Abstract
ABSTRACTPurpose: To describe the study design, interobserver variability of the questionnaires and clinical procedures of Hyderabad Ocular Morbidity in Elderly Study (HOMES) designed to, (a) to investigate the prevalence, causes and risk factors for visual impairment, and (b) to assess the impact of dispensing spectacles and cataract surgery on visual functions, fear of falls (FOF) and depression among the elderly in India.Methods: Individuals aged ≥60 years are considered elderly. The non-clinical protocol was administered by two trained investigators and included collection of personal, sociodemographic information, ocular and systemic history, Indian Visual Function Questionnaire (IND-VFQ33), Patient Health Questionnaire (PHQ9), Mini-Mental State Examination (MMSE) questionnaire, Hearing Handicap Inventory for the Elderly Screening (HHIE), Short Falls Efficacy Scale (SFES) questionnaire. The eye examination was conducted by a trained optometrist and vision technicians in clinics set-up in the homes and included visual acuity (VA) assessment for distance and near, anterior segment examination and fundus examination, and imaging. The reliability assessments were carried out among 138 participants.Result: The intraclass correlation (ICC) coefficients for MMSE, PHQ9, HHIE, SFES was 0.73 (95% CI: 0.62–0.81), 0.67 (95% CI: 0.54–0.77), 0.63 (95% CI: 0.48–0.74) and 0.70 (95% CI: 0.58–0.79) respectively. The ICC for INDVFQ domains ranged from 0.66 (95% CI: 0.55–0.74) for Psychosocial Impact to 0.88 (95% CI: 0.84–0.91) for activity limitation. The ICC for VA was 0.94 (95% CI: 0.92–0.96).Conclusion: All questionnaires demonstrated acceptable reliability and can be applied in the main study. HOMES is expected to provide data that will help plan strategies to contribute towards ‘healthy aging’ in India.
Highlights
253 million people are visually impaired, of which about 85% of them are 50 years of age and older.[1]
Studies have shown that visual impairment in the elderly affects all dimensions of their life including mobility, self-care, driving, participation in social and religious activities and overall quality of life.[13,14,15]
Reports have shown a delay in the risk of mortality as a result of cataract surgery,[19,20] and correction of refractive errors resulting in a significant improvement in the quality of life.[21,22]
Summary
253 million people are visually impaired, of which about 85% of them are 50 years of age and older.[1] India is home to 8.8 million blind individuals and nearly 50 million people with moderate-to-severe visual impairment (MSVI).[1] Over 75% of all visual impairment is avoidable (preventable or treatable) Both cataract and uncorrected refractive errors remain the leading causes of blindness, and uncorrected refractive errors remain the leading cause of SVI.[2] While cataract surgery is one of the most cost-effective interventions in healthcare,[3,4] uncorrected refractive errors can be corrected using spectacles. Visual impairment is more common among the elderly living in residential care when compared to those living in their own homes in the communities and noninstitutionalized environments.[5,6,7,8] A significant proportion of this visual impairment among the elderly in residential care can be corrected by simple interventions such as spectacles and cataract surgery.[9,10,11,12] Studies have shown that visual impairment in the elderly affects all dimensions of their life including mobility, self-care, driving, participation in social and religious activities and overall quality of life.[13,14,15] Visual impairment is associated with an increased risk of mortality.[16,17,18] Reports have shown a delay in the risk of mortality as a result of cataract surgery,[19,20] and correction of refractive errors resulting in a significant improvement in the quality of life.[21,22]
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