Biomedical subjects

S K West

Publications and source records attributed to S K West.

At least 19 recordsLinked to original sources

PubMed2006

Prevalence and risk factors for trachoma and ocular Chlamydia trachomatis infection in Niger.

AIMS: To determine the association of personal and household risk factors for trachoma and ocular Chlamydia trachomatis infection in Niger. METHODS: 12 villages were randomly selected. A census of all households was carried out, and 651 children aged 1-5 years were randomly selected and examined. Household and personal characteristics were determined, trachoma was clinically assessed and a swab for ocular C trachomatis infection was taken. RESULTS: The prevalence of trachoma was 43% (95% confidence interval (CI) 39% to 47%) and of infection was 21% (95% CI 18% to 24%). Children aged 3-5 years had a stronger association of clinical signs with infection, compared with those aged 1-2 years. Those with unclean faces were three times more likely to have clinical trachoma or ocular C trachomatis infection, compared with those with clean faces (OR 3.1 (95% CI 1.6 to 6.2) and 3.0 (95% CI 1.4 to 6.3), respectively). 75% of compounds were within 30 min of a water source. Flies on the face were a risk factor for trachoma but not for C trachomatis infection. CONCLUSIONS: The different association of clinical signs with infection in younger versus older children may be an age-dependent difference in the duration of clinical disease. In Niger, unclean faces are a major risk factor for trachoma. The ready availability of water for washing suggests that further research on the effect of a strong health education campaign promoting clean children is warranted in this area.

Age Distribution↗

PubMed2006

The association between epilation and corneal opacity among eyes with trachomatous trichiasis.

AIM: To examine the association between epilation and corneal opacity (CO) among trichiasis patients presenting for surgery. METHODS: Cross sectional data from the STAR trial were utilised. Patients presenting for trichiasis surgery in Wolayta Zone, Ethiopia, were evaluated for current trichiasis status. Number of inturned lashes, evidence of epilation, level of entropion, trichiasis duration, and CO were collected. The primary outcome was prevalence of CO, stratified by entropion and epilation status. RESULTS: Approximately 10% of eyes with mild entropion had CO, regardless of epilation status. Among eyes with moderate entropion, epilated eyes were less likely to have CO than non-epilated eyes (21% v 34% p = 0.002). The same association was seen in eyes with severe entropion: 43% of epilated eyes while 74% of non-epilated eyes had CO (p<0.0001). Presence of CO increased with age. Adjusted models showed a protective effect of epilation in eyes with moderate or severe entropion (OR: 0.51; 95% CI: 0.32 to 0.83 and OR: 0.24; 95% CI: 0.13 to 0.45, respectively). Among eyes with mild entropion there was no difference in the prevalence of CO comparing eyes that were epilated with those that were not epilated. CONCLUSION: Entropion was the most significant predictor of CO. Cross sectional associations suggest that epilation may not be helpful for eyes with mild entropion, but may offer protection against CO in eyes with moderate to severe entropion. Epilation should not be a substitute for trichiasis surgery, however, as 43% of eyes with severe entropion that were epilated still had CO.

Corneal Opacity↗

PubMed2005

An index of community ocular Chlamydia trachomatis load for control of trachoma.

Quantitative PCR (Q-PCR) technology has recently been applied to the measurement of ocular loads of Chlamydia trachomatis. We present an index called the community ocular C. trachomatis load (COCTL) which is similar to the community microfilarial load (CMFL) of onchocerciasis. Our index has the advantage of being scale-independent so that, for example, percentage changes are the same whether calculated per eye swab or per Q-PCR capillary. The COCTL for a population or subgroup is formed by adding the arbitrary concentration of 1 organism per ml to each individual Q-PCR quantification, calculating the geometric mean, and finally subtracting 1 per ml again. The use of the COCTL is illustrated in a study of trachoma in northern Tanzania. The COCTL is higher in people with clinical trachoma than those without (5.8 organisms per swab vs. 0.1), and in children aged six months to ten years than in the overall population (1.1 vs. 0.4). The COCTL index is potentially useful for sentinel sites, operational research and calibration of clinical measures of trachoma.

Administration, Oral↗

PubMed2005

Long term outcome of trichiasis surgery in the Gambia.

BACKGROUND: Trichiasis surgery is believed to reduce the risk of losing vision from trachoma. There are limited data on the long term outcome of surgery and its effect on vision and corneal opacification. Similarly, the determinants of failure are not well understood. METHODS: A cohort of people in the Gambia who had undergone surgery for trachomatous trichiasis 3-4 years earlier was re-assessed. They were examined clinically and the conjunctiva was sampled for Chlamydia trachomatis polymerase chain reaction (PCR) and general bacterial culture. RESULTS: In total, 141/162 people were re-examined. Recurrent trichiasis was found in 89/214 (41.6%) operated eyes and 52 (24.3%) eyes had five or more lashes touching the globe. Corneal opacification improved in 36 of 78 previously affected eyes. There was a general deterioration in visual acuity between surgery and follow up, which was greater if new corneal opacification developed or trichiasis returned. Recurrent trichiasis was associated with severe conjunctival inflammation and bacterial infection. C trachomatis was detected in only one individual. CONCLUSIONS: Recurrent trichiasis following surgery is a common potentially sight threatening problem. Some improvement in the cornea can occur following surgery and the rate of visual loss tended to be less in those without recurrent trichiasis. The role of conjunctival inflammation and bacterial infection needs to be investigated further. Follow up of patients is advised to identify individuals needing additional surgical treatment.

Aged↗

PubMed2005

Characteristics of trichiasis patients presenting for surgery in rural Ethiopia.

AIMS: To determine the characteristics of trichiasis patients presenting for surgery in Wolayta Zone of Ethiopia. METHODS: Patients referred for trichiasis surgery by community health agents were evaluated by trained integrated eye care workers (IECWs) for the presence of trichiasis, locations of inturned lashes, severity of trichiasis, corneal opacity, and visual acuity. RESULTS: 1635 individuals with trichiasis presented for surgery. 82% had bilateral trichiasis; 91% of patients reported trichiasis duration of >2 years. Epilation was practised by over three fourths of the study subjects. A high proportion of patients tested positive for ocular Chlamydia trachomatis at presentation. 17% had monocular blindness and 8% were binocularly blind. Corneal opacity was highly associated with the trichiasis duration and severity and visual loss was associated with corneal opacity. CONCLUSION: Severe trichiasis reflects the magnitude of the trachoma problem in Ethiopia. Visual impairment due to trichiasis is highly associated with disease severity and duration. Early intervention to correct trichiasis before it become severe is recommended to prevent visual impairment.

Adult↗

PubMed2004

Cataract surgery and subtype in a defined, older population: the SEECAT Project.

AIM: To describe the distribution of cataract subtypes present before surgery among a defined population of older, bilaterally pseudophakic individuals. METHODS: This was a cohort study of bilaterally pseudophakic individuals participating in the Salisbury Eye Evaluation (SEE), and their locally resident siblings. Subjects underwent slit lamp and retroillumination photography and grading using the Wilmer Cataract Grading System. For all individuals determined to be bilaterally pseudophakic, an attempt was made to determine for each eye the type(s) of cataract present before surgery, based on previous SEE photographs (for SEE participants) and/or medical records obtained from the operating ophthalmologist (for both SEE participants and their siblings). RESULTS: The mean age of 223 participants providing data in this study was 78.7 (SD 5.2) years, 19.3% of subjects were black and 60.1% female. The most common surgically removed cataract subtype in this population was pure nuclear (43.5%), followed by nuclear combined with posterior subcapsular cataract (PSC) (20.6%), and nuclear combined with cortical (13.9%); less common types were pure cortical (4.9%), pure PSC (4.5%), and PSC combined with cortical (2.7%). Factors such as sex and source of lens data (study photograph versus clinical record) did not significantly affect the distribution of lens opacity types, while PSC was significantly (p = 0.01) more common among younger people and nuclear cataract was significantly (p = 0.001) more common among white compared to black people. CONCLUSION: Epidemiological studies have suggested that the different subtypes of cataract are associated with different risk factors. As studies begin to identify new prevention strategies for cataract, it would appear likely that different strategies will be efficacious against different types of cataract. In this setting, it will be helpful to know which cataract types are most frequently associated with surgery. Among this older, majority white population, nuclear cataract showed a clear predominance among individuals having undergone surgery in both eyes. This may be contrasted with both clinic and population based studies of younger people, which have generally found PSC cataract to predominate.

Age Distribution↗

PubMed2002

Blindness and visual impairment in the Americas and the Caribbean.

AIM: To summarise available data on the prevalence and causes of visual impairment and blindness in the Americas and the Caribbean. METHODS: The published literature was searched in Medline and LILACS using the following key words: blindness, visual impairment, prevalence. Articles were reviewed, and the references of the articles were also searched for relevant articles, which were also reviewed. RESULTS: Using the mortality in children under the age of 5 as an indicator, the overall prevalence of childhood blindness (in the under age 15 group) for the region was estimated at 0.45/1000, with the majority (67%) living in countries with mortality of children under age 5 above 30/1000 live births. Corneal opacities were more common in countries where the under 5 year mortality are above 30/1000 live births and retinopathy of prematurity (ROP) was an important cause in countries with intermediate death rates. For adults, overall blindness rates were not estimated because of the social, economic, and ethnic diversity in the region. The primary causes of visual loss in adults in the Americas were age related eye diseases, notably cataract and glaucoma in the African-American and Hispanic populations, and age related macular degeneration in the white population. Uncorrected refractive error was a significant cause of decreased vision across ages, ethnic groups, and countries. CONCLUSION: More data are needed on the magnitude and causes of visual loss for the Caribbean and Latin American countries. Rates of blindness and visual loss from available data within these countries are widely disparate. Prevention and control of avoidable blindness needs to be an ongoing focus in this region.

Adolescent↗

PubMed2001

Hormone replacement therapy and lens opacities: the Salisbury Eye Evaluation project.

BACKGROUND: Data suggest a possible protective effect against lens opacity with use of hormone replacement therapy (HRT). However, no agreement exists on which opacity type is affected, and more exploration of the additional role of endogenous estrogen exposure is warranted. OBJECTIVE: To determine whether HRT and the prevalence of different lens opacity types are associated after controlling for endogenous estrogen exposure. DESIGN AND SETTING: Salisbury Eye Evaluation population-based prevalence survey of residents in an eastern US city. PARTICIPANTS: One thousand two hundred thirty-nine women aged 65 through 84 years. MAIN OUTCOME MEASURES: Nuclear, cortical, and posterior subcapsular opacity. RESULTS: We found a protective association between nuclear opacity and current (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3-0.7) and recent (OR, 0.4; 95% CI, 0.3-0.7) HRT use. Increasing number of births in younger women was also protective (test of trend, P =.05). Past HRT use protected against nuclear opacity only in women who had never been pregnant (OR, 0.2; 95% CI, 0.1-0.7). Past (OR, 0.2; 95% CI, 0.1-0.7) and current (OR, 0.3; 95% CI, 0.1-0.9) HRT use were associated with a lower prevalence of posterior subcapsular opacity. CONCLUSION: A protective association between the use of HRT and nuclear and posterior subcapsular opacities is reported, which should be confirmed in prospective studies.

Aged↗

PubMed2001

The prevalence of glaucoma in a population-based study of Hispanic subjects: Proyecto VER.

OBJECTIVE: To determine the prevalence of glaucoma in a population-based sample of Hispanic adults older than 40 years. METHODS: Using 1990 census data for Arizona, groups of persons living in sections of the city in Nogales and Tucson were randomly selected with a probability proportional to the Hispanic population older than 40 years. We tried to recruit all eligible adults in homes with 1 self-described Hispanic adult. Detailed ocular examinations at a local clinic included visual acuity testing, applanation tonometry, gonioscopy, an optic disc evaluation, and a threshold visual field test. Open-angle glaucoma (OAG) was defined using a proposed international system for prevalence surveys, including threshold visual field defect and optic disc damage. Angle-closure glaucoma was defined as bilateral appositional angle closure, combined with optic nerve damage (judged by field and disc as for OAG). RESULTS: Examinations were conducted in 72% (4774/6658) of eligible persons, with a 1.97% prevalence (95% confidence interval, 1.58%-2.36%) of OAG (94 persons). The age-specific OAG prevalence increased nonlinearly from 0.50% in those aged 41 to 49 years to 12.63% in those 80 years and older. Angle-closure glaucoma was detected in 5 persons (0.10%). Sex, blood pressure, and cigarette smoking were not significant OAG risk factors. Only 36 (38%) of the 94 persons with OAG were aware of their OAG before the study. Screening results with an intraocular pressure higher than 22 mm Hg (in the eye with a higher pressure) would miss 80% of the OAG cases. CONCLUSIONS: The prevalence of OAG in Hispanic persons was intermediate between reported values for white and black persons. The prevalence increased more quickly with increasing age than in other ethnic groups. Glaucoma was the leading cause of bilateral blindness.

Adult↗

PubMed2001

Trichiasis and disability in a trachoma-endemic area of Tanzania.

OBJECTIVE: To measure limitations in the daily activities of village life associated with having trichiasis for individuals with and without visual acuity loss. METHODS: Men and women 40 years and older in 6 randomly chosen rural villages in the Kongwa district of Tanzania had visual acuity measured and were examined by an ophthalmologist. Subjects indicated the degree of difficulty with daily activities of village life and whether the difficulty was related, in any way, to vision. Limitations were scored using an indicator of "any difficulty" and using a 4-point scale ranging from "no difficulty" to "unable to do." Scores of individuals with and without trichiasis were compared separately for men and women. RESULTS: Among men, trichiasis was associated with excess functional limitation only for those with visual acuity loss (adjusted difference in proportion of tasks [AD] compared with men with neither trichiasis nor visual impairment, 0.35; 95% confidence interval [CI], 0.23-0.47). For women, trichiasis alone was limiting (AD, 0.15; 95% CI, 0.08-0.22) similarly to visual acuity loss alone (AD, 0.09; 95% CI 0.06-0.13), and the combination led to greater limitations (AD, 0.32; 95% CI, 0.26-0.39). CONCLUSION: The burden of trichiasis is likely greater than previously estimated, especially in women for whom trichiasis alone was disabling.

Activities of Daily Living↗

PubMed2001

Determinants of trachoma endemicity using Chlamydia trachomatis ompA DNA sequencing.

A six-year prospective study of Chlamydia trachomatis infection and ocular disease in Tanzanian village children was conducted to identify the determinants of trachoma endemicity using sequencing of ompA. Overall, 749 conjunctival samples were obtained, with 176 children sampled in both 1989 and 1995. 31.1% (233/749) were positive by PCR-enzyme immunoassay, and 76% (176/233) of the positives were sequenced in variable domains (VD) 1 to 4 (22 children in both 1989 and 1995). Twenty-six ompA genotypes of serovar A, and 19 of B/Ba were identified, and only 20% of genotypes identified in 1995 matched those found in 1989. In particular, B/Ba genotypes exhibited a 15-base region in VD 2 with increased nucleotide substitution, and these types were associated with age and water availability. Homotypic infection and infection with multiple genotypes and high chlamydial load did predict subsequent severe trachoma (odds ratio (OR) = 10.14, 95% confidence interval (CI): 1.71, 60.23; OR = 6.40, 95% CI: 0.75, 54.41; OR = 6.74, 95% CI: 0.82, 55.38, respectively). And, multitypic infection was clustered with residence of village and associated with familial cattle ownership. In conclusion, high ompA polymorphism and the inability of some hosts to clear infection with the same ompA genotype suggest two distinct but converging mechanisms of endemic severe trachoma.

Amino Acid Sequence↗

PubMed2001

Progression of active trachoma to scarring in a cohort of Tanzanian children.

Risk factors for the incidence of scarring are needed to inform trachoma control programs in countries hyperendemic for this blinding disease. A cohort of pre-school children with constant, severe trachoma, and an age, sex, and neighborhood matched cohort of children without constant severe trachoma were followed for seven years to determine the incidence of scarring. The incidence of scarring in the children with constant severe trachoma was 29.2% versus 9.6% in the comparison group. In a model adjusting for multiple factors, significant predictors of scarring were increasing age, female, and constant severe trachoma (OR = 4.85, 95% CL = 2.05, 11.40). Infection with C. trachomatis at follow up was also associated with scarring in both groups of children. It is likely that these children have a different host response to infection, and represent a subgroup at high risk for the blinding complications of trachoma. Reducing exposure to infection in the community through antibiotics and changes in hygiene practices is still the most promising control strategy.

Child↗

PubMed2001

The SAFE strategy for trachoma control: planning a cost-effectiveness analysis of the antibiotic component and beyond.

AIM: A limited literature addresses the cost-effectiveness of the prevention and treatment of trachoma and its sequelae. The literature focuses on government costs. This paper motivates the inclusion of and details methods for measuring the costs for the target population. METHODS: Costs to the targeted population can be measured while studying efficacy or effectiveness. These costs can be added to the more frequently measured costs to the government to calculate costs for the entire society. This section indicates the types of costs to consider, refines the concept of costs, describes the necessary data, outlines how the methods of data collection fit with the methods that would be employed for a general effectiveness study, and describes the appropriate calculation of a cost-effectiveness ratio. RESULTS: The costs to the targeted population can be measured with few additional resources. Placing a value on villagers' time or translating clinical results into summary, preference-based health-related quality of life measures would increase the resources required more substantially. DISCUSSION: For theoretical and practical reasons, future cost-effectiveness analyses of the full SAFE strategy and the antibiotic component of the strategy should be done from a perspective that includes both the government and the targeted population. This can be useful in policy making and increase our understanding of reasons for less than universal participation.

Anti-Bacterial Agents↗

PubMed2001

Diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER.

OBJECTIVES: The prevalence rate of diabetes is probably higher in Hispanics than in Caucasians, although there is controversy about differences in the risk of diabetic retinopathy. The purpose of the study is to determine the prevalence rates of diabetes and diabetic retinopathy in a population-based study of Hispanics aged > or = 40 years. RESEARCH DESIGN AND METHODS: Proyecto VER is a random sample of Hispanic populations aged > or = 40 years in Arizona. A total of 4,774 individuals (71.6% of the eligible sample) completed the examinations. Diabetes was defined as self-report of a physician diagnosis or HbA(1c) value of > or = 7.0%. Diabetic retinopathy was assessed on stereo fundus photographs of fields 1, 2, and 4. RESULTS: The prevalence rate of diabetes in the Hispanic community (individuals > or = 40 years of age) was 22%. The prevalence rate of diabetic retinopathy (DR) was 48%; 32% had moderate to severe nonproliferative and proliferative retinopathy. DR increased with increasing duration of diabetes and increasing level of HbA(1c). The prevalence rate of DR-like changes in the sample of individuals without diabetic retinopathy was 15% and was not associated with hypertension, systolic blood pressure, or diastolic blood pressure. CONCLUSIONS: The prevalence rate of diabetes in this population of Hispanics is high, almost twice that of Caucasians. The prevalence rate of DR is high but similar to reports in a Caucasian population. The prevalence rate of 9% moderate to severe retinopathy in the newly diagnosed group suggests that efforts to improve detection and treatment of diabetes in Hispanics may be warranted.

Adult↗

PubMed2001

The association of multiple visual impairments with self-reported visual disability: SEE project.

PURPOSE: This report examines the relationship between psychophysical measures of visual impairment and self-reported difficulty with everyday visual tasks in a population-based sample of individuals 65 years of age and older. METHODS: Community-dwelling residents (n = 2520) of Salisbury, MD, between the ages of 65 and 84 were recruited for the study. Visual acuity under normal and low luminance, contrast and glare sensitivity, stereoacuity, and visual fields were measured. Subjective physical disability was assessed with the Activities of Daily Vision Scale (ADVS). RESULTS: In multiple regression analyses adjusted for demographic factors, cognitive status, depression, and number of comorbid medical conditions, each of the vision tests except low luminance acuity was independently associated with lower ADVS scores. The analyses indicate that a factor of 2 reduction in visual acuity or contrast sensitivity, comparable with that observed in mild to moderate lens opacity, was associated with a three- to fivefold odds of reporting difficulty with daily tasks. Although age alone was a significant risk factor for disability, it was not associated with overall ADVS score, once visual impairment and other chronic medical conditions were taken into account. CONCLUSIONS: Visual acuity, contrast and glare sensitivity, stereoacuity, and visual fields are significant independent risk factors for self-reported visual disability in an older population. Visual impairment defined by acuity alone is not the only dimension of the association with subjective disability. Additional vision measures are required to understand the impact of vision loss on everyday life.

Activities of Daily Living↗

PubMed2001

Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome.

OBJECTIVES: To compare the incidence of retinal detachment in patients treated with the ganciclovir implant compared with those treated using systemic therapy only, among 511 patients with the acquired immunodeficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis and to describe the influence of highly active antiretroviral therapy (HAART) on retinal detachment incidence. PATIENTS AND METHODS: All patients with AIDS and CMV retinitis at 1 center were followed up prospectively from CMV retinitis diagnosis for incidence of retinal detachment. Patient- and eye-specific data regarding demographic and clinical characteristics were collected at the time of CMV retinitis diagnosis. Use of anti-CMV and antiretroviral treatments and the development of an immunologic response to HAART during follow-up were recorded. RESULTS: No significant difference in the rate of retinal detachment was found between eyes treated with systemic therapy only and those treated with ganciclovir implants, whether used as primary therapy or subsequent to using systemic anti-CMV therapy. The use of HAART was associated with a 60% reduction in retinal detachment rate (P<.001), with the greatest benefit observed among patients who developed an immunologic response to HAART. CONCLUSIONS: Our results suggest that there is no substantial excess risk of retinal detachment when patients with AIDS and CMV retinitis are treated with ganciclovir implants as opposed to systemic anti-CMV therapy only. However, the use of HAART in these patients appears to reduce the risk of retinal detachment substantially.

AIDS-Related Opportunistic Infections↗

PubMed2001

The heritability of age-related cortical cataract: the twin eye study.

PURPOSE: A classical twin study was performed to establish the relative importance of genes and environment in cortical cataract. METHODS: Five hundred six pairs of unselected female twin volunteers (226 monozygotic and 280 dizygotic) with a mean age of 62 years (range, 49-79 years) were examined. Cortical cataract was assessed using the slit-lamp-based Oxford Clinical Cataract Classification and Grading System (clinical grading) and the Wilmer Automated Grading System, which analyzed digital retroillumination images of subjects' lenses (digital grading). The worse eye categorized score for each individual was used in maximum likelihood path modeling of the correlations within twin pairs. These correlations were used to determine the underlying liability to cortical cataract. RESULTS: Prevalence of significant cortical cataract (>/=5% of lens area) was similar in monozygotic and dizygotic twins, occurring in 19.4% and 20.6% with the clinical grading system and 24% and 23% using the digital grading system, respectively. Modeling suggested liability to cortical cataract is explained by additive and dominant genes, individual environment, and age. Estimates of the broad sense heritability of cortical cataract were 58% (95% confidence interval [CI], 51%-64%) for the clinical grading system and 53% (95% CI, 45%-60%) for the digital system. Dominant genes were estimated to contribute to 38% (95% CI, 1%-64%) of the genetic effect with the clinical grading and 53% (95% CI, 28%-60%) with the digital grading. Individual environment explained 26% and 37% and age 16% and 11% of cortical cataract variance in clinical and digital gradings, respectively. CONCLUSIONS: Genetic effects are important in the development of cortical cataract and involve the action of dominant genes.

Aged↗

PubMed2001

Psychometric properties of the 25-item NEI-VFQ in a Hispanic population: Proyecto VER.

PURPOSE: To assess the psychometric properties of the NEI-VFQ-25 in a population-based study of older Hispanic persons living in the United States, explore other demographic factors that affect participant response, and observe the comparability of the Spanish and English versions of the instrument. METHODS: A sample of randomly selected block groups in Tucson and Nogales, Arizona, were selected for study. Participants were interviewed at home; a majority of the interviews were conducted in Spanish. The home interview included questions from the NEI-VFQ-25 and HHANES: Presenting acuity was done using ETDRS methodology, followed by a standardized eye examination by an ophthalmologist. The authors analyzed the internal consistency of the NEI-VFQ-25 responses using Cronbach's alpha coefficient and the construct validity by assessing the relationship between presenting acuity and scale scores, adjusting for age and gender. A second model was also explored to determine whether other demographic variables affected scale scores; differences in reporting between the Spanish and English versions was observed in this model, used in a subset of the population that minimized interviewer effect. RESULTS: Of the 4774 participants in the study, 99.7% had completed questionnaires, not completed by proxy. The highest nonresponse rate occurred in the Driving scale, with 25% of participants not driving for reasons other than problems with vision. Internal consistency was high, with Cronbach alpha ranging between 0.65 and 0.86 for scales with multiple items. Adjusting for age and gender, those with presenting acuity worse than 20/40 scored significantly lower than those with presenting acuity 20/40 or better, for all scales. The demographic variables with the most consistent association across the NEI-VFQ-25 scales were presenting acuity, income, and gender. No significant differences in reporting were found between the Spanish and English versions of the questionnaire in the subset of the population. CONCLUSIONS: In this study of Hispanic people age 40 years or older, the NEI-VFQ-25 was sensitive to presenting acuity and other demographic variables, such as age, gender, and income. The findings from this psychometric analysis provide evidence of the reliability and validity of some of the scales in the 25-item NEI-VFQ when used among people with a range of visual acuity level, providing other explanatory variables are also considered.

Activities of Daily Living↗