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Novack GD, Robin AL. Ocular Pharmacology. J Clin Pharmacol 2024. [PMID: 38708561 DOI: 10.1002/jcph.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
Treatment of ocular diseases presents unique challenges and opportunities for the clinician and for the clinical pharmacologist. Ophthalmic pharmaceuticals, typically given as liquids, require consideration of solubility, physiological pH, and osmolarity, as well as sterility and stability, which in turn requires optimal pharmaceutics. Ocular tissue levels are challenging to obtain in humans, and the clinical pharmacokinetics is typically blood levels, which are primarily related to safety, rather than efficacy. The eye is a closed compartment with multiple physiological barriers with esterases and transporters, but relatively little cytochrome oxidases. Delivery routes include topical, intravitreal, and systemic. Patient dosing involves not only adherence issues common to all chronic diseases, but also performance requirements on eye drop instillation. Therapeutically, ocular diseases and their pharmacological treatments include both those analogous to systemic diseases (e.g., inflammation, infection, and neuronal degeneration) and those unique to the eye (e.g., cataract and myopia).
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Affiliation(s)
- Gary D Novack
- PharmaLogic Development, Inc., San Rafael, CA, USA
- Department of Ophthalmology and Vision Science, School of Medicine, University of California, Davis, CA, USA
| | - Alan L Robin
- Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
- Department of Ophthalmology, School of Medicine Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of International Health, Johns Hopkins University, Baltimore, MD, USA
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2
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Boey D, Tse T, Fitzmaurice K, Chan ML, Carey LM. Assessing Older Adults' Functional Visual Performance Using the Performance Quality Rating Scale. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023:15394492231220256. [PMID: 38159265 DOI: 10.1177/15394492231220256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Visual impairment has distinct impacts on the activities of older adults. Quantifying the functional impact of visual loss would facilitate targeted rehabilitation. The objectives of this study were to: (1) develop an observational assessment of the functional visual performance of older adults using the Performance Quality Rating Scale (PQRS); (2) test the feasibility and inter-rater agreement in a pilot sample of older adults with visual impairment. A convenience sample of older adults with vision loss (N = 20) performed seven pre-selected activities. Performance was videoed (N = 126 videos) and rated by two raters using specific operational definitions. All participants completed the seven activities with the given resources and 90% of videos were successfully rated using the developed PQRS. Inter-rater agreement was substantial (weighted Kappa = 0.71; 95% confidence interval [CI] = [0.64, 0.79]) for all activities. The developed PQRS for functional vision is feasible, with substantial inter-rater agreement, to assess functional vision of older adults in an outpatient setting.
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Affiliation(s)
- Debbie Boey
- La Trobe University, Melbourne, Victoria, Australia
- Tan Tock Seng Hospital, Singapore
| | - Tamara Tse
- La Trobe University, Melbourne, Victoria, Australia
| | | | | | - Leeanne M Carey
- La Trobe University, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
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Delavar A, Bu JJ, Radha Saseendrakumar B, Weinreb RN, Baxter SL. Gender Disparities in Depression, Stress, and Social Support Among Glaucoma Patients. Transl Vis Sci Technol 2023; 12:23. [PMID: 38149963 PMCID: PMC10755593 DOI: 10.1167/tvst.12.12.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose To understand differences in measures of depression, stress, and social support by gender among those diagnosed with glaucoma. Methods We obtained a cohort of glaucoma patients (any type) ages 18 years and over who answered the COVID-19 Participant Experience (COPE) survey of the NIH All of Us Research Program. We analyzed several measures of depression, stress, and social support by gender. Logistic regression was used to evaluate the association among reported stress associated with social distancing, depression (using Patient Health Questionnaire-9 [PHQ-9] scores), and measures of social support by self-reported gender, with men as the reference group. Multivariable models were adjusted for age, race and ethnicity, health insurance status, education, and income. Results Of 3633 glaucoma patients, 56.8% were women. Many patients had a PHQ-9 score > 4 (33.3%), indicating mild, moderate, or severe depression. In multivariable models, women were significantly more likely to report a PHQ-9 score > 4 (odds ratio [OR] = 1.40; 95% confidence interval [CI], 1.20-1.62; P < 0.001) and some or a lot of stress (OR = 1.34; 95% CI, 1.14-1.57; P < 0.001) compared with men. Further, women were significantly less likely to report having help all or most of the time if they needed someone to prepare meals (OR = 0.78; 95% CI, 0.67-0.92; P = 0.002) or perform daily chores (OR = 0.79; 95% CI, 0.67-0.91; P = 0.003) than men. Conclusions Women with glaucoma were more likely to experience depression and stress and were less likely to have social support on some measures than men. Translational Relevance The disproportionate burden of psychosocial factors among women may complicate glaucoma management.
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Affiliation(s)
- Arash Delavar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer J. Bu
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Bharanidharan Radha Saseendrakumar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Robert N. Weinreb
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
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Miller A, Macnaughton J, Crossland MD, Latham K. "I'm like something out of star wars": a qualitative investigation of the views of people with age-related macular degeneration regarding wearable electronic vision enhancement systems. Disabil Rehabil 2023:1-10. [PMID: 37933205 DOI: 10.1080/09638288.2023.2278179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/28/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE This study explores the initial views of people with age-related macular degeneration towards wearable electronic vision enhancement systems. METHODS Ten adults with age-related macular degeneration participated in semi-structured interviews, which were analysed using reflexive thematic analysis. RESULTS Four themes were identified. Firstly, participants spoke of the wide-ranging impact of sight loss and how current helpful coping strategies still had significant limitations, affecting their desire to seek new solutions. The second theme showed that "other people" offered welcomed support with existing electronic coping solutions and are needed to provide suitable advice and training. However, "other people" limited the acceptability of using new solutions in public places. The third theme captured participants' desire for a wearable aid providing image magnification and enhancement over a range of distances. The final theme covered the reality of some current wearable technology, perceived as heavy, enclosing, or strange in appearance. Appearance caused some to lose interest in use, although others reframed the devices' desired usefulness to solo and sedentary activities. CONCLUSION This population are interested in the potential benefits of wearable electronic vision enhancement systems. More work is needed to understand the suitability of current solutions due to participant concerns about training, appearance and performance.
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Affiliation(s)
- Andrew Miller
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Jane Macnaughton
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Michael D Crossland
- NIHR Moorfields Biomedical Research Centre and UCL Institute of Ophthalmology, London, UK
| | - Keziah Latham
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
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Deemer AD, Goldstein JE, Ramulu PY. Approaching rehabilitation in patients with advanced glaucoma. Eye (Lond) 2023; 37:1993-2006. [PMID: 36526861 PMCID: PMC10333291 DOI: 10.1038/s41433-022-02303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 12/23/2022] Open
Abstract
Vision loss from advanced glaucoma is currently irreversible and impairs functional visual ability to effectively perform everyday tasks in a number of distinct functional domains. Vision rehabilitation strategies have been demonstrated to be effective in low vision populations and should be utilized in persons with advanced glaucoma to reduce disability and improve quality of life. Initial challenges to rehabilitation include an incomplete understanding of vision rehabilitation by the physician and patient, motivation to integrate rehabilitation into the plan of care, and availability of suitable providers to deliver this care. Physicians, working with well-trained vision rehabilitation providers can maximize function in important visual domains customized to the patient based on their needs, specific complaints, severity/pattern of visual damage, and comorbidities. Potential rehabilitative strategies to be considered for reading impairment include spectacle correction, visual assistive equipment, and sensory substitution, while potential strategies to facilitate driving in those deemed safe to do so include refractive correction, lens design, building confidence, restriction of driving to safer conditions, and avoiding situations where cognitive load is high. Mobility is frequently disrupted in advanced glaucoma, and can be addressed through careful distance refraction, behavior modification, home modification, mobility aids, walking assistance (i.e., sighted guide techniques), and smartphone/wearable technologies. Visual motor complaints are best addressed through optimization of lighting/contrast, sensory substitution, IADL training, and education. Special rehabilitative concerns may arise in children, where plans must be coordinated with schools, and working adults, where patients should be aware of their rights to accommodations to facilitate specific job tasks.
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Affiliation(s)
- Ashley D Deemer
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Judith E Goldstein
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pradeep Y Ramulu
- Dana Center for Preventative Ophthalmology; Glaucoma Division, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Miller A, Crossland MD, Macnaughton J, Latham K. Are wearable electronic vision enhancement systems (wEVES) beneficial for people with age-related macular degeneration? A scoping review. Ophthalmic Physiol Opt 2023. [PMID: 36876427 DOI: 10.1111/opo.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the United Kingdom. It has a wide-ranging detrimental impact on daily living, including impairment of functional ability and quality of life. Assistive technology designed to overcome this impairment includes wearable electronic vision enhancement systems (wEVES). This scoping review assesses the usefulness of these systems for people with AMD. METHODS Four databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science and Cochrane CENTRAL) were searched to identify papers that investigated image enhancement with a head-mounted electronic device on a sample population that included people with AMD. RESULTS Thirty-two papers were included: 18 studied the clinical and functional benefits of wEVES, 11 investigated use and usability and 3 discussed sickness and adverse effects. CONCLUSIONS Wearable electronic vision enhancement systems provide hands-free magnification and image enhancement producing significant improvements in acuity, contrast sensitivity and aspects of laboratory-simulated daily activity. Adverse effects were infrequent, minor and spontaneously resolved with the removal of the device. However, when symptoms arose, they sometimes persisted with continued device usage. There are multi-factorial influences and a diversity of user opinions on promotors to successful device use. These factors are not exclusively driven by visual improvement and incorporate other issues including device weight, ease of use and inconspicuous design. There is insufficient evidence of any cost-benefit analysis for wEVES. However, it has been shown that a user's decision to make a purchase evolves over time, with their estimates of cost falling below the retail price of the devices. Additional research is needed to understand the specific and distinct benefits of wEVES for people with AMD. Further patient-centred research should assess the benefits of wEVES in user-led activities when directly compared with alternative coping strategies, allowing professionals and users to make better prescribing and purchasing decisions.
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Affiliation(s)
- Andrew Miller
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | | | - Jane Macnaughton
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Keziah Latham
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
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Delavar A, Bu JJ, Radha Saseendrakumar B, Weinreb RN, Baxter SL. Mental health and social support among glaucoma patients enrolled in the NIH All of Us COVID-19 Participant Experience (COPE) survey. BMC Ophthalmol 2023; 23:63. [PMID: 36782129 PMCID: PMC9923653 DOI: 10.1186/s12886-023-02771-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/04/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic created many challenges for our society. In this study, we explore how measures of mental health, coping strategies, and social support during the pandemic varied by glaucoma status. METHODS A cohort of patients aged 40 and over enrolled in the NIH All of Us Research Program, a nationwide longitudinal cohort, who answered the COVID-19 Participant Experience (COPE) survey was obtained. We analyzed several measures of mental health, coping strategies, and social support used during the early stages of the COVID-19 pandemic. Surveys were recurring and answered from May 2020 to February 2021. Demographics and the most recently answered survey responses were obtained and stratified by glaucoma status. Pearson's Chi-squared tests and multivariable logistic regressions adjusting for age, gender, race, ethnicity, and income were used to generate p-values, odds ratios (ORs) and 95% confidence intervals (CIs) between outcome measures and glaucoma status. RESULTS Of 42,484 patients who responded to All of Us COPE survey items, 2912 (6.9%) had a diagnosis of glaucoma. On Pearson's Chi-squared tests glaucoma patients were less likely to report drinking alcohol (P = 0.003), eating more food than usual (P = 0.004), and using marijuana (P = 0.006) to cope with social distancing than those without a diagnosis of glaucoma. Further, glaucoma patients had lower rates of probable mild, moderate, or severe depression as calculated by Patient Health Questionnaire-9 (PHQ-9) scores (P < 0.001) and had lower rates of reporting some or a lot of stress from social distancing (P < 0.001). However, glaucoma patients were less likely to report having someone to help prepare meals (P = 0.005) or help with daily chores (P = 0.003) if they became sick with COVID-19. In multivariable logistic regression analyses adjusting for confounding factors, no differences were found for measures of mental health or social support. CONCLUSIONS Glaucoma patients did not fare worse on many measures of mental health and coping strategies during the early stages of the COVID-19 pandemic compared those without glaucoma. However, a substantial proportion of glaucoma patients still endorsed stress, social isolation, and probable depression, representing challenges for disease management.
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Affiliation(s)
- Arash Delavar
- grid.266100.30000 0001 2107 4242Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive MC 0946, La Jolla, CA 92093 USA
| | - Jennifer J. Bu
- grid.266100.30000 0001 2107 4242Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive MC 0946, La Jolla, CA 92093 USA
| | - Bharanidharan Radha Saseendrakumar
- grid.266100.30000 0001 2107 4242Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive MC 0946, La Jolla, CA 92093 USA
| | - Robert N. Weinreb
- grid.266100.30000 0001 2107 4242Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA USA
| | - Sally L. Baxter
- grid.266100.30000 0001 2107 4242Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Drive MC 0946, La Jolla, CA 92093 USA
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Okrent Smolar AL, Gagrani M, Ghate D. Peripheral visual field loss and activities of daily living. Curr Opin Neurol 2023; 36:19-25. [PMID: 36409221 DOI: 10.1097/wco.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE OF REVIEW Peripheral visual field (VF) loss affects 13% of the population over 65. Its effect on activities of daily living and higher order visual processing is as important as it is inadequately understood. The purpose of this review is to summarize available literature on the impact of peripheral vision loss on driving, reading, face recognition, scene recognition and scene navigation. RECENT FINDINGS In this review, glaucoma and retrochiasmal cortical damage are utilized as examples of peripheral field loss which typically spare central vision and have patterns respecting the horizontal and vertical meridians, respectively. In both glaucoma and retrochiasmal damage, peripheral field loss causes driving difficulty - especially with lane maintenance - leading to driving cessation, loss of independence, and depression. Likewise, peripheral field loss can lead to slower reading speeds and decreased enjoyment from reading, and anxiety. In glaucoma and retrochiasmal field loss, face processing is impaired which impacts social functioning. Finally, scene recognition and navigation are also adversely affected, impacting wayfinding and hazard detection leading to decreased independence as well as more frequent injury. SUMMARY Peripheral VF loss is an under-recognized cause of patient distress and disability. All peripheral field loss is not the same, differential patterns of loss affect parameters of activities of daily living (ADL) and visual processing in particular ways. Future research should aim to further characterize patterns of deranged ADL and visual processing, their correlation with types of field loss, and associated mechanisms.
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Affiliation(s)
| | - Meghal Gagrani
- Department of Ophthalmology, University of Pittsburgh School of Medicine Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deepta Ghate
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
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Boey D, Fitzmaurice K, Tse T, Chan ML, Carey LM. Classifying Types of Visual Loss Linked With Function to Inform Referral to Vision Rehabilitation for Older Adults in Singapore. Gerontol Geriatr Med 2022; 8:23337214221130652. [PMID: 36275409 PMCID: PMC9580095 DOI: 10.1177/23337214221130652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/28/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: Visual impairment restricts performance in activities of daily living. The aim of this study was to classify types of visual loss associated with function in older adults based on clinical data and World Health Organization (WHO) acuity and visual field criteria. Methods: Seven hundred retrospective medical records of older adults seen at the outpatient ophthalmology clinics of a Singapore hospital were reviewed. Extracted data was mapped to the WHO low vision criteria. A flow chart was developed to classify the main types of visual loss aligned with function. Results: The flow chart developed describes four major types of visual loss: (1) full visual field with decreased visual acuity, (2) any visual field loss with greater than ten degrees of available field, (3) peripheral field loss with less than 10° of available field, and (4) any visual field loss due to a cortical event. Within each major type, sub-categories were identified reflecting the complexity of the visual impact of the eye conditions. Conclusion: The flow chart can be applied to outpatient records to identify older adults with different types of visual loss to inform targeted rehabilitation linked with function.
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Affiliation(s)
- Debbie Boey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia,Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore,Debbie Boey, Department of Occupational Therapy, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
| | - Kerry Fitzmaurice
- Orthoptics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Tamara Tse
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | | | - Leeanne M. Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia,Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Macnamara A, Coussens S, Chen C, Schinazi VR, Loetscher T. The psychological impact of instrumental activities of daily living on people with simulated age-related macular degeneration. BJPsych Open 2022; 8:e152. [PMID: 35938537 PMCID: PMC9380024 DOI: 10.1192/bjo.2022.558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with age-related macular degeneration (AMD) can report reduced mental health. There is also evidence that they struggle with daily tasks because of vision loss. AIMS The purpose of this study was to assess the psychological impact of instrumental activities of daily living on people with simulated AMD. METHOD Twenty-four normally sighted participants completed 12 household tasks, in a simulated home environment, under a moderate-to-severe AMD simulation. Participants' psychological state was measured through self-report questionnaires and physiological measurements related to anxiety and stress. Tasks were completed twice, under counterbalanced vision conditions (normal and simulated AMD). RESULTS Linear mixed models on vision condition (normal versus simulated AMD) and trial order (trial 1 versus trial 2) revealed a significant large negative effect of the AMD simulation on time to complete tasks, and the anxiety, task engagement and distress self-reports (all P < 0.024, all ω2 > 0.177). There were also significant medium-large effects of trial order on time, task incompletion, task errors, and the anxiety and task engagement self-reports (all P < 0.047, all ω2 > 0.130), whereby the results improved during the second attempt at the tasks. No physiological measures were significant (all P > 0.05). CONCLUSIONS Completing instrumental activities of daily living under an AMD simulation had a negative impact on participants' self-reported mental state. The observed trial order effects also illuminated how practice with tasks could ease anxiety and stress over time.
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Affiliation(s)
- Anne Macnamara
- Cognitive Ageing & Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Australia
| | - Scott Coussens
- Cognitive Ageing & Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Australia
| | - Victor R Schinazi
- Department of Psychology, Faculty of Society & Design, Bond University, Australia; and Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore
| | - Tobias Loetscher
- Cognitive Ageing & Impairment Neurosciences Laboratory, UniSA Justice & Society, University of South Australia, Australia
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11
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Wang Q, Zhang S, Wang Y, Zhao D, Chen X, Zhou C. The Effect of Dual Sensory Impairment and Multimorbidity Patterns on Functional Impairment: A Longitudinal Cohort of Middle-Aged and Older Adults in China. Front Aging Neurosci 2022; 14:807383. [PMID: 35462686 PMCID: PMC9028763 DOI: 10.3389/fnagi.2022.807383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/16/2022] [Indexed: 11/26/2022] Open
Abstract
Objective There is an urgent need to evaluate the contribution of several co-existing diseases on health. This study aims to explore the combined effect of dual sensory impairment (DSI) and multimorbidity patterns on functional impairment among middle-aged and older adults in China. Methods Data were from 10,217 adults aged 45 or older from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Sensory impairments were self-reported measures. Multimorbidity patterns were identified by using k-means cluster analyses. Functional impairment was defined using activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale. Generalized estimating equation models were estimated to assess the effect of co-occurring DSI and multimorbidity on functional impairment. Results DSI prevalence was 50.4%, and multimorbidity prevalence was 37.7% at the baseline. The simultaneous presence of DSI and multimorbidity was associated with increased odds of ADL limitations (OR = 2.27, 95% CI: 2.11–2.43) and IADL limitations (OR = 1.89, 95% CI: 1.77–2.02). Five multimorbidity patterns were identified: the cardio-cerebrovascular pattern, the stomach-arthritis pattern, the respiratory pattern, the hepatorenal pattern, and the unspecified pattern. Compared to DSI only, DSI plus the hepatorenal pattern was most strongly associated with functional impairment (for ADL: OR = 2.70, 95% CI: 2.34–3.12; for IADL: OR = 2.04, 95% CI: 1.77–2.36). Conclusion Middle-aged and older adults with co-occurrence of DSI and multimorbidity are at increased risk of functional impairment, especially those with multimorbidity characterized by the hepatorenal pattern. These findings imply that integrated care for DSI and multimorbidity may be a potent pathway in improving functional status.
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Affiliation(s)
- Qiong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Shimin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States
- Department of Economics, Yale University, New Haven, CT, United States
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- *Correspondence: Chengchao Zhou,
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Kee QT, Abd Rahman MH, Mohamad Fadzil N, Mohammed Z, Shahar S. The impact of near visual impairment on instrumental activities of daily living among community-dwelling older adults in Selangor. BMC Res Notes 2021; 14:395. [PMID: 34689826 PMCID: PMC8543948 DOI: 10.1186/s13104-021-05813-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Objective Near visual impairment (VI) is a common disability in an aging population. Near vision is crucial in activity of daily living including reading, smartphone and computer use and meal preparation. This study was conducted to determine the association between near visual acuity (VA) and contrast sensitivity (CS) with activity of daily living (ADL) among visually impaired older adults. Results A total of 208 participants aged ≥ 60 were recruited from the population-based longitudinal study on neuroprotective model for healthy longevity. Habitual near VA and CS were measured using Lighthouse near VA chart and Pelli-Robson CS chart, respectively. Lawton instrumental activities of daily living (IADL) was used to assess ADL. There are 41.8% participants with near visual impairment and 28.7% among them had IADL disability. Independent t test showed significant lower mean IADL score among visually impaired participants [t(206) = 2.03, p = 0.04]. IADL score significantly correlated with near VA (r = − 0.21, p = 0.05) but not with CS (r = − 0.14, p = 0.21). Near VA (B = − 0.44, p = 0.03) and age (B = − 0.07, p = 0.01) significantly predicted IADL. The findings show poorer VA renders higher IADL disability, which may necessitate interventions to improve ADL among visually impaired older adults.
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Affiliation(s)
- Qiu Ting Kee
- Optometry and Vision Sciences Programme, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan , Kuala Lumpur, Malaysia
| | - Mohd Harimi Abd Rahman
- Optometry and Vision Sciences Programme, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan , Kuala Lumpur, Malaysia.
| | - Norliza Mohamad Fadzil
- Optometry and Vision Sciences Programme, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan , Kuala Lumpur, Malaysia
| | - Zainora Mohammed
- Optometry and Vision Sciences Programme, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan , Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Programme, Center of Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Wilayah Persekutuan, Kuala Lumpur, Malaysia
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13
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Ramulu PY, Mihailovic A, E JY, Miller RB, West SK, Gitlin LN, Friedman DS. Environmental Features Contributing to Falls in Persons With Vision Impairment: The Role of Home Lighting and Home Hazards. Am J Ophthalmol 2021; 230:207-215. [PMID: 33951447 DOI: 10.1016/j.ajo.2021.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate whether home hazards and lighting levels are associated with higher fall rates in adults with varying degrees of visual field (VF) damage from glaucoma. METHODS Participants with diagnosed or suspected glaucoma provided three years of prospective falls data via monthly falls diaries. A post-fall telephone questionnaire determined fall locations. Seven home areas were evaluated for hazards and lighting via an in-home assessment. Multivariate models adjusting for relevant confounders, including age, sex, comorbidity, and severity of VF damage, evaluated the influence of hazards and lighting on fall rates in each home region. RESULTS Mean baseline age for the 170 participants was 71.0 (7.6) years and 78 (46%) of participants were female. Fifty-nine participants experienced a total of 83 home falls, with the greatest number of falls occurring on the indoor stairs (n = 24, 29%) and bedroom (n = 17, 21%). Neither the number nor the percentage of hazardous items graded as hazardous was associated with the rate of falls (P > .26). Each 10-fold increase in room lighting was associated with 35% fewer falls in that home region (P = .02). The relation between lighting and the rate of falls did not differ with the degree of visual field damage (P > .3), and a lower fall rate was noted with better lighting even in participants with mild or no VF damage (rate ratio = 0.52/10-fold better lighting; P = 0.01). CONCLUSIONS Fewer home falls were found with better lighting, but not with fewer home hazards. Lighting improvements at home may reduce fall rates in older adults. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
| | | | - Jian-Yu E
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rhonda B Miller
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - Laura N Gitlin
- Johns Hopkins School of Nursing, Baltimore, MD; College of Nursing and Health Professions, Drexel University, Philadelphia, PA
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD; Massachusetts Eye and Ear, Glaucoma Division, Boston, MA, USA
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14
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The link between vision impairment and depressive symptomatology in late life: does having a partner matter? Eur J Ageing 2021; 19:521-532. [PMID: 36052196 PMCID: PMC9424365 DOI: 10.1007/s10433-021-00653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 11/04/2022] Open
Abstract
Visual impairment contributes to poor mental health among older adults by restricting everyday functioning and participation. This study examined whether the negative link between vision impairment and depressive symptomatology was less severe among partnered than among single older adults. We merged data from a survey among people with vision impairment with a reference population from the most recent wave of the Danish Longitudinal Study of Ageing (DLSA) (N = 5831 Mage = 74.37, range: 65–97 years, 53.1% female), investigating whether paths from poor vision via three mediators—functional limitations, emotional support and participation in social activities—to depressive symptomatology differ by partnership status. Structural equation modeling suggested that the direct path from vision impairment to depressive symptomatology is more than twice as strong for single than for partnered older adults. Thus being partnered reduces the negative link from vision impairment to depressive symptomatology. However, the path from vision impairment to emotional support is significantly stronger among single than among partnered individuals. Thus negative spillover effects from the visual impairment on the non-impaired partner’s mental health may compromise that partner’s ability to provide emotional support. Taking into account both partnership status and the mental health of both partners may help professionals more precisely target interventions aimed at reducing the risk of depression in visually impaired older adults.
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15
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Boey D, Tse T, Lim YH, Chan ML, Fitzmaurice K, Carey L. The impact of low vision on activities, participation, and goals among older adults: a scoping review. Disabil Rehabil 2021; 44:5683-5707. [PMID: 34448416 DOI: 10.1080/09638288.2021.1937340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Participation is a key outcome of rehabilitation. However, no reviews have investigated the impact of low vision on the activities, participation, and goals of older adults. This paper aims to review and synthesize available literature on how low vision impacts the activity and participation of older adults. METHOD A scoping review was conducted. The key findings were extracted from 30 full-text articles that met the selection criteria. The International Classification of Functioning, Disability and Health was used to frame the findings at the activity and participation levels. RESULTS At the activity level, the categories of Walking, Moving around in different locations, and Reading were commonly impacted by low vision. The main domains impacted at the participation level were Community, social and civic life and Interpersonal interaction and relationships. Only one study addressed the goals of older adults with low vision. CONCLUSION Low vision impacts reading, walking, and moving around in different locations. Rehabilitation therapists should be aware of and consider assessing these activities. Further research is needed on the impact of low vision on other functional activities, participation, and self-identified goals of older adults to guide clinical practice.Implications for rehabilitationLow vision has an impact on the activity level of older adults, consistently identified in the areas of walking and moving around in different locations and reading for knowledge and leisure.At the participation level, the impact of low vision is less frequently identified compared to the areas identified at the activity level, in the areas of leisure, social interactions and basic and instrumental ADL.Rehabilitation therapists working with older adults with low vision should assess clients' performance of moving around in different locations, in addition to walking, and include screening questions on the impact of low vision on driving.Rehabilitation therapists working with older adults with low vision should determine clients' reading needs and acquire competence in assessing clients' reading ability and providing intervention for different types of reading to enable them to continue participating in various life situations that require the performance of reading.
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Affiliation(s)
- Debbie Boey
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore
| | - Tamara Tse
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Yi Hui Lim
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore
| | - Mei Leng Chan
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore
| | - Kerry Fitzmaurice
- Orthoptics, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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16
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Cao G, Wang K, Han L, Zhang Q, Yao S, Chen Z, Huang Z, Luo Y, Hu Y, Xu B. Visual trajectories and risk of physical and cognitive impairment among older Chinese adults. J Am Geriatr Soc 2021; 69:2877-2887. [PMID: 34111310 DOI: 10.1111/jgs.17311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES To identify visual trajectories and examine their relationships with physical and cognitive function in older Chinese adults. DESIGN Population-based longitudinal study. SETTING The Chinese Longitudinal Healthy Longevity Survey. PARTICIPANTS A total of 16,151 participants aged ≥65 years. MEASUREMENTS Visual, physical (including activities of daily living [ADL] and instrumental ADL [IADL]), and cognitive function were assessed at baseline and subsequently every 3 years. ADI disability and IADL disability were defined as needing any help in any item of the Katz scale and a modified Lawton's scale, respectively. Cognitive impairment was defined as a Chinese version of the Mini-Mental State Examination score below 24. A group-based trajectory model was used to determine visual trajectories adjusted for age, sex, and education. Associations of visual trajectories with ADL disability, IADL disability, and cognitive impairment were evaluated using generalized estimating equation models adjusted for potential confounders. RESULTS This study identified three distinct visual trajectories, including no decline (32.4%), moderate decline (48.3%), and progressive decline (19.3%) during the follow-up period. Compared with the no decline trajectory, both the moderate decline (ADL disability: OR = 2.75, 95% CI: 2.30-3.28; IADL disability: OR = 3.01, 95% CI: 2.74-3.31; cognitive impairment: OR = 3.37, 95% CI: 3.02-3.76) and the progressive decline (ADL disability: OR = 8.50, 95% CI: 6.55-11.02; IADL disability: OR = 12.96, 95% CI: 9.95-16.87; cognitive impairment: OR = 10.84, 95% CI: 8.89-13.23) trajectories were significantly associated with an increased risk of functional impairment. Compared with the moderate decline trajectory, the progressive decline trajectory was significantly associated with an increased risk of ADL disability (OR = 3.09, 95% CI: 2.46-3.89), IADL disability (OR = 4.30, 95% CI: 3.29-5.61), and cognitive impairment (OR = 3.22, 95% CI:2.63-3.93). CONCLUSION Older Chinese adults exhibit three distinct visual trajectories and those with decline trajectories in vision have an increased risk of functional impairment than those with a trajectory of no decline in vision.
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Affiliation(s)
- Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Qin Zhang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China.,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Shanshan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zishuo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Ziting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, China
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17
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Anstice NS, Thompson B. The measurement of visual acuity in children: an evidence‐based update. Clin Exp Optom 2021; 97:3-11. [DOI: 10.1111/cxo.12086] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/02/2013] [Accepted: 04/16/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nicola S Anstice
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand,
| | - Benjamin Thompson
- Department of Optometry and Vision Science, University of Auckland, Auckland, New Zealand,
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18
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Swenor BK, Lee MJ, Varadaraj V, Whitson HE, Ramulu PY. Aging With Vision Loss: A Framework for Assessing the Impact of Visual Impairment on Older Adults. THE GERONTOLOGIST 2021; 60:989-995. [PMID: 31504483 DOI: 10.1093/geront/gnz117] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 12/26/2022] Open
Abstract
There is limited research examining the impact of visual impairment (VI) on older adults while considering the complexities of aging, leaving gaps in our understanding of how health consequences of VI might be averted. We created a framework integrating concepts from disability, geriatrics, and ophthalmology that conceptualizes how VI challenges successful aging. Here, VI influences multiple functional domains, and increases the risk of negative health outcomes. This model acknowledges that common causes, such as risk factors that affect eyes and other systems simultaneously, may also drive the relationship between VI and health outcomes. Finally, the model highlights how the impact of VI on aging outcomes can be addressed at multiple intervention points.
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Affiliation(s)
- Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
| | - Moon J Lee
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
| | - Varshini Varadaraj
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
| | - Heather E Whitson
- Department of Medicine (Geriatrics), Duke University Medical Center, Durham, North Carolina.,Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.,Duke Aging Center, Duke University Medical Center, Durham, North Carolina.,Geriatrics Research, Education and Clinical Center, Durham VA Medical Center, North Carolina
| | - Pradeep Y Ramulu
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
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Abstract
SIGNIFICANCE Lighting assessments are an important component of low-vision rehabilitation but are rarely studied systematically. Our study indicates that preferred lighting levels support improvements in reading ease and enjoyment, independently of the evaluation technique. To determine preferred illumination level and color temperature, the LuxIQ is quicker to administer and covers broad options of settings. PURPOSE The purpose of this study was to determine if preferred lighting, as assessed by the LuxIQ versus a standard lighting assessment, leads to better reading outcomes in individuals with low vision. METHODS Preferred lighting was assessed at home with visually impaired persons (mean age, 75.3 years), using the LuxIQ (n = 18) or a standard technique based on trying out light bulbs of various intensity and color temperature (n = 16). Maximum reading speed and reading acuity were measured before the lighting intervention and then under the preferred lighting conditions. A 1-month telephone follow-up evaluated the (1) compliance with the lighting recommendations and, for those who modified their lighting, (2) their level of satisfaction with the length of reading time and eye strain felt during reading. RESULTS Compared with usual lighting conditions, most participants preferred a cooler temperature at a higher illuminance level. Neither lighting assessment type appeared to lead to substantially improved objectively measurable reading outcomes. At the 1-month follow-up, 56% of the participants had modified their lighting, having a significant effect on satisfaction (P < .01), independent of assessment method. Of 18 respondents, 16 (87.5%) mentioned that reading was more enjoyable or easier with the lighting modifications. CONCLUSIONS Both lighting assessment methods lead to comparable results, but the LuxIQ is easier and faster to use. More research is needed to determine whether the LuxIQ is suitable to be incorporated into clinical practice.
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20
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Almajid R, Tucker C, Keshner E, Vasudevan E, Wright WG. Effects of wearing a head-mounted display during a standard clinical test of dynamic balance. Gait Posture 2021; 85:78-83. [PMID: 33517040 DOI: 10.1016/j.gaitpost.2021.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 10/24/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of virtual reality (VR) in clinical settings has increased with the introduction of affordable, easy-to-use head-mounted displays (HMDs). However, some have raised concerns about the effects that HMDs have on posture and locomotion, even without the projection of a virtual scene, which may be different across ages. RESEARCH QUESTION How does HMD wear impact the kinematic measures in younger and older adults? METHODS Twelve healthy young and sixteen older adults participated in two testing conditions: 1) TUG with no HMD and 2) TUG with an HMD displaying a scene of the actual environment (TUGHMD). The dependent variables were the pitch, yaw, and roll peak trunk velocities (PTVs) in each TUG component, turning cadence, and the time to complete the TUG and its components - SIT-TO-STAND, TURN, WALK, and STAND-TO-SIT. RESULTS Wearing the HMD decreased turning cadence and pitch and yaw PTVs in all TUG components, decreased roll PTV in SIT-TO-STAND and TURN, and increased the time taken to complete all TUG components in all participants. Wearing the HMD decreased the pitch PTV in SIT-TO-STAND in older relative to younger adults. Wearing an HMD affected TUG performance in younger and older adults, which should be considered when an HMD is used for VR applications in rehabilitation. SIGNIFICANCE Our findings highlight the importance of considering the physical effect of HMD wear in clinical testing, which may not be present with non-wearable VR technologies.
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Affiliation(s)
- Rania Almajid
- Department of Physical Therapy, West Coast University, 590 N Vssermont Ave, Los Angeles, CA, 90004, USA; Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - Carole Tucker
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - Emily Keshner
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - Erin Vasudevan
- Department of Health and Rehabilitation Sciences, School of Health Technology and Management, Stony Brook University, 101 Nicolls Road, Health Sciences Center, Stony Brook, 11794, USA.
| | - William Geoffrey Wright
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA; Department of Bioengineering, Temple University 1801 N Broad St., Philadelphia, PA, 19122, USA.
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21
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Odden JL, Mihailovic A, Boland MV, Friedman DS, West SK, Ramulu PY. Assessing Functional Disability in Glaucoma: The Relative Importance of Central Versus Far Peripheral Visual Fields. Invest Ophthalmol Vis Sci 2020; 61:23. [PMID: 33201185 PMCID: PMC7683851 DOI: 10.1167/iovs.61.13.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose To evaluate the importance of central versus far peripheral visual field (VF) loss in assessing disability in glaucoma. Methods In total, 231 patients with glaucoma or suspected glaucoma completed 24-2 VF testing and automated peripheral VFs using the suprathreshold 30- to 60-degree pattern. Questionnaires assessed fear of falling (FoF), quality of life (QOL), instrumental activities of daily living (IADLs), and driving habits; nonsedentary time, reading speed, and gait were objectively measured. Multivariable regression models analyzed the effect of central VF and/or peripheral VF damage on each outcome. Results In models including both central and peripheral VF damage (independent effects), greater central, but not peripheral, VF damage was associated with greater FoF, worse QOL, fewer daily steps, and difficulty with IADLs (P < 0.02 for central; P > 0.5 for peripheral). For gait measures, greater peripheral, but not central, damage was associated with shorter steps and shorter strides, as well as greater variability in step length (P < 0.03 for peripheral; P > 0.14 for central). Model R2 values were not substantially higher (less than 5% additional explained variability) for models including both central and peripheral VF damage as compared to the best models incorporating only one region of VF damage (i.e., central or peripheral). Conclusions The relative importance of central 24 degrees versus more peripheral VF damage differs across functional domains in patients with glaucoma. Central damage is more strongly associated with most disability outcomes, although peripheral damage is more associated with specific gait measures. Studies examining the relative importance of various VF regions should assess functional domain separately and eschew integrated measures of quality of life/activity limitation.
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Affiliation(s)
- Jamie L Odden
- Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Aleksandra Mihailovic
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States.,Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Michael V Boland
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States
| | - David S Friedman
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States.,Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sheila K West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States.,Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States.,Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States
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22
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Does functional assessment predict everyday visual functioning? Visual function testing and quality of life in mild/moderate age-related macular degeneration. Int Ophthalmol 2020; 40:3241-3249. [PMID: 32666168 DOI: 10.1007/s10792-020-01508-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To prospectively assess correlations between self-reported vision-related quality of life (VR-QoL) and clinical functional assessments in mild/moderate age-related macular degeneration (AMD). METHODS Cross-sectional analysis of 64 participants with bilateral mild/moderate AMD. Microperimetry (MP), flicker perimetry (FP), multifocal electroretinogram (mfERG) findings, best-corrected visual acuity (BCVA) and the National Eye Institute Visual-Function Questionnaire-25 (NEI VFQ-25) were assessed for correlation between clinical testing results and NEI VFQ-25 findings. RESULTS MP findings in the better eye were weakly correlated with NEI VFQ-25 subscales for colour, general, near and distance vision (p < 0.05 and R2 < 0.3 for all). FP findings and mfERG response density were not correlated with any subscale, apart from mfERG ring 1 response density and general health (p < 0.05, R2 = 0.41). mfERG latency was weakly correlated with general vision in the better eye in rings 2 and 4 (p < 0.05, R2 < 0.2). CONCLUSION Functional assessment in mild/moderate AMD is at best, weakly correlated with patient-reported VR-QoL. Despite the growing awareness of the importance of VR-QoL outcomes in improving patient outcomes and satisfaction, surrogate markers of these outcomes remain elusive, and testing of VR-QoL in regular clinical settings remains difficult.
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Friedman DS, Ramulu PY. The Potential for Worse Outcomes of Visual Impairment in Those With Dementia. JAMA Ophthalmol 2020; 138:763-764. [DOI: 10.1001/jamaophthalmol.2020.1560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David S. Friedman
- Massachusetts Eye and Ear Glaucoma Center of Excellence, Harvard University, Boston, Massachusetts
| | - Pradeep Y. Ramulu
- Wilmer Eye Institute Glaucoma Center of Excellence, Johns Hopkins University, Baltimore, Maryland
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Mokhles P, van Gorcom L, Schouten JSAG, Berendschot TTJM, Beckers HJM, Webers CAB. Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients, ocular hypertension and glaucoma suspect patients. Eye (Lond) 2020; 35:883-891. [PMID: 32494040 DOI: 10.1038/s41433-020-0991-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 01/27/2023] Open
Abstract
AIM To assess the visual acuity at the end of life in glaucoma suspect patients, ocular hypertension, and patients treated for glaucoma and to find factors contributing to a reduced visual acuity in this cohort of deceased patients. METHODS In a cohort of 3883 medically treated glaucoma patients, glaucoma suspect, or patients with ocular hypertension assembled in 2001-2004, 1639 were deceased. Patient data were collected from electronic and paper patient files. The files of 1378 patients were studied and the last measured visual acuity and ocular comorbidities influencing the visual acuity were extracted. RESULTS Our results show that only 37.2% of patients had no visual impairment in either eye, 30.5% was visually impaired or blind in both eyes and 4.1% was blind in both eyes, all based on VA. The most common contributing factors for severe visual impairment or blindness (prevalence ≥ 1%) were: glaucoma, retinal vein occlusion, dry and exudative age-related macular degeneration, past retinal detachment, amblyopia, diabetic retinopathy, anterior ischemic optic neuropathy, trauma, decompensated cornea, past keratitis, enucleation, corneal transplantation, and macular hole. CONCLUSIONS Despite the current advanced treatment modalities for glaucoma, 30.5% of patients had a VA < 0.5 in both eyes and 4.1% was blind in both eyes. However, this disability cannot be confidently attributed only to glaucoma. Besides glaucoma, most common contributing factors were among others retinal and macular diseases. Patient management in glaucoma should be based on more than lowering the intraocular pressure to prevent blindness at the end of life.
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Affiliation(s)
| | - Luuk van Gorcom
- University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Jan S A G Schouten
- University Eye Clinic Maastricht, Maastricht, The Netherlands.,Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
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Cooper OAE, Taylor DJ, Crabb DP, Sim DA, McBain H. Psychological, social and everyday visual impact of diabetic macular oedema and diabetic retinopathy: a systematic review. Diabet Med 2020; 37:924-933. [PMID: 31479552 DOI: 10.1111/dme.14125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 01/11/2023]
Abstract
AIMS To synthesize the evidence on the impact of diabetic retinopathy and diabetic macular oedema from the patient perspective. METHODS A systematic literature review was conducted using MEDLINE Complete, PsycINFO, EMBASE and AMED. We included articles investigating the impact of the condition on quality of life, symptoms, visual functioning, activities of daily living, well-being, social functioning, and financial status. The studies evaluated were observational, including cross-sectional, prospective cohort and retrospective cohort designs. Outcome data were extracted and synthesized. RESULTS Searches yielded 5114 publications. After screening, 85 studies were included, measuring the following outcomes: visual functioning (n=46); quality of life (n=22); well-being (n=16); functional status (n=5); work (n=4); and visual task performance (n=2). Diabetic retinopathy has a considerable impact on visual functioning and this is greater in people with greater disease severity. Diabetic retinopathy significantly limits activities including working, driving, walking and reading, and has the potential to have a negative impact on psychological well-being. CONCLUSIONS Diabetic retinopathy is associated with poor self-reported visual functioning, well-being, and health-related quality of life. Ability to perform basic everyday tasks appears to diminish with disease severity. Some studies suggest impaired mobility and problems with work, but there are gaps in this evidence.
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Affiliation(s)
- O A E Cooper
- School of Health Sciences, City, University of London, London, UK
| | - D J Taylor
- School of Health Sciences, City, University of London, London, UK
| | - D P Crabb
- School of Health Sciences, City, University of London, London, UK
| | - D A Sim
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - H McBain
- School of Health Sciences, City, University of London, London, UK
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Park S, Smith J, Dunkle RE, Ingersoll-Dayton B, Antonucci TC. Health and Social-Physical Environment Profiles Among Older Adults Living Alone: Associations With Depressive Symptoms. J Gerontol B Psychol Sci Soc Sci 2020. [PMID: 28637214 DOI: 10.1093/geronb/gbx003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES We examined differences in depressive symptoms among people 65 and older who live alone, exploring whether these differences are associated with both health and environmental contexts. METHOD Data are from the 2006 wave of Health Retirement Study (N = 2,956, age range: 65-104). We used a two-step cluster analytical approach to identify subgroups of health-limitation profiles and environmental profiles. Logistic regression models determined associations between subgroups and depressive symptoms. RESULTS Cluster analysis identified four health-profile subgroups (sensory-cognitively impaired, physically impaired, multiply impaired, and healthy) and three different physical-social environmental-profile subgroups (physically average/socially unsupported, physically unsupported/socially supported, and physically supported/socially above average). Compared to members of healthier groups, members of the multiply impaired group were the oldest and were more likely both to live in senior housing and to have depressive symptoms if they lived in a physically average/socially unsupported environment. Members of the sensory-cognitively impaired group were more likely to have depressive symptoms when they lived in a physically unsupported/socially supported environment. DISCUSSION Findings regarding the range of both health and social-physical environmental profiles as well as the associations between person-environment profiles combinations (fit) and depressive symptomatology have important policy and intervention implications.
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Affiliation(s)
- Sojung Park
- Brown School of Social Work, Washington University in Saint Louis, Missouri
| | - Jacqui Smith
- Department of Psychology and Institute for Social Research, Ann Arbor
| | - Ruth E Dunkle
- School of Social Work, University of Michigan, Ann Arbor
| | | | - Toni C Antonucci
- Department of Psychology and Institute for Social Research, Ann Arbor
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Eye Examination Recency among African American Older Adults with Chronic Medical Conditions. Healthcare (Basel) 2020; 8:healthcare8020094. [PMID: 32290596 PMCID: PMC7348871 DOI: 10.3390/healthcare8020094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Pervasive racial and economic inequalities have a disproportionate impact on health care utilization among African Americans. One area where we see such disparities is in the recency of eye examinations among the economically disadvantaged. However, our current understanding of the barriers and facilitators of eye examinations in underserved African-American older adults is limited. Aims: Building on Andersen’s model of health service use and using an exploratory approach; we tested various demographic, social, and health factors that were associated with eye examination among underserved middle-aged and older adults in South Los Angeles. We examined predisposing characteristics, enabling factors, and need-for-care characteristics. Methods: With a cross-sectional design, we conducted this survey on a convenience sample of (n = 740) non-institutionalized African-American older adults who were 55+ years old and residing in South Los Angeles, CA, USA. Data were collected on demographic factors, continuity of care, access to care, self-rated health, chronic medical conditions, and depressive symptoms. The outcome was recency of eye examination. Multivariate regression was used for data analysis. Results: 59% of the participants had received at least one eye examination during the last 12 months. A total of 17% had an eye examination within the last two years. Notably, 26% of diabetic participants did not have an eye examination within the last two years. One out of four participants indicated that, within the last two years, no provider ever recommended that they receive an eye examination. Age, education, continuity of medical care, accessibility of medical care, satisfaction with medical care, providers’ recommendation for eye examination, self-rated health, and a diagnosis of hypertension and diabetes mellitus were predictors of eye examination recency. Overall, our analysis indicates that these enabling factors accounted for most of the variance in the recency of eye examinations. Conclusion: A large proportion of underserved African-American middle-aged and older adults in South Los Angeles do not comply with the recommended annual eye examination. This is, in part, because about one-third of them have not received an eye exam recommendation from their health care providers. However, a wide range of factors such as age, education, continuity of care, satisfaction with access, self-rated health, and a diagnosis of hypertension and diabetes mellitus, also influence whether or not African-American middle-aged and older adults receive an eye examination. Programs should address a wide range of multi-level factors to tackle this health inequality.
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Boureau AS, Masse H, Chapelet G, de Decker L, Chevalet P, Pichierri S, Weber M, Berrut G. Tele-ophthalmology for screening for eye diseases in older patients with cognitive complaints. J Telemed Telecare 2020; 27:493-500. [PMID: 31896286 DOI: 10.1177/1357633x19893883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Population-based studies show a significant increase in the prevalence of visual impairment in older patients. However, older patients and patients with lower Mini-Mental State Examination (MMSE) scores have few ophthalmological assessments. The main objective of our study was to evaluate the feasibility of tele-ophthalmological screening for ophthalmological diseases in older patients referred for cognitive assessment. METHODS This monocentric prospective study included patients referred to a memory clinic for cognitive assessment. All patients underwent a geriatric assessment comprising a cognitive assessment associated with tele-ophthalmological screening undertaken by an orthoptist, including undilated retinal photography. The retinal photographs were subsequently sent to an ophthalmologist. We identified patients who were not eligible for ophthalmological assessment, for patients that had to come back due to poor-quality retinal photographs and finally for detected eye diseases. The association between the geriatric variable and newly detected eye diseases was analysed in univariable and multivariable analyses. RESULTS The mean age of the 298 patients included was 83.5 years ± 5.65; 29.5% were male. The mean MMSE score was 20.8 ± 5.2; 66.3% of patients had a diagnosis of dementia. Eighteen patients (6.0%) were not eligible for ophthalmological examination and 13 patients (4.6%) were asked to come back owing to poor-quality retinal photographs. Forty-one patients (13.7%) had a newly detected eye disease. In multivariable analysis, patients with a lower MMSE had significantly more newly identified eye diseases. DISCUSSION The tele-ophthalmological screening method identified unknown ophthalmological diseases requiring specialised management in this older population with cognitive complaints.
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Affiliation(s)
- Anne-Sophie Boureau
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France.,L'Institut du Thorax, Université de Nantes, France
| | - Helene Masse
- Department of Ophthalmology, CHU de Nantes, Université de Nantes, France
| | | | - Laure de Decker
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Pascal Chevalet
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Sophie Pichierri
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
| | - Michel Weber
- Department of Ophthalmology, CHU de Nantes, Université de Nantes, France
| | - Gilles Berrut
- Department of Geriatrics, CHU de Nantes, Université de Nantes, France
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Dubey S, Bedi H, Bedi M, Matah P, Sahu J, Mukherjee S, Chauhan L. Impact of Visual Impairment on the Wellbeing and Functional Disability of Patients with Glaucoma in India. J Curr Ophthalmol 2020; 32:14-18. [PMID: 32510008 PMCID: PMC7265270 DOI: 10.1016/j.joco.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 09/11/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022] Open
Abstract
Purpose: To investigate the impact of glaucoma-associated vision loss on quality of life and social functioning in Indians. Methods: A cross-sectional study with prospective enrollment was conducted. Participants were divided as: mild, moderate, and severe. Severity of glaucoma was stratified by the degree of binocular visual field loss in accordance with the Nelson Glaucoma Severity Scale (NGSS). The Glaucoma Quality of Life-15 (GQL-15) and a self-developed social function scale (SFS) were utilized to assess patients' wellbeing. Results: A total of 260 patients (mean ± SD age = 58.1 ± 12.01 years; 106 females) participated in the study. Univariate analyses revealed a significant relationship between final quality of life score and number of anti-glaucoma medications (P = 0.01), previous surgeries (P = 0.00), patients age (P = 0.00), patients education level (P = 0.02), and severity of glaucoma (P = 0.00). Previous surgeries (P = 0.04) and severity of glaucoma (P = 0.00) were significant predictors of GQL-15 summary score. With increasing glaucoma severity, patients noted greater difficulty with peripheral vision, glare and dark adaptation, and outdoor tasks (P < 0.0001). Severe glaucoma also impacted patients' functional performance—a significant decline was observed in sense of personal (P < 0.0001) and social wellbeing (P < 0.0001). Conclusions: Patients with advanced glaucoma report significant decline in functioning, their ability to interact in community, take care of self, and do leisure activities. Glaucoma imposes greater social burden on the elderly by impacting their sense of personal safety. Targeted visual and social rehabilitative programs are necessary to improve their wellbeing and independent functioning.
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Affiliation(s)
| | - Harleen Bedi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Manveen Bedi
- Illinois College of Optometry, Chicago, Illinois, USA
| | - Preeti Matah
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
| | - Jigyasa Sahu
- Dr. Shroff's Charity Eye Hospital, New Delhi, India
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Jones PR, Tigchelaar I, Demaria G, Wilson I, Bi W, Taylor DJ, Crabb DP. Refinement and preliminary evaluation of two tablet-based tests of real-world visual function. Ophthalmic Physiol Opt 2019; 40:35-46. [PMID: 31879994 PMCID: PMC7028122 DOI: 10.1111/opo.12658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/09/2019] [Indexed: 01/07/2023]
Abstract
Purpose To describe, refine, evaluate, and provide normative control data for two freely available tablet‐based tests of real‐world visual function, using a cohort of young, normally‐sighted adults. Methods Fifty young (18–40 years), normally‐sighted adults completed tablet‐based assessments of (1) face discrimination and (2) visual search. Each test was performed twice, to assess test‐retest repeatability. Post‐hoc analyses were performed to determine the number of trials required to obtain stable estimates of performance. Distributions were fitted to the normative data to determine the 99% population‐boundary for normally sighted observers. Participants were also asked to rate their comprehension of each test. Results Both tests provided stable estimates in around 20 trials (~1–4 min), with only a further reduction of 14%–17% in the 95% Coefficient of Repeatability (CoR95) when an additional 40 trials were included. When using only ~20 trials: median durations for the first run of each test were 191 s (Faces) and 51 s (Search); test‐retest CoR95 were 0.27 d (Faces) and 0.84 s (Search); and normative 99% population‐limits were 3.50 d (Faces) and 3.1 s (Search). No participants exhibited any difficulties completing either test (100% completion rate), and ratings of task‐understanding were high (Faces: 9.6 out of 10; Search: 9.7 out of 10). Conclusions This preliminary assessment indicated that both tablet‐based tests are able to provide simple, quick, and easy‐to‐administer measures of real‐world visual function in normally‐sighted young adults. Further work is required to assess their accuracy and utility in older people and individuals with visual impairment. Potential applications are discussed, including their use in clinic waiting rooms, and as an objective complement to Patient Reported Outcome Measures (PROMs).
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Affiliation(s)
- Pete R Jones
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Iris Tigchelaar
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Ocusweep, Turku, Finland.,Doctoral Program in Clinical Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Giorgia Demaria
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Graduate School of Medical Sciences (Research School of Behavioral and Cognitive Neurosciences), University of Groningen, Groningen, the Netherlands
| | - Iain Wilson
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Wei Bi
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Ramulu PY, Mihailovic A, West SK, Gitlin LN, Friedman DS. Predictors of Falls per Step and Falls per Year At and Away From Home in Glaucoma. Am J Ophthalmol 2019; 200:169-178. [PMID: 30639366 DOI: 10.1016/j.ajo.2018.12.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 12/24/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine where glaucoma patients most often fall and how integrated visual field (IVF) damage affects falls rates per year (falls/year) and per step (falls/step) at and away from home. DESIGN Prospective, observational cohort study. METHODS In 225 patients with glaucoma or suspected glaucoma, falls data were collected via calendars, fall location was classified through follow-up questionnaires, and steps taken at and away from home were judged by integrating data from annual week-long accelerometer and GPS trials. Main outcome measures were the association of IVF sensitivity with fall rates per year or step, stratified by location. RESULTS Participants took more away steps than home steps (2366 vs 1524, P < .001), and differences in away vs home steps did not vary with IVF sensitivity (P = .22). A total of 57% of falls occurred at home, with each home step twice as likely to result in a fall as compared to each away step (rate ratio = 2.02, P < .001). Worse IVF sensitivity was not associated with a higher rate of home falls/year or away falls/year (P > .1 for both), but was associated with a higher rate of home falls/step (rate ratio = 1.34/5 dB worse sensitivity, P = .03) and away falls/step (rate ratio = 1.47/5 dB worse sensitivity, P = .003). CONCLUSIONS In this glaucoma population, most falls occurred at home, and the risk of any step resulting in a fall was higher at home. Those with greater VF damage were more likely to fall for each step taken both at and away from home. Efforts such as home environmental modification should be considered in the visually impaired to prevent falls while maintaining physical activity.
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Duquette J, Loiselle J, Fréchette C, Déry L, Senécal MJ, Wittich W, Wanet-Defalque MC. Reliability and validity of the Canadian-French ecological adaptation of the weighted version of the Melbourne low-vision ADL Index. Disabil Rehabil 2019; 42:1021-1030. [PMID: 30714431 DOI: 10.1080/09638288.2018.1516813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (MIDVAQ) is the Canadian-French adaptation of the Melbourne Low-Vision ADL Index. It measures performance, personal importance and handicap situation in 16 instrumental activities requiring near vision (standardized material, part A) and in 9 self-care and domestic activities (self-report questionnaire, part B). This study aimed at measuring the MIDVAQ reliability and its relationship with measures of visual functions and functional vision.Methods: The MIDVAQ was administered twice to 100 visually impaired participants, at home, with their personal visual and non-visual aid. A second rater was present at T1. Two different versions of part A were used alternately at T1 and T2.Results: The total Handicap scale demonstrates good internal reliability (Cronbach's alpha coefficient = 0.82) and very high inter-rater and test-retest reliability (ICCs = 1.00 and 0.86). Part A alternative versions are highly comparable. Vision function measures are significantly correlated with total Handicap score, for which 48% of the variance is explained by functional vision estimates, age, and education.Conclusions: The MIDVAQ is highly valid and reliable. It can be useful to measure the functional impact of the visual impairment, its progression, and the outcomes of low vision rehabilitation services.Implications for rehabilitationEven if administered at home in an ecological way, this measure of the impact of the visual impairment in daily activities is very reliable.Given its good metric properties, this tool can be confidently used to assess the functional impact of visual impairment, outcomes of the low vision rehabilitation services, etc.This measurement tool provides complementary information to those obtained from clinical measures of visual functions, by reflecting the interaction between the functional abilities with the requirements of the environment.
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Affiliation(s)
- Josée Duquette
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Canada
| | | | | | - Lise Déry
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Canada
| | - Marie-Josée Senécal
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Canada
| | - Walter Wittich
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Canada.,School of Optometry, University of Montreal, Montreal, Canada
| | - Marie-Chantal Wanet-Defalque
- Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montréal, Canada.,School of Optometry, University of Montreal, Montreal, Canada
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Charlesworth JM, Davidson MA. Undermining a common language: smartphone applications for eye emergencies. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:21-40. [PMID: 30697086 PMCID: PMC6339640 DOI: 10.2147/mder.s186529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Emergency room physicians are frequently called upon to assess eye injuries and vision problems in the absence of specialized ophthalmologic equipment. Technological applications that can be used on mobile devices are only now becoming available. Objective To review the literature on the evidence of clinical effectiveness of smartphone applications for visual acuity assessment marketed by two providers (Google Play and iTunes). Methods The websites of two mobile technology vendors (iTunes and Google Play) in Canada and Ireland were searched on three separate occasions using the terms “eye”, “ocular”, “ophthalmology”, “optometry”, “vision”, and “visual assessment” to determine what applications were currently available. Four medical databases (Cochrane, Embase, PubMed, Medline) were subsequently searched with the same terms AND mobile OR smart phone for papers in English published in years 2010–2017. Results A total of 5,024 Canadian and 2,571 Irish applications were initially identified. After screening, 44 were retained. Twelve relevant articles were identified from the health literature. After screening, only one validation study referred to one of our identified applications, and this one only partially validated the application as being useful for clinical purposes. Conclusion Mobile device applications in their current state are not suitable for emergency room ophthalmologic assessment, because systematic validation is lacking.
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Affiliation(s)
- Jennifer M Charlesworth
- School of Medicine, National University of Ireland, Galway, Ireland, .,AM Charlesworth & Associates Science and Technology Consultants, Ottawa, ON, Canada,
| | - Myriam A Davidson
- AM Charlesworth & Associates Science and Technology Consultants, Ottawa, ON, Canada,
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Duquette J, Loiselle J, Fréchette C, Déry L, Senécal MJ. Occupational performance in the basic and instrumental daily activities of persons with low vision who received rehabilitation services. Br J Occup Ther 2018. [DOI: 10.1177/0308022618808734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The objective was to describe the occupational performance in basic and instrumental daily activities of persons living in the community who have received comprehensive interdisciplinary low vision rehabilitation services. Method The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (a measure of the impact of visual impairment in daily activities) was administered at home to 102 individuals who participated in a comprehensive low vision rehabilitation program. Performance in 16 near-vision activities was measured with the person's aids and strategies; nine more global tasks were questionnaire-based. Handicap scores were obtained by multiplying performance × importance ratings. Results Average performance was satisfactory or very satisfactory for 21/25 items, even if 92% of the participants had a moderate or severe visual impairment. A severe or total handicap was present in at least one activity for 79% of the subjects. The most handicapping activities required visual searches of finely printed information on a complex or visually crowded document, or shopping and mobility. Conclusion People with low vision who took part in a comprehensive rehabilitation program generally face no or slight handicap situations in their basic and instrumental daily activities. However, major handicap situations may remain in some important activities.
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Affiliation(s)
- Josée Duquette
- Research Officer, CISSS de la
Montérégie-Centre – Institut Nazareth et Louis-Braille, Longueuil, QC, Canada
- Clinician/health care professional
member, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal,
Montreal, CA, Canada
| | | | | | - Lise Déry
- Clinician/health care professional
member, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal,
Montreal, CA, Canada
- Low Vision Therapist, CISSS de la
Montérégie-Centre – Institut Nazareth et Louis-Braille, Longueuil, QC, Canada
| | - Marie-Josée Senécal
- Clinician/health care professional
member, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal,
Montreal, CA, Canada
- Optometrist, CISSS de la
Montérégie-Centre – Institut Nazareth et Louis-Braille, Longueuil, QC, Canada
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The mediating roles of functional limitations and social support on the relationship between vision impairment and depressive symptoms in older adults. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18001010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractVision impairment is prevalent and it is strongly associated with depressive symptoms in older adults. This study aimed to investigate the mediating roles of functional limitations and social support on the relationship between vision impairment and depressive symptoms in older adults. This study used data from a probability-based sample of 1,093 adults aged 60 and older in Shanghai, China. Structural equation models were used to examine the structural relationships among sets of variables simultaneously, including vision impairment, activities of daily living ADLs, instrumental ADLs (IADLs), friends support, family support, relatives support and depressive symptoms. The bootstrapping method and the program PRODCLIN were used to test the indirect effects of these variables. This study found that vision impairment was directly associated with a higher level of depressive symptoms, and the association was partially mediated by functional limitations (IADLs) and social support (friends support). The study demonstrates that improving social support from friends and enhancing social participation for visually impaired older adults can reduce depressive symptoms. More importantly, this study contributes to the knowledge of mediating mechanisms between vision impairment and depressive symptoms.
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Roh M, Selivanova A, Shin HJ, Miller JW, Jackson ML. Visual acuity and contrast sensitivity are two important factors affecting vision-related quality of life in advanced age-related macular degeneration. PLoS One 2018; 13:e0196481. [PMID: 29746512 PMCID: PMC5944956 DOI: 10.1371/journal.pone.0196481] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 04/14/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Vision loss from age-related macular degeneration (AMD) has a profound effect on vision-related quality of life (VRQoL). The pupose of this study is to identify clinical factors associated with VRQoL using the Rasch- calibrated NEI VFQ-25 scales in bilateral advanced AMD patients. METHODS We retrospectively reviewed 47 patients (mean age 83.2 years) with bilateral advanced AMD. Clinical assessment included age, gender, type of AMD, high contrast visual acuity (VA), history of medical conditions, contrast sensitivity (CS), central visual field loss, report of Charles Bonnet Syndrome, current treatment for AMD and Rasch-calibrated NEI VFQ-25 visual function and socioemotional function scales. The NEI VFQ visual function scale includes items of general vision, peripheral vision, distance vision and near vision-related activity while the socioemotional function scale includes items of vision related-social functioning, role difficulties, dependency, and mental health. Multiple regression analysis (structural regression model) was performed using fixed item parameters obtained from the one-parameter item response theory model. RESULTS Multivariate analysis showed that high contrast VA and CS were two factors influencing VRQoL visual function scale (β = -0.25, 95% CI-0.37 to -0.12, p<0.001 and β = 0.35, 95% CI 0.25 to 0.46, p<0.001) and socioemontional functioning scale (β = -0.2, 95% CI -0.37 to -0.03, p = 0.023, and β = 0.3, 95% CI 0.18 to 0.43, p = 0.001). Central visual field loss was not assoicated with either VRQoL visual or socioemontional functioning scale (β = -0.08, 95% CI-0.28 to 0.12,p = 0.44 and β = -0.09, 95% CI -0.03 to 0.16, p = 0.50, respectively). CONCLUSION In patients with vision impairment secondary to bilateral advanced AMD, high contrast VA and CS are two important factors affecting VRQoL.
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Affiliation(s)
- Miin Roh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alexandra Selivanova
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hyun Joon Shin
- Division of Aging, Brigham and Women's Hospital, Department of Medicine, VA Boston Health care system, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mary Lou Jackson
- VGH/Univeristy of British Coumbia Eye Care Centre, Vancouver, British Columbia, Canada
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Choudhary M, Safe S, Malek G. Suppression of aberrant choroidal neovascularization through activation of the aryl hydrocarbon receptor. Biochim Biophys Acta Mol Basis Dis 2018; 1864:1583-1595. [PMID: 29481912 DOI: 10.1016/j.bbadis.2018.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/17/2018] [Accepted: 02/20/2018] [Indexed: 12/13/2022]
Abstract
The aryl hydrocarbon receptor (AhR) is a ligand activated transcription factor, initially discovered for its role in regulating xenobiotic metabolism. There is extensive evidence supporting a multi-faceted role for AhR, modulating physiological pathways important in cell health and disease. Recently we demonstrated that the AhR plays a role in the pathogenesis of age-related macular degeneration (AMD), the leading cause of vision loss in the elderly. We found that loss of AhR exacerbates choroidal neovascular (CNV) lesion formation in a murine model. Herein we tested the therapeutic impact of AhR activation on CNV lesion formation and factors associated with aberrant neovascularization. We screened a panel of synthetic drugs and endogenous AhR ligands, assessed their ability to activate AhR in choroidal endothelial cells, and inhibit angiogenesis in vitro. Drugs with an anti-angiogenic profile were then administered to a murine model of CNV. Two compounds, leflunomide and flutamide, significantly inhibited CNV formation concurrent with positive modifying effects on angiogenesis, inflammation, extracellular matrix remodeling, and fibrosis. These results validate the role of the AhR pathway in regulating CNV pathogenesis, identify mechanisms of AhR-based therapies in the eye, and argue in favor of developing AhR as a drug target for the treatment of neovascular AMD.
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Affiliation(s)
- Mayur Choudhary
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Stephen Safe
- Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
| | - Goldis Malek
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA; Department of Pathology, Duke University School of Medicine, Durham, NC, USA.
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Kurichi JE, Kwong PL, Xie D, Bogner HR. Predictive Indices for Functional Improvement and Deterioration, Institutionalization, and Death Among Elderly Medicare Beneficiaries. PM R 2017; 9:1065-1076. [PMID: 28456694 DOI: 10.1016/j.pmrj.2017.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prediction models can help clinicians provide the best and most appropriate care to their patients and can help policy makers design services for groups at highest risk for poor outcomes. OBJECTIVE To develop prediction models identifying both risk factors and protective factors for functional deterioration, institutionalization, and death. DESIGN Cohort study using data from the Medicare Current Beneficiary Survey (MCBS). SETTING Community survey. PARTICIPANTS This study included 21,264 Medicare beneficiaries 65 years of age and older who participated in the MCBS from the 2001-2008 entry panels and were followed up for 2 years. METHODS The index was derived in 60% and validated in the remaining 40%. β Coefficients from a multinomial logistic regression model were used to derive points, which were added together to create scores associated with the outcome. MAIN OUTCOME MEASURE The outcome was activity of daily living (ADL) stage transitions over 2 years following entry into the MCBS. Beneficiaries were categorized into 1 of 4 outcome categories: stable or improved function, functional deterioration, institutionalization, or death. RESULTS Our model identified 16 factors for functional deterioration (age, gender, education, living arrangement, dual eligibility, proxy use, Alzheimer disease/dementia, angina pectoris/coronary heart disease, diabetes, emphysema/asthma/chronic obstructive pulmonary disease, mental/psychiatric disorder, Parkinson disease, stroke/brain hemorrhage, hearing impairment, vision impairment, and baseline ADL stage) after backward selection (P < .05). Compared to stable or improved function, the risk of functional deterioration ranged from ≤1 to ≥6, ≤4 to ≥22 for the risk of institutionalization, and ≤3 to ≥16 for the risk of death. CONCLUSION Predictive indices, or point and scoring systems used to predict outcomes, can identify elderly Medicare beneficiaries at risk for functional deterioration, institutionalization, and death and can aid policy makers, clinicians, and family members in improving care for older adults and supporting successful aging in the community. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jibby E Kurichi
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, 423 Guardian Dr, 907 Blockley Hall, Philadelphia, PA 19104-6021(∗).
| | - Pui L Kwong
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(†)
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(‡)
| | - Hillary R Bogner
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA(§)
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Chatard H, Tepenier L, Jankowski O, Aussems A, Allieta A, Beydoun T, Salah S, Bucci MP. Effects of Age-Related Macular Degeneration on Postural Sway. Front Hum Neurosci 2017; 11:158. [PMID: 28408876 PMCID: PMC5374199 DOI: 10.3389/fnhum.2017.00158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/17/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose: To compare the impact of unilateral vs. bilateral age-related macular degeneration (AMD) on postural sway, and the influence of different visual conditions. The hypothesis of our study was that the impact of AMD will be different between unilateral and bilateral AMD subjects compared to age-matched healthy elderly. Methods: Postural stability was measured with a platform (TechnoConcept®) in 10 elderly unilateral AMD subjects (mean age: 71.1 ± 4.6 years), 10 elderly bilateral AMD subjects (mean age: 70.8 ± 6.1 years), and 10 healthy age-matched control subjects (mean age: 69.8 ± 6.3 years). Four visual conditions were tested: both eyes viewing condition (BEV), dominant eye viewing (DEV), non-dominant eye viewing (NDEV), and eyes closed (EC). We analyzed the surface area, the length, the mean speed, the anteroposterior (AP), and mediolateral (ML) displacement of the center of pressure (CoP). Results: Bilateral AMD subjects had a surface area (p < 0.05) and AP displacement of the CoP (p < 0.01) higher than healthy elderly. Unilateral AMD subjects had more AP displacement of the CoP (p < 0.05) than healthy elderly. Conclusions: We suggest that ADM subjects could have poor postural adaptive mechanisms leading to increase their postural instability. Further studies will aim to improve knowledge on such issue and to develop reeducation techniques in these patients.
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Affiliation(s)
- Hortense Chatard
- UMR 1141, Institut National de la Santé et de la Recherche Médicale-Université Paris 7, Robert Debré University HospitalParis, France.,Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University HospitalParis, France.,Centre Ophtalmologique du Val-d'Oise (OPH95)Osny, France
| | - Laure Tepenier
- Groupe Hospitalier Cochin-Hôtel-Dieu, Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Paris Descartes UniversityParis, France
| | | | | | - Alain Allieta
- Centre Ophtalmologique du Val-d'Oise (OPH95)Osny, France
| | - Talal Beydoun
- Groupe Hospitalier Cochin-Hôtel-Dieu, Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Paris Descartes UniversityParis, France
| | - Sawsen Salah
- Groupe Hospitalier Cochin-Hôtel-Dieu, Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Paris Descartes UniversityParis, France
| | - Maria P Bucci
- UMR 1141, Institut National de la Santé et de la Recherche Médicale-Université Paris 7, Robert Debré University HospitalParis, France.,Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University HospitalParis, France
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Bal S, Kurichi JE, Kwong PL, Xie D, Hennessy S, Na L, Pezzin LE, Streim JE, Bogner HR. Presence of Vision Impairment and Risk of Hospitalization among Elderly Medicare Beneficiaries. Ophthalmic Epidemiol 2017; 24:364-370. [PMID: 28346032 DOI: 10.1080/09286586.2017.1296961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine the association between vision impairment and all-cause hospitalization among elderly Medicare beneficiaries. METHODS A population-based study (N = 22,681) of community-dwelling Medicare beneficiaries aged 65 years and older who participated in the Medicare Current Beneficiary Survey for the years 2001-2007. Beneficiaries were classified into self-reported presence of vision impairment versus no vision impairment. Inpatient hospitalizations were identified using Medicare claims data. A multivariable Cox proportional hazard model examined the association between presence of vision impairment and time to first hospitalization within 3 years of survey entry after adjusting for sociodemographics, comorbidities, hearing impairment, and activity limitation stages derived from difficulty performing the activities of daily living. RESULTS Medicare beneficiaries who self-reported the presence of vision impairment were significantly more likely to be hospitalized over 3 years compared to beneficiaries without vision impairment even after adjustment for potentially influential covariates (hazard ratio = 1.14 and 95% confidence interval: 1.05-1.23). CONCLUSIONS Medicare beneficiaries with self-reported vision impairment were at higher risk of hospitalization during a 3-year period. Further research may identify reasons that are amenable to policy interventions.
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Affiliation(s)
- Sila Bal
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Jibby E Kurichi
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Pui L Kwong
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Dawei Xie
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Sean Hennessy
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA.,b Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Ling Na
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Liliana E Pezzin
- c Department of Medicine , Medical College of Wisconsin , Milwaukee , WI , USA
| | - Joel E Streim
- d Geriatric Psychiatry Section of the Department of Psychiatry , Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, and VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center , Philadelphia , PA , USA
| | - Hillary R Bogner
- a Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA.,e Department of Family Medicine and Community Health, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
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Pabon S, Sunness JS, Kaleem MA. Low Vision Therapy for Glaucoma Patients. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pérès K, Matharan F, Daien V, Nael V, Edjolo A, Bourdel-Marchasson I, Ritchie K, Tzourio C, Delcourt C, Carrière I. Visual Loss and Subsequent Activity Limitations in the Elderly: The French Three-City Cohort. Am J Public Health 2017; 107:564-569. [PMID: 28207341 DOI: 10.2105/ajph.2016.303631] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the relationship between vision and disability in the elderly. METHODS We used a baseline visual indicator (combining near acuity with Snellen equivalent < 20/30 and self-reported distance visual loss) to explore the association between visual loss and subsequent disability (mobility, instrumental activities of daily living [IADLs], ADLs, and participation restriction) from 1999 to 2007 in 8491 elderly participants of the French Three-City Cohort (Bordeaux, Dijon, and Montpellier). RESULTS In multiadjusted analyses, near visual impairment, alone or associated with distance visual function loss, was associated with greater risk of developing ADL limitations (P = .027), IADL limitations (P = .002), and participation restriction (P < .001), but not mobility (P = .848). The disabling impact of visual loss was significant for 11 of the 15 activities, when analyzed one by one. CONCLUSIONS Both near and distance visual loss was associated with greater functional decline over time, and the combination of the two could be even worse. Public Health Implications. In the context of rapid aging of the population, maintaining good vision in the elderly represents a promising prevention track, visual impairment being common in the elderly, largely undermanaged, and mostly reversible. Further research, especially trials, is necessary to estimate the public health impact of such interventions.
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Affiliation(s)
- Karine Pérès
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Fanny Matharan
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Vincent Daien
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Virginie Nael
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Arlette Edjolo
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Isabelle Bourdel-Marchasson
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Karen Ritchie
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Cécile Delcourt
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
| | - Isabelle Carrière
- Karine Pérès, Fanny Matharan, Virginie Nael, Arlette Edjolo, Christophe Tzourio, and Cécile Delcourt are with Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Bordeaux, France. Vincent Daien, Karen Ritchie, and Isabelle Carrière are with INSERM, U1061, Montpellier, France. Isabelle Bourdel-Marchasson I is with Pole de gérontologie clinique, CHU Bordeaux, Bordeaux, France
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Taylor DJ, Hobby AE, Binns AM, Crabb DP. How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review. BMJ Open 2016; 6:e011504. [PMID: 27913556 PMCID: PMC5168634 DOI: 10.1136/bmjopen-2016-011504] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To review systematically the evidence of age-related macular degeneration (AMD) affecting real-world visual ability and quality of life (QoL). To explore trends in specific topics within this body of the literature. DESIGN Systematic review. METHODS A systematic literature search was carried out using MEDLINE, EMBASE, CINAHL, PsycINFO, PsychARTICLES and Health and Psychosocial Instruments for articles published up to January 2015 for studies including people diagnosed with AMD, assessing real-world visual ability or QoL as an outcome. Two researchers screened studies for eligibility. Details of eligible studies including study design, characteristics of study population and outcomes measured were recorded in a data extraction table. All included studies underwent quality appraisal using the Mixed Methods Appraisal Tool 2011 Version (MMAT). RESULTS From 5284 studies, 123 were eligible for inclusion. A range of approaches were identified, including performance-based methods, quantitative and qualitative patient-reported outcome measures (PROMs). AMD negatively affects tasks including mobility, face recognition, perception of scenes, computer use, meal preparation, shopping, cleaning, watching TV, reading, driving and, in some cases, self-care. There is evidence for higher rates of depression among people with AMD than among community dwelling elderly. A number of adaptation strategies have been associated with AMD of varying duration. Much of the research fails to report the type of AMD studied (59% of included studies) or the duration of disease in participants (74%). Of those that do report type studied, the breakdown is as follows: wet AMD 20%, dry AMD 4% and both types 17%. CONCLUSIONS There are many publications highlighting the negative effects of AMD in various domains of life. Future research should focus on delivering some of this research knowledge into patient management and clinical trials and differentiating between the types of AMD.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Angharad E Hobby
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Alison M Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Cheng HC, Guo CY, Chen YJ, Chen MJ, Ko YC, Huang N, Liu CJL. Patient-Reported Vision-Related Quality-of-Life Differences between Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma. PLoS One 2016; 11:e0163123. [PMID: 27690232 PMCID: PMC5045164 DOI: 10.1371/journal.pone.0163123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/03/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate the different impacts on patient-reported vision-related quality of life (pVRQOL) outcomes in patients with primary angle-closure glaucoma(PACG) and primary open-angle glaucoma(POAG). Methods Prospective cross-sectional study. PACG and POAG patients who had a best-corrected visual acuity(BCVA) in the better eye equal to or better than 20/60, intraocular pressure controlled at or below 25 mmHg and reliable visual field test were invited to participate. The control group included patients with BCVA in the better eye equal to or better than 20/60 and who did not have major eye disease. A validated Taiwanese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25(T)) was performed to assess pVRQOL. The association between each domain of NEI VFQ-25(T) among 3 groups was determined using multivariable linear regression analysis. Results A total of 106 PACG, 186 POAG, and 95 controls were enrolled. In multivariable regression analysis of all three groups(PACG/POAG/controls), compared to POAG, PACG showed a weakly positive association with social functioning (R2 = 0.13, β = 0.22, P = 0.04). PACG showed no significantly negative impact on pVRQOL compared to controls. Taking only glaucoma patients into consideration, PACG patients had a higher score on social functioning compared to POAG (R2 = 0.16, β = 0.27, P = 0.01). The results of other domains of NEI VFQ-25(T) between the two groups did not differ significantly(p>0.05). Conclusions In patients with controlled disease, the impact of PACG and POAG on most domains of NEI VFQ-25(T) were similar, except for better social functioning in PACG compared to POAG.
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Affiliation(s)
- Hui-Chen Cheng
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Jing Chen
- Division of Biostatistics, Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | - Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Catherine Jui-ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Cimarolli VR, Boerner K, Reinhardt JP, Horowitz A, Wahl HW, Schilling O, Brennan-Ing M. A population study of correlates of social participation in older adults with age-related vision loss. Clin Rehabil 2016; 31:115-125. [PMID: 26817810 DOI: 10.1177/0269215515624479] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine personal characteristics, disease-related impairment variables, activity limitations, and environmental factors as correlates of social participation in older adults with vision loss guided by the World Health Organization's International Classification of Functioning, Disability and Health Model. DESIGN Baseline data of a larger longitudinal study. SETTING Community-based vision rehabilitation agency. SUBJECTS A total of 364 older adults with significant vision impairment due to age-related macular degeneration. MAIN MEASURES In-person interviews assessing social participation (i.e. frequency of social support contacts, social/leisure challenges faced due to vision loss, and of social support provided to others) and hypothesized correlates (e.g. visual acuity test, Functional Vision Screening Questionnaire, ratings of attachment to house and neighborhood, environmental modifications in home). RESULTS Regression analyses showed that indicators of physical, social, and mental functioning (e.g. better visual function, fewer difficulties with instrumental activities of daily living, fewer depressive symptoms) were positively related to social participation indicators (greater social contacts, less challenges in social/leisure domains, and providing more support to others). Environmental factors also emerged as independent correlates of social participation indicators when functional variables were controlled. That is, participants reporting higher attachment to their neighborhood and better income adequacy reported having more social contacts; and those implementing more environmental strategies were more likely to report greater challenges in social and leisure domains. Better income adequacy and living with more people were related to providing more social support to others. CONCLUSION Environmental variables may play a role in the social participation of older adults with age-related macular degeneration.
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Affiliation(s)
| | - Kathrin Boerner
- 2 Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Joann P Reinhardt
- 1 Research Institute on Aging, Jewish Home Lifecare, New York, NY, USA.,3 Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Amy Horowitz
- 4 Graduate School of Social Service, Fordham University, New York, NY, USA
| | - Hans-Werner Wahl
- 5 Department of Psychological Aging Research, Heidelberg University, Heidelberg, Germany
| | - Oliver Schilling
- 5 Department of Psychological Aging Research, Heidelberg University, Heidelberg, Germany
| | - Mark Brennan-Ing
- 6 ACRIA, Center on HIV and Aging, New York, NY, USA.,7 New York University, College of Nursing, New York, NY, USA
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Umfress AC, Brantley MA. Eye Care Disparities and Health-Related Consequences in Elderly Patients with Age-Related Eye Disease. Semin Ophthalmol 2016; 31:432-8. [PMID: 27116323 DOI: 10.3109/08820538.2016.1154171] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The elderly population in the United States (age 65 and older) is growing rapidly, estimated by the U.S. Census Department to reach 83.7 million by 2050.(1) Visual impairment increases with age among all racial and ethnic groups.(2) In the elderly, the most common culprits for vision loss are cataract, glaucoma, and age-related macular degeneration (AMD).(2) In the developed world, vision loss from cataract has been dramatically reduced by increased access to cataract surgery. However, AMD and glaucoma lead to irreversible vision loss without early diagnosis and intervention. In the U.S., cases of AMD are expected to double by 2050, reaching 17.8 million among patients age 50 or older.(3) Similarly, cases of glaucoma are expected to reach 5.5 million by 2050, an increase of over 90% from 2014.(3) The visually impaired elderly face disparities in access to eye care, and subsequent general medical and psychosocial complications.
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Affiliation(s)
- Allison C Umfress
- a Vanderbilt Eye Institute, Vanderbilt University Medical Center , Nashville , TN , USA
| | - Milam A Brantley
- a Vanderbilt Eye Institute, Vanderbilt University Medical Center , Nashville , TN , USA
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Cimarolli VR, Casten RJ, Rovner BW, Heyl V, Sörensen S, Horowitz A. Anxiety and depression in patients with advanced macular degeneration: current perspectives. Clin Ophthalmol 2015; 10:55-63. [PMID: 26766899 PMCID: PMC4699633 DOI: 10.2147/opth.s80489] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Age-related macular degeneration (AMD) - despite advances in prevention and medical treatment options - remains prevalent among older adults, often resulting in functional losses that negatively affect the mental health of older adults. In particular, the prevalence of both anxiety and depression in patients with AMD is high. Along with medical treatment options, low vision rehabilitation and AMD-specific behavioral and self-management programs have been developed and have demonstrated effectiveness in improving the mental health of AMD patients. This article reviews the prevalence of anxiety and depression in patients with advanced AMD, discusses potential mechanisms accounting for the development of depression and anxiety in AMD patients, presents the state-of the-art of available interventions for addressing anxiety and depression in AMD patients, and delineates recommendations for eye care professionals regarding how to screen for these two prevalent mental health problems and how to facilitate appropriate treatment for patients with AMD.
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Affiliation(s)
| | - Robin J Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry W Rovner
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Department of Psychiatry, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; Department of Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Vera Heyl
- Institute of Special Education, University of Education, Heidelberg, Germany
| | - Silvia Sörensen
- Warner School of Education and Human Development, University of Rochester, Rochester, NY, USA; Department of Ophthalmology, Flaum Eye Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Amy Horowitz
- Graduate School of Social Service, Fordham University, New York, NY, USA
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48
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Novack GD, Robin AL. Ocular pharmacology. J Clin Pharmacol 2015; 56:517-27. [PMID: 26360129 DOI: 10.1002/jcph.634] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/08/2015] [Indexed: 12/28/2022]
Abstract
Ophthalmic diseases include both those analogous to systemic diseases (eg, inflammation, infection, neuronal degeneration) and not analogous (eg, cataract, myopia). Many anterior segment diseases are treated pharmacologically through eye drops, which have an implied therapeutic index of local therapy. Unlike oral dosage forms administered for systemic diseases, eyedrops require patients not only to adhere to treatment, but to be able to accurately perform-ie, instill drops correctly. Anatomical and physiological barriers make topical delivery to the anterior chamber challenging-in some cases more challenging than absorption through the skin, nasal passages, or gut. Treatment of the posterior segment (eg, vitreous, retina, choroid, and optic nerve) is more challenging due to additional barriers. Recently, intravitreal injections have become a standard of care with biologics for the treatment of macular degeneration and other diseases. Although the eye has esterases, hydroxylases, and transporters, it has relatively little CYP450 enzymes. Because it is challenging to obtain drug concentrations at the target site, ocular clinical pharmacokinetics, and thus pharmacokinetic-pharmacodynamic interactions, are rarely available. Ophthalmic pharmaceuticals require consideration of solubility, physiological pH, and osmolarity, as well as sterility and stability, which in turn requires optimal pharmaceutics. Although applied locally, ocular medications may be absorbed systemically, which results in morbidity and mortality (eg, systemic hypotension, bronchospasm, and bradycardia).
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Affiliation(s)
- Gary D Novack
- PharmaLogic Development, Inc., San Rafael, CA, USA.,Departments of Pharmacology and Ophthalmology, University of California, Davis, CA, USA
| | - Alan L Robin
- Department of Ophthalmology, University of Maryland, Baltimore, MD, USA.,Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology, Johns Hopkins University, Baltimore, MD, USA
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49
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Prenner JL, Halperin LS, Rycroft C, Hogue S, Williams Liu Z, Seibert R. Disease Burden in the Treatment of Age-Related Macular Degeneration: Findings From a Time-and-Motion Study. Am J Ophthalmol 2015; 160:725-31.e1. [PMID: 26142721 DOI: 10.1016/j.ajo.2015.06.023] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 06/24/2015] [Accepted: 06/24/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine the time burden of managing neovascular age-related macular degeneration (AMD) imposed on physicians, staff, patients, and caregivers. DESIGN Mixed-methods, prospective, observational time-and-motion study. METHODS The multicenter study was conducted from March 2011 through August 2012. Retina specialists administering ≥50 vascular endothelial growth factor (VEGF)-inhibitor injections monthly were surveyed and completed records for ≥5 patients scheduled for office visits within 3 weeks for anti-VEGF injection or monitoring. A survey was administered to 75 neovascular AMD patients aged ≥50 years who received ≥1 anti-VEGF injection in the past 6 months. Telephone interviews were conducted with 13 neovascular AMD patient caregivers. RESULTS Fifty-six physicians provided data for 221 patients with neovascular AMD. Patients accounted for 20% of the health care staff's time per week, with an average of 23 staff members. An average patient visit for neovascular AMD was 90 minutes (range: 13 minutes to >4 hours). Patients reported an average time per visit of almost 12 hours, including preappointment preparation (16 minutes), travel (66 minutes), waiting time (37 minutes), treatment time (43 minutes), and postappointment recovery (9 hours). Patients stated that caregivers took time away from work (22%) and personal activities (28%) to provide transportation to appointments. CONCLUSIONS Neovascular AMD management imposes a substantial time burden on physicians, staff, patients, and caregivers. There may be a need for additional support and/or reimbursement for services required by patients and caregivers and provided by physicians.
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Affiliation(s)
- Jonathan L Prenner
- NJ Retina, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
| | - Lawrence S Halperin
- Retina Group of Florida, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Susan Hogue
- RTI Health Solutions, Research Triangle Park, North Carolina
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50
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Waisbourd M, Parker S, Ekici F, Martinez P, Murphy R, Scully K, Wizov SS, Hark LA, Spaeth GL. A prospective, longitudinal, observational cohort study examining how glaucoma affects quality of life and visually-related function over 4 years: design and methodology. BMC Ophthalmol 2015; 15:91. [PMID: 26231376 PMCID: PMC4522094 DOI: 10.1186/s12886-015-0088-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/23/2015] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study is to summarize the design and methodology of a prospective, longitudinal, observational cohort study to investigate how glaucoma affects patients’ quality of life and visually-related function over a 4-year period. Methods/Design One hundred sixty-one (161) subjects were enrolled in this ongoing study. Patients between the ages of 21–85 years with a minimum 2-year diagnosis of primary open-angle glaucoma, chronic primary angle-closure glaucoma or pseudoexfoliation glaucoma were included. Each patient visited Wills Eye Hospital for a baseline visit. Follow-up is planned for a minimum of 4 years, with annual visits. Each visit includes (1) Clinical evaluation: a slit lamp examination, fundoscopy, intraocular pressure measurement, visual field examination, spectral domain optical coherence tomography, Pelli-Robson Contrast Sensitivity test and the Spaeth-Richman Contrast Sensitivity test; (2) a performance based measure: the Compressed Assessment of Ability Related to Vision; and (3) Subjective measures of vision-related quality of life (the National Eye Institute Visual Functioning Questionnaire 25 and the Modified Glaucoma Symptom Scale). Discussion The results of this ongoing, prospective, longitudinal study are expected to shed light on the relationships between clinical measures, performance-based measures and subjective measures of well-being, in order to assess changes in the quality of life and the ability to function of patients with glaucoma over time.
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Affiliation(s)
- Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Samantha Parker
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Feyzahan Ekici
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Patricia Martinez
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Rachel Murphy
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Katie Scully
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Sheryl S Wizov
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA, 19107, USA.
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