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The economic burden of major adult visual disorders in the United States.

OBJECTIVE: To estimate the societal economic burden and the governmental budgetary impact of the following visual disorders among US adults aged 40 years and older: visual impairment, blindness, refractive error, age-related macular degeneration, cataracts, diabetic retinopathy, and primary open-angle glaucoma. DESIGN: We estimated 3 components of economic burden: direct medical costs, other direct costs, and productivity losses. We used private insurance and Medicare claims data to estimate direct medical costs; epidemiologic evidence from multiple published sources to estimate other direct costs, such as nursing home costs; and data from the Survey of Income and Program Participation to estimate productivity losses. We used budgetary documents and our direct medical and other direct cost estimates to approximate the governmental budgetary impact. RESULTS: We estimated that the annual total financial burden of major adult visual disorders is $35.4 billion ($16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses) and that the annual governmental budgetary impact is $13.7 billion. CONCLUSIONS: Major visual disorders among Americans older than 40 years result in substantial economic costs for the US economy. Well-designed public health programs may have the ability to reduce this burden in the future.

Absenteeism↗

Age-related eye disease, visual impairment, and survival: the Beaver Dam Eye Study.

OBJECTIVE: To investigate the relationship of age-related maculopathy, cataract, glaucoma, visual impairment, and diabetic retinopathy to survival during a 14-year period. METHODS: Persons ranging in age from 43 to 84 years in the period from September 15, 1987, to May 4, 1988, participated in the baseline examination of the population-based Beaver Dam Eye Study (n = 4926). Standardized protocols, including photography, were used to determine the presence of ocular disease. Survival was followed using standardized protocols. RESULTS: As of December 31, 2002, 32% of the baseline population had died (median follow-up, 13.2 years). After adjusting for age, sex, and systemic and lifestyle factors, poorer survival was associated with cortical cataract (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.06-1.37), any cataract (HR, 1.16; 95% CI, 1.03-1.32), diabetic retinopathy (HR per 1-step increase in 4-level severity, 1.36; 95% CI, 1.14-1.63), and visual impairment (HR, 1.24; 95% CI, 1.04-1.48) and marginally associated with increasing severity of nuclear sclerosis (HR, 1.07; 95% CI, 0.99-1.16). Age-related maculopathy and glaucoma were not associated with poorer survival. Associations tended to be slightly stronger in men than women. CONCLUSIONS: Cataract, diabetic retinopathy, and visual impairment were associated with poorer survival and not explained by traditional risk factors for mortality. These ocular conditions may serve as markers for mortality in the general population.

Adult↗

Cognitive impairment in the Age-Related Eye Disease Study: AREDS report no. 16.

OBJECTIVE: To investigate potential associations between cognitive function and/or impairment and age-related macular degeneration (AMD) and visual impairment in the Age-Related Eye Disease Study (AREDS). METHODS: The AREDS is an 11-center natural history study of AMD and age-related cataract. The AREDS Cognitive Function Battery was administered to 2946 participants. The battery consists of 6 neuropsychological tests measuring performance in several cognitive domains. The Dunnett multiple comparison test was used to identify differences by AMD and visual acuity severity. The relationship with cognitive impairment was also assessed using logistic regression. RESULTS: Mean scores of instruments in the AREDS Cognitive Function Battery declined with increased macular abnormalities and reduced visual acuity. After adjustment for age, sex, race, education, smoking status, diabetes mellitus, hypertension, and depression, increased macular abnormalities (trend P value <.05) reduced mean cognitive function scores as measured by the Modified Mini-Mental State Examination and the Wechsler Logical Memory Scale. Reduced vision was found to be associated with reduced mean cognitive function scores as measured by the Modified Mini-Mental State Examination and letter and verbal fluency tasks. Persons with vision worse than 20/40 OU were more likely to be cognitively impaired (Modified Mini-Mental State Examination score <80) (odds ratio, 2.88 [95% confidence interval, 1.75-4.76]) compared with persons with visual acuity of 20/40 or better OU. CONCLUSION: These data suggest a possible association of advanced AMD and visual acuity with cognitive impairment in older persons.

Aged↗

Reading aids for adults with low vision.

BACKGROUND: The purpose of low vision rehabilitation is to allow people to resume or to continue to perform daily living tasks, reading being one of the most important. This is achieved by providing appropriate optical devices and special training in the use of residual vision and low vision aids, which range from simple optical magnifiers to high power video magnifiers. OBJECTIVES: The objective of this review was to assess the effects of reading aids for adults with low vision. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library, MEDLINE, EMBASE, SIGLE, LILACS, IndMed to July 2006 and the reference lists of relevant articles. We used the Science Citation Index to find articles that cited the included studies and contacted investigators and manufacturers of low vision aids. We handsearched the British Journal of Visual Impairment from 1983 to 1999 and the Journal of Visual Impairment and Blindness from 1976 to 1991. SELECTION CRITERIA: This review included randomised and quasi-randomised trials in which any device or aid used for reading had been compared to another device or aid in people aged 16 or over with low vision as defined by the study investigators. DATA COLLECTION AND ANALYSIS: Each author independently assessed trial quality and extracted data. MAIN RESULTS: Eight small studies with a cross-over design (221 people overall) and one three parallel-arm study (243 participants) were included in the review. The cross-over studies evaluated various types of aids. The quality of the studies was unclear in most cases, especially concerning carry-over or period effects. In one study on 20 participants head-mounted electronic devices (four types) were worse than optical devices. We could not find any differences in comparisons among electronic devices when pooling 23 participants of two small studies. One study on 10 people found that overlay coloured filters were no better than a clear filter. A parallel-arm study including 243 patients with age-related macular degeneration found that custom or standard prism spectacles are not different from conventional near spectacles, but the estimated difference was not precise. AUTHORS' CONCLUSIONS: Further research is needed on the comparison of different types of low vision aids. It will be also necessary to delineate patient's characteristics that predict performance with costly electronic devices as well as their sustained use in the long term compared to simpler and cheaper optical devices.

Adult↗

Postural balance and health-related factors in middle-aged and older women with injurious falls and non-fallers.

BACKGROUND AND AIMS: Older fallers aged over 70 years have shown impaired balance abilities, but it is unclear if impairment in balance control can be detected among fallers who are in their 50's and 60's. The aim of this study was to analyze possible differences in balance control and other health-related factors between female fallers and non-fallers aged 50-68 years. METHODS: Women 50-68 years of age (N=40) who had fallen outside and needed medical attention were recruited through a larger fall accident study. Non-fallers (N=97) were women representing the same age group who had not fallen during the preceding 12 months. A battery of standing force platform balance tests were administered together with an interview on health status, use of medication, dizziness, vision, hearing, and physical activity. RESULTS: Significant differences were not found between women with injurious falls and non-fallers in the various balance tests. In the younger age group (50-58 years), chronic illnesses, use of medication, dizziness, and self-reported problems with vision and hearing were more common in fallers than in non-fallers. CONCLUSIONS: Our results suggest that, in active and independent women aged 50-68 years, it is not possible to use standing force platform balance tests to detect differences between fallers and non-fallers. However, younger women (50-58 years) with injurious falls reported more health-related problems than other groups, a fact which should be taken into consideration to prevent further development of fall-related problems.

Accidental Falls↗