Visual function in preimetrically blind fields.
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Blindness↗
SEARCH · PubMed Health
Results for “Persons with Visual Disabilities”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Can an eye in phthisis be rehabilitated? A case of improved vision with 1-year follow-up.
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Burns, Chemical↗
Acute care hospital utilization by patients with visual impairment.
OBJECTIVE: To assess whether visual impairment contributes to average length of stay (ALOS) within inpatient care facilities. METHODS: We used the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) data for 1993, containing 1 principal diagnosis code and up to 8 secondary diagnosis codes for approximately 2.6 million hospital discharges. We evaluated ALOS differences in patients with and without visual impairment and in patients with eye pathologic conditions, including eye surgery. Visual impairment is not a primary admitting diagnosis, but may be coded as a secondary diagnosis. Eye pathology comprises a large variety of conditions, including corneal ulcers, abscesses, corneal deposits, edema, cataracts, vitreous hemorrhages, and many other eye disorders (ICD-9-CM codes 360-368.9 and 370-379). RESULTS: The ALOS was 13.4 days for patients with visual impairment (N = 5764), 11.9 days for patients with either eye pathology or visual impairment (N = 60,085), and 8.2 days for patients with no visual impairment (N = 2,546,586). Using a series of multivariate models that controlled for the variables of age, sex, and payer source, as well as disease, disorders, and ophthalmology procedures, we found that the existence of visual impairment added 2.4 days to the ALOS (P<.001), while eye pathology combined with a secondary diagnosis of visual impairment added 1.8 days to the ALOS (P<.001). CONCLUSIONS: Visual impairment contributes significantly to hospital length of stay. A better understanding of the functional care needs of patients with visual impairment in an acute care setting and at the time of discharge from the hospital may contribute to reducing excess ALOS and its related costs while improving the quality of patient care.
Adult↗
Age-specific causes of bilateral visual impairment.
OBJECTIVES: To describe the age-specific prevalence of common eye diseases causing bilateral visual impairment and estimate the total number of Australians with cause-specific visual impairment. METHODS: Cluster-stratified random sample of 5147 residents aged 40 years and older from urban and rural areas and aged-care facilities. Participants completed a standardized interview and eye examination. Four levels of bilateral visual impairment were defined: less than 20/40 to 20/60 and/or homonymous hemianopia (mild), less than 20/60 to 20/200 or better and/or less than 20 degrees to 10 degrees radius field (moderate), less than 20/200 to 10/200 and/or less than 10 degrees to 5 degrees radius field (severe), and less than 1O/ 200 and/or less than 50 radius field (profound). The major cause of vision loss was identified for all participants found to be visually impaired. RESULTS: Uncorrected refractive error was the most common cause of bilateral visual impairment across all decades of life, rising from 0.5% in 40- to 49-year-olds to 13% among those aged 80 years and older. Prevalence of visual impairment due to diabetic retinopathy was 0.7% in 50- to 59-year-olds and 0.8% in those older than 80 years. Visual impairment due to glaucoma had a prevalence of 0.7% among 60-year-olds and rose to 4% of those older than 90 years. The prevalence of visual impairment due to cataract (only present in those aged 70 years or older) rose from 0.6% to 11% in those older than 90 years, and the prevalence of visual impairment due to age-related macular degeneration rose from 0.8% to 16% in those older than 90 years. CONCLUSIONS: The predominant causes of visual impairment change with age. Recognition of these patterns is fundamental for early diagnosis and treatment of eye disease and, where appropriate, referral for rehabilitation.
Adult↗
Visual acuity impairment and mortality in US adults.
OBJECTIVE: To examine the associations between reported visual impairment (VI) and mortality in a nationally representative sample of US adults. METHODS: The National Health Interview Survey is a multistage probability survey of the US civilian population. Adults within households were administered questions about VI and selected eye diseases (n = 116 796). Mortality linkage data with more than 96% of the 1986-1994 survey participants were available through December 31, 1997. Statistical analyses included Cox proportional hazards regression analysis. MAIN OUTCOME MEASURES: All-cause, cardiovascular disease-related, and cancer-related mortality. RESULTS: A total of 327 participants (0.3%) had severe bilateral VI; an additional 4754 (4%) had some VI and/or severe VI in at least one eye. Mortality linkage identified 8949 deaths. After controlling for survey design, age, race, marital status, educational level, reported health status, glaucoma, cataract, and retinopathy, women, but not men, with reported severe bilateral VI were at a significantly increased risk of death relative to their counterparts without VI (hazard ratio [95% confidence interval], 2.21 [1.61-3.02] and 1.33 [0.96-1.84], respectively); risk of mortality was also slightly but significantly elevated in women and men with some reported VI compared with those reporting no VI. Similar patterns of associations were found for cardiovascular disease-related mortality. Risk of cancer-related mortality was not associated with VI. CONCLUSION: Reported severe bilateral VI and, to a smaller extent, less severe VI are associated with an increased risk of all-cause mortality and cardiovascular disease-related mortality in US women; there is weaker evidence for an association between VI and mortality in US men.
Adolescent↗
The impact of diabetic retinopathy on participation in daily living.
OBJECTIVE: To determine the restriction of participation in daily activities of people with diabetic retinopathy using the Impact of Vision Impairment questionnaire. METHODS: Individuals with diabetic retinopathy and a visual acuity (VA) worse than 20/40 or 6/12 in the better eye were eligible. Participants answered demographic questions and had VA information abstracted from medical records. If VA information was unavailable, it was assessed by an orthoptist. MAIN OUTCOME MEASURES: All participants completed the Impact of Vision Impairment questionnaire, which was either self-administered or interviewer administered. The physical and mental health components were assessed using the Medical Outcomes Study 12-Item Short Form (SF-12) questionnaire. RESULTS: Forty-five participants (mean age, 67.5 years) were recruited, with almost 70% (30/45) recording a VA worse than 20/60 or 6/18 in the better eye. The median duration of vision loss was 2.0 years. The highest restriction was reported for the Leisure and Work, Mobility, and Consumer and Social Interaction domains (mean, 3.0, 2.8, and 2.8, respectively), compared with the Emotional Reaction to Visual Loss and Household and Personal Care domains (mean, 2.3 and 2.1, respectively) (P<.005). The activities with the greatest restriction of participation were reading print, mobility, work, and leisure. A poorer VA in the better eye correlated independently with increased restriction of participation, as measured by the Impact of Vision Impairment questionnaire scores (partial correlations, 0.29-0.41; P< or =.03). CONCLUSION: Low-vision rehabilitation services aiming to improve outdoor mobility, print reading, participation in leisure activities, and psychological health may be an effective strategy to help people with diabetic retinopathy increase their participation in daily activities.
Activities of Daily Living↗
Blindness and visual impairment: a public health issue for the future as well as today.
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Blindness↗
Associations of mortality with ocular disorders and an intervention of high-dose antioxidants and zinc in the Age-Related Eye Disease Study: AREDS Report No. 13.
OBJECTIVE: To assess the association of ocular disorders and high doses of antioxidants or zinc with mortality in the Age-Related Eye Disease Study (AREDS). METHODS: Baseline fundus and lens photographs were used to grade the macular and lens status of AREDS participants. Participants were randomly assigned to receive oral supplements of high-dose antioxidants, zinc, antioxidants plus zinc, or placebo. Risk of all-cause and cause-specific mortality was assessed using adjusted Cox proportional hazards models. RESULTS: During median follow-up of 6.5 years, 534 (11%) of 4753 AREDS participants died. In fully adjusted models, participants with advanced age-related macular degeneration (AMD) compared with participants with few, if any, drusen had increased mortality (relative risk [RR], 1.41; 95% confidence interval [CI], 1.08-1.86). Advanced AMD was associated with cardiovascular deaths. Compared with participants having good acuity in both eyes, those with visual acuity worse than 20/40 in 1 eye had increased mortality (RR, 1.36; 95% CI, 1.12-1.65). Nuclear opacity (RR, 1.40; 95% CI, 1.12-1.75) and cataract surgery (RR, 1.55; 95% CI, 1.18-2.05) were associated with increased all-cause mortality and with cancer deaths. Participants randomly assigned to receive zinc had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89). CONCLUSIONS: The decreased survival of AREDS participants with AMD and cataract suggests that these conditions may reflect systemic rather than only local processes. The improved survival in individuals randomly assigned to receive zinc requires further study.
Aged↗
Cause-specific visual impairment and mortality: results from a population-based study of older people in the United Kingdom.
OBJECTIVE: To assess the association between mortality and cause-specific visual impairment in older people. METHODS: Visual acuity and causes of visual impairment were collected in 13 569 participants 75 years and older participating in a randomized trial of health screening. Participants were followed up for mortality for a median of 6.1 years. RESULTS: Compared with those with 6/6 (or 20/20 Snellen) or better visual acuity, the age- and sex-adjusted rate ratio for visually impaired people (binocular visual acuity <6/18 or <20/60 Snellen) was 1.60 (95% confidence interval, 1.47-1.74), which was markedly attenuated (rate ratio, 1.17; 95% confidence interval, 1.07-1.27) after adjustment for confounding factors. People whose visual impairment was due to cataract or age-related macular degeneration had excess risks of all-cause and cardiovascular mortality, which disappeared after adjustment. People with refractive error remained at small risk, despite adjustment, probably owing to residual confounding from factors associated with minimal use of eye services rather than underlying eye disease. There were no associations with cancer mortality. CONCLUSION: Associations reported for visual impairment and mortality or for specific causes of visual impairment reflect confounding by comorbidities, risk factors, and other factors related to susceptibility to death rather than an independent biological association of vision problems or specific eye diseases.
Aged↗
Prevalence of age-related macular degeneration in a population-based sample of Hispanic people in Arizona: Proyecto VER.
OBJECTIVE: To report the prevalence of age-related macular degeneration (AMD) in a population-based sample of Hispanic individuals aged 50 years and older. METHODS: Proyecto VER (Vision and Eye Research) is a population-based study of blindness and visual impairment of Hispanic people in Arizona. Participants underwent complete ophthalmic evaluation, including stereoscopic fundus photography of fields 1, 2, and 4. All photographs for participants aged 50 years and older were graded using the Wisconsin Age-Related Maculopathy Grading system. The following signs were graded: drusen size, drusen type, and the area covered by drusen; pigmentary abnormalities; geographic atrophy; and exudative AMD. RESULTS: Sixty-seven percent (3178) of the original 4774 participants were 50 years of age or older. Of those, 92% (2928) had fundus photographs in at least 1 eye, and 95% (2780) of the photographs were of sufficient quality to grade early and late AMD. OUTCOME MEASURES: The overall prevalence of late AMD was 0.5%. The prevalence increased from 0.1% in the 50- to 59-year age group to 4.3% in the group aged 80 years and older. Likewise, early AMD was strongly associated with age with a prevalence of 20% in the 50- to 59-year age group, increasing to 54% in the group aged 80 years and older. The prevalence of early AMD in Hispanic people was significantly higher than the reported prevalence in the white population. However, the prevalence of late AMD was lower than the estimates for the white population of the United States. CONCLUSIONS: Although early macular changes were very common among Hispanic people, the prevalence of late AMD was infrequent. Further work is necessary to understand the underlying reasons for the different patterns of presentation of early and late signs of AMD among racial/ethnic groups and to characterize early AMD based on predictive value for severe disease in different populations.
Age Distribution↗
Poor uptake of cataract surgery in nursing home residents: the Salisbury Eye Evaluation in Nursing Home Groups study.
OBJECTIVE: To compare the uptake of cataract surgery in nursing homes in which assistance was provided in obtaining services with that in control homes. METHODS: The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) project is a randomized clinical trial studying the effect of a comprehensive vision restoration-rehabilitation program, including the provision of cataract surgery services when needed. Twenty-eight nursing homes in the Eastern Shore area of Maryland and Delaware were matched in pairs by size and payment type. Nursing homes within each pair were randomized to usual care or targeted intervention. Persons with cataract causing visual acuity in the better eye to be worse than 20/40 were informed of the possible benefit of cataract surgery. For those in intervention homes, additional support was provided in obtaining cataract surgery. RESULTS: Of residents with vision-impairing cataract in intervention homes, 31% underwent cataract surgery vs 2% in usual-care facilities. Residents with cataract compared with all residents without visual impairment, regardless of nursing home assignment, tended to be older (mean age, 86.7 vs 82.1 years; P<.001), were more likely to be black (age-adjusted P<.001), had lower Mini-Mental State Examination scores (mean, 11.7 vs 16.2; age-adjusted P<.001), and longer length of stay (mean, 42.3 vs 24.4 months; P<.001). Furthermore, cataract was associated with significant visual impairment and with functional limitations, with 20% of those recommended for surgery having a visual acuity of 20/100 or worse in the better-seeing eye. CONCLUSIONS: Screening for and identifying cataracts as a cause of vision loss rarely results in uptake of cataract surgery services in nursing homes. The addition of a support system to facilitate the process of scheduling surgery and getting to and from the hospital dramatically increases uptake rates.
Aged↗
Visual impairment and eye abnormalities in Oklahoma Indians.
OBJECTIVE: To determine the prevalence of visual impairment and eye abnormalities in Oklahoma Indians. METHODS: The cross-sectional study included 1019 Oklahoma Indians, aged 48 to 82 years; 60.2% were women. All participants gave a personal interview, and all underwent an eye examination, including the determination of best-corrected visual acuity and an ophthalmoscopic examination. In addition, two 45 degrees fundus photographs were taken of each eye, and these photographs were graded by the Fundus Photography Reading Center at the University of Wisconsin, Madison. RESULTS: Among the 1019 participants, 77.4% had a visual acuity of 20/20 or better, 19.5% and 2.5% had visual acuities of between 20/25 and 20/40 and between 20/50 and 20/190, respectively; and 0.6% were legally blind, all in the better eye. Cataract was the most frequent contributing cause and age-related macular degeneration the second most frequent contributing cause of visual impairment. The overall prevalence proportions of age-related macular degeneration, cataract, diabetic retinopathy, and definite glaucoma were 33.6%, 39.6%, 20.1%, and 5.6%, respectively. Most of the other eye abnormalities were rare in the study participants, except for pinguecula (42.4%) and dermatochalasis (30.1%). CONCLUSIONS: Oklahoma Indians have a higher prevalence of visual impairment, age-related macular degeneration, and diabetic retinopathy than other ethnic groups. The implementation of adequate treatment and prevention programs for eye diseases is indicated.
Aged↗
Community-based vision-rehabilitation services provide help and hope.
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Community Health Services↗
Complex visual hallucinations in the visually impaired: a structured history-taking approach.
OBJECTIVE: To study complex visual hallucinations in visually impaired individuals. METHODS: A prospective comparative study involving structured history taking and cognitive assessment in 48 consecutive visually impaired individuals with best-corrected visual acuity of 20/200 or worse and an age-matched cohort of 48 consecutive patients with visual acuity of 20/40 or better in at least 1 eye. RESULTS: Thirty visually impaired subjects (63%) experienced hallucinations, unrelated to specific ocular pathology. None volunteered the symptom; 2 admitted hallucinations on nonleading questioning and 28 on direct questioning. All displayed insight into the unreality of their hallucinations, although 18 (60%) achieved this after initial deception. Seventeen (57%) expressed concern; 7 (23%) experienced disturbing images. Nineteen (63%) feared being labeled as insane were they to admit to hallucinations, while 10 (33%) were fearful of impending insanity. Sixteen (94%) of 17 concerned patients derived comfort from sympathetic reassurance that their hallucinations did not represent sinister pathology. In contrast, none of the individuals with normal vision experienced any hallucinations (P<.001). Cognition was intact in all groups. CONCLUSIONS: Complex visual hallucinations with insight commonly occur in visually impaired, cognitively intact individuals due to acquired visual impairment and are unrelated to chronological age. Hallucinatory experiences are almost invariably admitted to only on direct questioning, due to fears of being considered insane. Although generally pleasant, hallucinations may cause distress, because of content or implications of the hallucinatory activity. Sympathetic explanation affords significant emotional relief.
Adult↗
Self-reported comorbidities and visual function in a population-based study: the Los Angeles Latino Eye Study.
OBJECTIVE: To assess the association of self-reported systemic and ocular comorbid disease and visual function in Latino subjects. METHODS: National Eye Institute 25-item Visual Function Questionnaire (NEI-VFQ-25) and eye examination data were obtained from 5380 participants in the Los Angeles Latino Eye Study, a population-based prevalence study of eye disease in Latino subjects 40 years and older. We developed and contrasted 5 comorbidity measures. One-way analysis of variance was used to assess the association between comorbidity and visual impairment and self-reported visual function. Regression analyses determined the association of sociodemographic variables, clinical variables, and the best measure of comorbidity with the NEI-VFQ-25 composite score. The main outcome measure was self-reported visual function as assessed by the NEI-VFQ-25 composite score. RESULTS: On average, visual function subscale scores were lowest for those participants with the most systemic comorbid conditions (P<.05). This was more evident in participants with moderate or severe visual impairment compared with those with mild or no visual impairment (P<.05). CONCLUSIONS: Self-reported systemic comorbidities were associated with self-reported visual function. This association was greater at more severe levels of visual impairment. Of the 5 comorbidity measures assessed, the measure that summed the number of self-reported systemic comorbidities correlated most with self-reported visual function.
Adult↗
Ophthalmologists' referrals improve the lives of visually impaired patients.
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Humans↗
Development of visual acuity in children with cerebral visual impairment.
OBJECTIVE: To study the development of visual acuity in term-born children with cerebral visual impairment and a history of neonatal hypoxic-ischemic encephalopathy. METHODS: We studied 19 term-born children, aged 6 months to 6 years, with moderate to severe neonatal hypoxic-ischemic encephalopathy and behaviors indicative of cerebral visual impairment. Longitudinal measures of grating acuity were obtained using preferential looking (PL) and visual evoked potential (VEP) procedures. Visual acuities at first and last visits were compared. The courses of acuity development in the 9 children who underwent both VEP and PL acuity assessment at 4 or more ages were compared with normal development. RESULTS: All children had measurable PL and VEP acuity, despite poor visual behavior. In nearly all, both PL and VEP acuity were below normal for age. For both PL and VEP measures, acuity at the last visit was, on average, 1 octave better than at the first visit, with a rate of improvement lower than normal. Although parallel courses of PL and VEP development occurred in many, substantial disparities in PL and VEP acuity were observed in others. CONCLUSIONS: Modest increases in PL and VEP grating acuity occur during early childhood in many of these patients. The rate of increase is lower than normal.
Blindness, Cortical↗
Development of cataract and associated risk factors: the Visual Impairment Project.
OBJECTIVE: To evaluate risk factors for the development of cataract in Australian residents. METHODS: A total of 3721 participants from 9 randomly selected urban districts within Victoria were recruited and invited to attend comprehensive standardized interviews and ophthalmic examinations at baseline and then 5-year follow-up. Lens opacities were graded clinically and on photographs according to the Wilmer cataract grading system. The development of cortical, nuclear, and posterior subcapsular cataract were assessed separately for associated risk factors. Risk exposure at baseline was used as the predictor for cataract development, which included various sociodemographic, dietary, familial, medical, and ocular characteristics of the participants. Risk factor analyses were performed by univariate and multivariate logistic regression. RESULTS: Increased age was a risk factor for development of all types of cataract with an increasing risk trend throughout life for nuclear cataract. Female sex, a laborer's occupation, and myopia were independent risk factors for development of cortical cataract. For development of nuclear cataract, the independent risk factors were having a birthplace outside Australia and New Zealand, current cigarette smoking, and having a history of arthritis. Diabetes mellitus and having taken calcium channel blockers for longer than 5 years were independent risk factors for posterior subcapsular cataract. CONCLUSIONS: The trend of increasing incidence of cataract with increased age is a major public health concern with an aging population in Australia and the world. Among the risk factors identified, cigarette smoking is a factor that is readily modifiable and preventable. The other risk factors identified require further support or clarification of underlying mechanisms to find modifiable features.
Adult↗