSIONS

The PedsQL 4.0 in its current state is not a valid psychometric scale to effectively evaluate the impact of refractive errors on HRQoL in preschool children in Singapore.

Metric properties of the MacDQoL, individualized macular-disease-specific quality of life instrument, and newly identified subscales in French, German, Italian, and American populations

OBJECTIVES

The aims of this analysis were to confirm the UK results in other countries and to explore the possibility of subscales of the 25-Item Macular disease Dependent Quality of Life (MacDQoL) questionnaire.

METHODS

Two clinical studies were pooled. Principal components analyses (Varimax) were conducted on baseline data from each country and from all combined. Factorial structures were compared between countries, and Cronbach alpha values were used to identify item clusters. Four groups of patients were created according to visual acuity (VA) in the best eye (BE < 10/20; BE ≥ 10/20) and worst eye (WE < 10/100; WE ≥ 10/100). These groups were used to investigate (analysis of variance) the sensitivity of MacDQoL to VA impairment and to compare it with the NEI-VFQ-25 generic visual function questionnaire.

RESULTS

A total of 797 patients (mean age 76.8 years; 55.8% women) had wet age-related macular degeneration (AMD). Strong correlations between the MacDQoL items (r > 0.48) and factor loadings > 0.49 on a forced one-factor analysis supported the use of an average weighted impact score. Four constructs (Cronbach alpha > 0.8) were derived, represented by the labels: Essential tasks, Family/social life, Activities/capabilities, and Embarrassment. The structure did not differ among the four countries involved, except one item (Finance), which has been excluded. Patients with BE VA <10/20 and WE VA <10/100 produced significantly worse overall scores than those with BE VA >10/20 and WE VA >10/100 (MacDQoL P < 0.0001; NEI-VFQ-25 P < 0.0001).

CONCLUSIONS

The analysis confirmed the metric properties of the MacDQoL. The MacDQoL offers a broad individualized measure of the impact of MD on quality of life.

The eye amputated - consequences of eye amputation with emphasis on clinical aspects, phantom eye syndrome and quality of life

In this thesis the term eye amputation (EA) covers the removing of an eye by: evisceration, enucleation and exenteration. Amputation of an eye is most frequently the end-stage in a complicated disease, or the primary treatment in trauma and neoplasm. In 2010 the literature is extensive due to knowledge about types of surgery, implants and surgical technique. However, not much is known about the time past surgery.

THE PURPOSE OF THE PHD THESIS WAS

To identify the number of EA, the causative diagnosis and the indication for surgical removal of the eye, the chosen surgical technique and to evaluate a possible change in surgical technique in Denmark from 1996 until 2003 (paper I); To describe the phantom eye syndrome and its prevalence of visual hallucinations, phantom pain and phantom sensations (paper II); To characterise the quality of phantom eye pain, including its intensity and frequency among EA patients. We attempted to identify patients with increased risk of developing pain after EA and investigated if preoperative pain is a risk factor for a later development of phantom pain (paper III); In addition we wanted to investigate the health related quality of life, perceived stress, self rated health, job separation due to illness or disability and socio-economic position of the EA in comparison with the general Danish population (paper IV).

THE STUDIES WERE BASED ON

Records on 431 EA patients, clinical ophthalmological examination and an interview study of 173 EA patients and a questionnaire answered by 120 EA patients.

CONCLUSIONS

The most frequent indications for EA in Denmark were painful blind eye (37%) and neoplasm (34%). During the study period 1996-2003, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most frequent triggers were darkness, closing of the eyes, fatigue and psychological stress. Fifty-four percent of the patients had visual hallucinations more than once a week. Ten patients were so visually disturbed that it interfered with their daily life. Approximately 23% of all EA experience phantom pain for several years after the surgery. Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive (n=19); (ii) radiating, zapping or shooting (n=8); (iii) superficial burning or stinging (n=5); or a mixture of these different pain qualities (n=7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 [range: 1-89]. One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Factors associated with phantom pain were: ophthalmic pain before EA, the presence of implant and a patient reported high degree of conjunctival secretion. A common reason for EA is the presence of a painful blind eye. However, one third of these patients continue to have pain after the EA. Phantom sensations were present in 2% of the patients. The impact of an eye amputation is considerable. EA patients have poorer health related quality of life, poorer self-rated health and more perceived stress than does the general population. The largest differences in health related quality of life between the EA patients and the general population were related to role limitations due to emotional problems and mental health. Patients with the indication painful blind eye are having lower scores in all aspects of health related quality of life and perceived stress than patients with the indication neoplasm and trauma. The percentage of eye amputated which is divorced or separated was twice as high as in the general population. Furthermore, 25% retired or changed to part-time jobs due to eye disease and 39.5% stopped participating in leisure activities due to their EAs.