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PubMed2005

The impact of visual impairment on health, function and mortality.

BACKGROUND AND AIMS: Our aim was to determine the impact of visual impairment on self-rated health, function and mortality amongst a community-dwelling elderly cohort. METHODS: The study design was prospective and longitudinal, subjects being taken from an age-homogeneous, community-dwelling cohort comprising 452 subjects aged 70 in 1990 and 839 subjects aged 77 in 1998. Comprehensive data were collected by structured interviews and medical examinations carried out during home visits. Data included each subject's demographic and socio-economic profile, medical history, physical findings, functional status and self-rated health status. Visual acuity was measured using a Snellen chart and visual impairment was defined as best-eye corrected visual acuity of 20/40 or worse on Snellen chart testing. RESULTS: Measured and self-reported visual impairment correlated closely, and were significantly more prevalent amongst subjects with low education and poor financial status. Visually impaired subjects showed significantly greater dependence in ADL and IADL, poor self-rated health, less ability to rely on friends, increased loneliness and, in men aged 77, increased visits to the emergency room and hospital admissions. Visual impairment at age 70 significantly predicted poor self-rated health (p=0.029, OR 2.36, 95% CI 1.09-5.10), dependence in ADL (p=0.007, OR 2.91, 95% CI 1.34-6.33), general tiredness (p=0.037, OR 2.40, 95% CI 1.06-5.44), and mortality, with a two-and-a-half-fold increase in risk of death at seven years (p=0.0017,OR 2.84, 95% CI 1.48-5.46). CONCLUSIONS: Visual impairment in the elderly increases the risk of social, functional and medical decline.

Aged↗

PubMed1999

[Cerebral visual impairment in children].

Visual handicaps in children are often difficult to diagnose in early age and several etiological possibilities have to be ruled out. Cerebral visual impairments are of greater importance than most epidemiological studies indicate. Children with low birth weight are at special risk for visual disturbancies. Children with developmental dysfunctions and retardation and with neurohandicaps may have combined anterior ocular pathology and cerebral visual impairment. Health professionals responsible for the investigation of children with learning disabilities and visuomotor problems, must have a good understanding of visual development and processing.

Adolescent↗

PubMed2005

Causes of visual disability in children and young adults.

PURPOSE: Blindness and visual disability is a great problem all over the world. Loss of visual acuity in children requires special attention. The aim of the study was to determine the causes of uni- and bilateral low vision in children and young adults. Patients were from our clinic and from the School for the Blind and Visually Impaired in Lodz. MATERIAL AND METHODS: The study group included 271 patients aged from 3 months to 21 years, visually disabled and with uniocular reduction of visual acuity to 25% or less. RESULTS: The commonest cause of low visual acuity in the group was optic nerve atrophy (22%) due to perinatal hypoxia. Other important causes were retinopathy of prematurity (17%) and congenital abnormalities of the eye globe (11%). The main causes of uniocular low vision were anisometropia and strabismus. CONCLUSIONS: The main cause of visual impairment and disability in the study group from our region was optic nerve atrophy. Retinopathy of prematurity was also frequently seen in the handicapped children and was responsible for severe visual loss. Anisometropia and strabismus were predominant causes of uniocular visual deterioration, but not of visual disability.

Adolescent↗

PubMed2003

The relationship between visual disability and visual field in patients with glaucoma.

PURPOSE: To evaluate the relationship between visual disability and the remaining visual field in glaucoma patients. DESIGN: Prospective noncomparative survey. PARTICIPANTS: One hundred forty-seven Japanese patients with glaucoma were examined. METHODS: Using a previously developed questionnaire, we assessed the relationship between visual disability indices and both the visual field examined using program 30-2 of the Humphrey Field Analyzer and visual acuity. MAIN OUTCOME MEASURES: Pearson's correlation coefficients between visual disability indices and the 22 visual field and 2 visual acuity measurements were calculated. Multiple regression analysis with stepwise variable selection identified factors significantly contributing to visual disability. RESULTS: We identified a significant correlation between visual disability and both the visual field and visual acuity measurements collected. Of the factors examined, retinal sensitivity in the lower hemifield within 5 degrees of the fixation and visual acuity in the better eye significantly contributed to all the item and total disability indices (DIs), measurements of the degree of visual disability as evaluated by the questionnaire; visual acuity in the worse eye contributed to two of the seven item DIs, as well as the total DI. The R value for total DI (R = 0.87, P < 0.0001) indicated that approximately 76% of the visual disability could be explained by these factors. CONCLUSIONS: The Japanese glaucoma patients' visual disability is explained primarily by retinal sensitivity in the lower hemifield within 5 degrees of the fixation and visual acuity in the better eye and secondarily by visual acuity in the worse eye.

Adult↗

PubMed2005

Financing oral health services for people with special needs: projecting national expenditures.

Low-income people with disabilities or who are elderly have more dental disease, more missing teeth, and more difficulty obtaining dental care than other members of the general population. These realities lead to untreated infection, increased medical costs and needless suffering for the most vulnerable members of our society. It is critical we provide adequate reimbursement for oral health services in order to avoid the tragic and costly consequences of oral neglect. This article focuses on the financial implications of delivering oral health services to low-income individuals who are "aged, blind, and disabled" in the United States. The experience of providing oral health services in California for these populations is extrapolated to predict the cost implications of a national reimbursement system for ABD adults under Medicaid and reform Medicaid oral health programs for vulnerable children. The new federal dollars required to implement this legislation would be more than offset by a conservatively estimated 0.5 percent reduction in costly emergency room and hospital charges for the treatment of serious dental problems, as well as a reduction in the prevalence and severity of several general health conditions. Treating and/or preventing oral infection and disease for the ABD populations in our country will significantly reduce overall health care costs, improve quality of life, and end needless suffering for America's most vulnerable citizens. Treating and/or preventing oral infection and disease for this population simply is the right thing to do.

Adult↗

PubMed2002

Assessment of the impact of vision impairment.

PURPOSE: To describe the psychometric characteristics of the Impact of Vision Impairment (IVI) Profile and evaluate its validity and reliability over time and between different forms of administration. METHODS: The IVI is a 32-item questionnaire developed to measure the impact of vision impairment on restriction of participation in daily activities in five domains of functioning. Each item is rated on a six-level scale from "no difficulty" to "can't do because of vision." The IVI was administered by trained interviewers to 115 people with impaired vision (visual acuity less than 6/12 or visual field deficit) who attended the Royal Victorian Eye and Ear Hospital, a vision rehabilitation agency, or a self-help group for people with impaired vision. Data were also collected on demographic characteristics of participants, cause of vision impairment, and distance and near vision. General health status was assessed with the Short Form-12 (SF-12) of the Physical and Mental Health Summary Scales. A subset of participants completed the IVI twice, either 1 to 2 weeks apart or by different forms of administration (different interviewers or self). RESULTS: Internal consistency of total and domain average IVI scores was high (alpha = 0.80-0.96) and sequential elimination of items did not affect consistency. Total and domain average IVI scores correlated moderately with both near and distance vision (r = 0.21-0.31) but did not correlate with physical or general health or comorbidity. Total and domain average IVI scores correlated most closely with global measures of restriction of participation (r = 0.44-0.82). Principal-components analysis confirmed that all IVI items contribute to one underlying theme and tended to confirm two of the five domains: emotional reaction to vision loss and mobility. The first three components explained 43%, 8%, and 6% of the variation in the data. Guttman split-half reliability coefficients between different forms of administration and over time ranged from 0.73 to 0.94 for domain and total IVI scores. Mean absolute difference for domain and total scores between administrations was less than 1 step for all domains and the total score. CONCLUSIONS: This study provides support that the IVI has sufficient internal and construct validity to measure the effect of vision impairment on restriction of participation in daily activities. The IVI demonstrates acceptable reliability over a short period and yields consistent results between interviewers. The IVI can also be self-administered with assurance that the results will be comparable to those that would have been obtained by a trained interviewer. Therefore, the psychometric characteristics of the IVI support its use in assessment of the vision rehabilitation needs of people with impaired vision. Its stability over time indicates that it has potential to evaluate outcomes of intervention.

Activities of Daily Living↗

PubMed2005

The effect of rehabilitation on depression among visually disabled older adults.

There has been a great deal of interest in identifying the impact of rehabilitation on psychological well-being, as well as functional ability, among elders with disabilities, but empirical data remain limited. This descriptive study of participants in vision rehabilitation service examines the effect of specific vision rehabilitation services (low vision clinical services, skills training, counseling, optical device use, and adaptive device use) on change in depression among a sample of older adults with age-related vision impairments. Participants (N = 95) were interviewed at application for services and then approximately two years later. Findings from hierarchical regression analyses indicated that low vision clinical services, counseling, and use of optical devices, in separate models, each significantly contributed to a decline in depression, after controlling for age, health status, vision status, functional disability, as well as baseline depression. When all service variables were entered into the same equation, they explained an additional 10% of the variance in change in depression. Given the well documented robust relationship between disability and depression, findings point to the influence of vision rehabilitation interventions on both physical and psychological functioning, and underscore the need for future, controlled research on rehabilitation service models that address mental health issues.

Adaptation, Psychological↗

PubMed2006

Psychological distress and visual functioning in relation to vision-related disability in older individuals with cataracts.

OBJECTIVE: To determine whether demographic, health status and psychological functioning measures, in addition to impaired visual acuity, are related to vision-related disability. METHODS: Participants were 105 individuals (mean age=73.7 years) with cataracts requiring surgery and corrected visual acuity in the better eye of 6/24 to 6/36 were recruited from waiting lists at three public out-patient ophthalmology clinics. Visual disability was measured with the Visual Functioning-14 survey. Visual acuity was assessed using better and worse eye logMAR scores and the Melbourne Edge Test (MET) for edge contrast sensitivity. Data relating to demographic information, depression, anxiety and stress, health care and medication use and numbers of co-morbid conditions were obtained. RESULTS: Principal component analysis revealed four meaningful factors that accounted for 75% of the variance in visual disability: recreational activities, reading and fine work, activities of daily living and driving behaviour. Multiple regression analyses determined that visual acuity variables were the only significant predictors of overall vision-related functioning and difficulties with reading and fine work. For the remaining visual disability domains, non-visual factors were also significant predictors. Difficulties with recreational activities were predicted by stress, as well as worse eye visual acuity, and difficulties with activities of daily living were associated with self-reported health status, age and depression as well as MET contrast scores. Driving behaviour was associated with sex (with fewer women driving), depression, anxiety and stress scores, and MET contrast scores. CONCLUSION: Vision-related disability is common in older individuals with cataracts. In addition to visual acuity, demographic, psychological and health status factors influence the severity of vision-related disability, affecting recreational activities, activities of daily living and driving.

Activities of Daily Living↗

PubMed2006

Perceived overprotection: support gone bad?

OBJECTIVE: This article focuses on the effects of perceived overprotection, a potentially problematic aspect of receiving support, on the ability to adjust to a chronic impairment, specifically, age-related vision loss. Perceived overprotection is an especially critical issue in this population of chronically ill older adults because of the safety issues associated with vision impairment and because perceptions on the part of the older adult that the support providers are overprotective may lead to excess disability. METHODS: Participants were 584 older men and women with age-related vision impairment who applied for services at a vision rehabilitation agency. Path analysis was used to examine the effects of perceived overprotection on two positive indicators of adjustment: vision-specific adaptation and environmental mastery. Moreover, antecedents of perceived overprotection were examined. RESULT: Higher levels of perceived overprotection were associated with less optimal adjustment to age-related vision loss, with lower scores on measures of vision-specific adaptation and environmental mastery. Higher levels of functional disability and instrumental support received were associated with higher levels of perceived overprotection. DISCUSSION: Findings indicate that support providers of older adults with visual impairment as well as vision rehabilitation service providers need to be aware of the detrimental impact of perceived overprotection.

Adaptation, Psychological↗

PubMed2003

The influence of health, social support quality and rehabilitation on depression among disabled elders.

This study examined the influence of health, social support, disability, and vision rehabilitation services on depression among visually impaired older adults seeking vision rehabilitation services. Participants (n = 95) were interviewed at application and approximately two years later. The first hierarchical regression model focused on concurrent relationships at baseline. The second model used baseline health and social support variables, along with indicators of change in vision and use of rehabilitation services, in order to predict change in depression over time. Findings indicate that being unmarried, in poorer health, having lower quality of relationships with family, and lower stability in friendships were significant independent risk factors for initial depression, explaining 50% of the variance. Decline in depression over time was predicted by younger age, better self-rated health, stability of friendships, and use of rehabilitation services that, along with baseline depression, explained 61% of the variance in depressive symptomatology at the two-year follow-up. Findings highlight the importance of qualitative aspects of social support for older disabled adults, as well as the distinction that needs to be made between factors that predict concurrent mental health status and those predicting change in status over time.

Activities of Daily Living↗

PubMed2004

Trends in visual acuity impairment in US adults: the 1986-1995 National Health Interview Survey.

OBJECTIVE: To assess 10-year trends in reported visual impairment. METHODS: The National Health Interview Survey is a continuous multistage area probability survey of the US civilian noninstitutionalized population living at addressed dwellings. Adults within randomly selected households were administered a chronic conditions list that included questions about visual impairment. Proxy information on these conditions was obtained when household members were unavailable for interview. Complete data were available on 132 860 adults 18 years or older in survey years 1986 to 1995. Prevalence rates were adjusted for age and sample survey design. RESULTS: Annual age-adjusted rates of some visual impairment ranged from 3.6% to 4.6%. Rates of severe bilateral visual impairment ranged from 0.2% to 0.4%. There was some evidence for increasing rates of visual impairment among younger adults 18 to 39 years of age (annual increase, 0.03%; P =.03). However, there were no significant changes in reported visual impairment rates in older adults stratified into 10-year age groups. CONCLUSIONS: Data from the National Health Interview Survey provide no evidence that reported visual impairment rates are declining in the US noninstitutionalized population from 1986 to 1995. Additional treatment advances, greater use of existing treatments, including correcting refractive errors, and further reductions in risk factors for disabling eye diseases may be necessary before population-level reductions in visual impairment rates can be achieved.

Adolescent↗

PubMed2004

Impact of bilateral visual impairment on health-related quality of life: the Blue Mountains Eye Study.

PURPOSE: To assess the impact of visual impairment on health-related quality of life (HRQOL) in an older population and compare it with the impact of major medical conditions. METHODS: Participants of the second cross-sectional Blue Mountains Eye Study (BMES; n = 3509; mean age, 66.7 years; 57% female) were asked to complete the self-administered 36-item Short-Form health survey (SF-36), a comprehensive interview, and an eye examination. Visual impairment was defined as visual acuity less than 20/40 (better eye). RESULTS: Of 3154 (89.9%) participants with complete data, 172 (5.5%) had visual impairment due to refractive errors (correctable visual impairment) and 66 (2.1%) due to eye conditions (noncorrectable visual impairment; 49 mild, 9 moderate, 8 severe). After adjustment for demographic and medical confounders, there was a trend toward lower SF-36 scores in participants with noncorrectable impairment than in those with correctable impairment (physical component score [PCS] Ptrend = 0.01 and mental component score [MCS] Ptrend = 0.02). Increasingly severe noncorrectable visual impairment was associated with significantly poorer SF-36 scores in all but two dimensions. The impact of noncorrectable visual impairment was comparable to that from major medical conditions (e.g., stroke) and had a greater impact on mental than physical domains (mean MCS = 46.2, PCS = 41). No significant differences in HRQOL were demonstrated between visual impairment cases caused by age-related maculopathy and cataract, after adjusting for severity of visual impairment. CONCLUSIONS: Noncorrectable visual impairment was associated with reduced functional status and well-being, with a magnitude comparable to major medical conditions. These data have implications for disability weights such as those developed by the Global Burden of Disease study.

Aged↗

PubMed1998

Melatonin: interesting, but not miraculous.

(1) In the United States melatonin is just a dietary supplement, but in Europe its status varies from country to country and also over time. It is illegal in some European member states but tolerated or authorised as a drug or dietary product elsewhere. Melatonin, a hormone secreted by the pineal gland, has been on the front cover of magazines throughout the world for its claimed effects on ageing, cancer and many other health problems, opening up a vast potential market. (2) Only its use in jet lag, sleep disorders and advanced cancer has been tested clinically (albeit scantily). (3) Melatonin seems to alleviate jet lag symptoms, but that could be linked to its moderate hypnotic effect. (4) The use of melatonin to treat major insomnia cannot be envisaged until its long-term safety has been proven. With this proviso, and if efficacy is confirmed in sufficiently large comparative trials, melatonin could prove useful for treating major sleep disorders in some patients, especially blind people and those with severe neurological disabilities. (5) According to open trials conducted by a single team, melatonin, alone or combined with interleukin-2, could slightly lengthen the survival of patients with some advanced cancers, but even partial tumour remissions are rare. (6) All other "indications" are based on simplistic hypotheses or purely commercial considerations.

Adjuvants, Immunologic↗

PubMed2005

Prevalence and burden of self-reported blindness and low vision for individuals living in institutions: a nationwide survey.

BACKGROUND: The prevalence of self-reported low vision (LV) and blindness, and their associated disabilities, handicaps and socio-economic consequences for individuals living in institutions are poorly documented. METHODS: 2,075 institutions were selected at random and eight individuals were picked at random from the list of residents. Three groups of individuals were defined: blind, LV, and a control group (CG). These were compared after adjustment for age and co-morbidities. Of the 15,403 individuals, 14,603 interviews (94.9%) were completed. RESULTS: The prevalence of blindness was 1.6% and the LV 13.4%. Blind individuals needed assistance more often (OR: 2.65 to 11.35) than CG members while the assistance required by LV individuals was similar to that for the CG. Blind individuals required institution adaptation (building and furniture changes) more often than the CG. Blind (57.9%) and LV individuals (35.4%) were more often registered for social allowances. Monthly social allowances were EUR 86 higher for blind than LV individuals. Monthly family incomes were found to be similar between the three groups (from EUR 782 to 797). Social and demographic data, institution description, income, handicaps, disabilities, social allowances and details of daily activities were collected interviews. CONCLUSION: The results demonstrate the impact of self-reported blindness and LV on daily life for patients living in institutions.

Activities of Daily Living↗

PubMed2006

Services available to sight-impaired and legally blind patients in Ontario: the Ontario model.

The Participation and Activity Limitation Survey undertaken by Statistics Canada in 2001 identified 635,000 Canadians who have a seeing disability. By 2015 these numbers are expected to double, with the largest group of patients residing in Ontario, the province with the largest population. Ontario has a long-established history of vision rehabilitation, but recent demographic changes and an ever-increasing older population have made the planning of vision rehabilitation services in Ontario (as in the rest of Canada) even more urgent. The intent of this paper is to present the variety of services currently available to the visually impaired in Ontario.

Blindness↗

PubMed2003

Estimating the burden and economic impact of trachomatous visual loss.

OBJECTIVE: To estimate the burden (disability-adjusted life years) and economic impact (potential productivity loss) associated with trachomatous visual loss. DATA: National survey data on trachomatous blindness or visual impairment since 1980. METHODS: The primary results summarized studies for countries with known or suspected blinding trachoma within World Development Report demographic regions. The number of cases was based on the year 2000 population. The years of life with disability calculation used the age-sex distribution of trachomatous visual loss. The one-year potential productivity loss calculation used the agricultural value added per worker in 1998. RESULTS: Countries with known or suspected blinding trachoma have 3.8 million cases of blindness and 5.3 million cases of low vision and a potential productivity loss of 2.9 billion US dollars (1995 US dollars). Prevalent cases of trachomatous visual loss yield 39 million lifetime DALYs. CONCLUSIONS: For resource allocation, the burden of disease can be compared with the expected costs of eradication of trachomatous blindness.

Adolescent↗

PubMed2006

Utility and validity of the self-administered SF-36: findings from an older population.

INTRODUCTION: The objectives of this study were to assess the utility and validity of the self-administered SF-36 and the effect of visual or cognitive impairment on these measures in an older population. MATERIALS AND METHODS: Attempt rates, completion rates and internal consistency (Cronbach alpha) were compared within the second cross-sectional, population-based Blue Mountains Eye Study (n = 3509, mean age 66.7 years, 57% women). RESULTS: The SF-36 was attempted by 3162 (90.1%) participants, of which 2470 (78.1%) completed all items and 2873 (90.9%) completed sufficient items for calculation of all dimensions. In a multivariate model adjusting for age, sex, and presenting visual and cognitive impairments, women (P = 0.011) and participants with visual or cognitive impairments (P < 0.0001) were less likely to attempt the questionnaire. Completion rates were significantly lower with increasing age (P < 0.0001), in men (P < or = 0.0005) and in those with cognitive impairment (P < 0.0001). A high level of internal consistency (Cronbach alpha > 0.85 for all dimensions) and construct validity was demonstrated, the latter distinguishing between those with and without medical conditions, disabilities or recent hospital admissions (P < 0.01). As the prevalence of visual or cognitive impairment was relatively low in this population, we found no apparent effect of these impairments on the validity of SF-36. CONCLUSIONS: Attempt and completion rates, but not internal consistency and construct validity, of the SF-36 were influenced by age, gender, and presenting visual and cognitive impairments. The overall high attempt and completion rates, internal consistency and construct validity suggest that the self-administered SF-36 is a suitable healthrelated quality of life (HRQOL) measure in similar older community-living populations.

Aged↗

PubMed2002

Prevalence of visual impairment and utilization of rehabilitation services in the visually impaired elderly population of Quebec.

Data on the prevalence of reported visual impairment and on the utilization of rehabilitation services were collected on a sample consisting of 1777 community-residing people aged at least 65 years. A visual disability was considered to be present if the answer to at least one of the following two questions was positive: Do you have trouble reading ordinary newsprint with glasses (if normally worn)? Do you have trouble clearly seeing the face of someone 12 feet away with glasses (if normally worn)? Prevalence of a reported near disability was 7.6%, prevalence of a reported distance disability was 4.4%, and 3.5% of subjects reported both types of disability. In a subsample of the surveyed population, the positive predictive value was 21% and the negative predictive value was 100%, using moderate or worse visual impairment as the gold standard. Among those answering yes to both questions, 11.4% received services from a rehabilitation center and 10.0% from a nonprofit agency. The utilization rates (adjusted to apply only to those whose visual impairment was confirmed by visual examination) reached 20% for rehabilitation centers and 17.5% for nonprofit agencies. Low utilization of rehabilitation services raises questions concerning the role of general eye care practitioners, community-based health centers, and rehabilitation centers in the rehabilitative process of the visually impaired elderly.

Aged↗