Age-related Vision Research Articles

Negotiating ‘positive’ aging in the presence of age-related vision loss (ARVL): The shaping and perpetuation of disability

IntroductionWhile previous research has explored the meaning of positive aging discourses from the perspective of older adults, the perspective of older adults aging with a disability has not been studied. In fact the intersection of aging and disability has been largely underexplored in both social gerontology and disability studies. MethodThis critical ethnography engaged ten older adults aging with vision loss in narrative interviews, participant observation sessions, and semi-structured in-depth interviews. The overarching objective was to understand those attributes that older adults with age-related vision loss perceive as being the markers of a ‘good old age.’ The authors critically examined how these markers, and their disabling effects, are situated in ageist and disablist social assumptions regarding what it means to ‘age well’. ResultsThe participants' descriptions of the markers of a ‘good old age’ were organized into five main themes: 1) maintaining independence while negotiating help; 2) responding positively to vision loss; 3) remaining active while managing risk; 4) managing expectations to be compliant, complicit, and cooperative and; 5) striving to maintain efficiency. ConclusionThe study findings have provided helpful insights into how the ideas and assumptions that operate in relation to disability and impairment in late life are re-produced among older adults with age-related vision loss and how older adults take on an identity that is consistent with socially embedded norms regarding what it means to ‘age well’.

A population study of correlates of social participation in older adults with age-related vision loss

Objective: To examine personal characteristics, disease-related impairment variables, activity limitations, and environmental factors as correlates of social participation in older adults with vision loss guided by the World Health Organization’s International Classification of Functioning, Disability and Health Model. Design: Baseline data of a larger longitudinal study. Setting: Community-based vision rehabilitation agency. Subjects: A total of 364 older adults with significant vision impairment due to age-related macular degeneration. Main Measures: In-person interviews assessing social participation (i.e. frequency of social support contacts, social/leisure challenges faced due to vision loss, and of social support provided to others) and hypothesized correlates (e.g. visual acuity test, Functional Vision Screening Questionnaire, ratings of attachment to house and neighborhood, environmental modifications in home). Results: Regression analyses showed that indicators of physical, social, and mental functioning (e.g. better visual function, fewer difficulties with instrumental activities of daily living, fewer depressive symptoms) were positively related to social participation indicators (greater social contacts, less challenges in social/leisure domains, and providing more support to others). Environmental factors also emerged as independent correlates of social participation indicators when functional variables were controlled. That is, participants reporting higher attachment to their neighborhood and better income adequacy reported having more social contacts; and those implementing more environmental strategies were more likely to report greater challenges in social and leisure domains. Better income adequacy and living with more people were related to providing more social support to others. Conclusion: Environmental variables may play a role in the social participation of older adults with age-related macular degeneration.

Absence of collagen XVIII in mice causes age-related insufficiency in retinal pigment epithelium proteostasis.

Collagen XVIII has the structural properties of both collagen and proteoglycan. It has been found at the basement membrane/stromal interface where it is thought to mediate their attachment. Endostatin, a proteolytic fragment from collagen XVIII C-terminal end has been reported to possess anti-angiogenic properties. Age-related vision loss in collagen XVIII mutant mice has been accompanied with a pathological accumulation of deposits under the retinal pigment epithelium (RPE). We have recently demonstrated that impaired proteasomal and autophagy clearance are associated with the pathogenesis of age-related macular degeneration. This study examined the staining levels of proteasomal and autophagy markers in the RPE of different ages of the Col18a1 (-/-) mice. Eyes from 3, 6-7, 10-13 and 18months old mice were enucleated and embedded in paraffin according to the routine protocol. Sequential 5μm-thick parasagittal samples were immunostained for proteasome and autophagy markers ubiquitin (ub), SQSTM1/p62 and beclin-1. The levels of immunopositivity in the RPE cells were evaluated by confocal microscopy. Collagen XVIII knock-out mice had undergone age-related RPE degeneration accompanied by an accumulation of drusen-like deposits. Ub protein conjugate staining was prominent in both RPE cytoplasm and extracellular space whereas SQSTM1/p62 and beclin-1 stainings were clearly present in the basal part of RPE cell cytoplasm in the Col18a1 (-/-) mice. SQSTM1/p62 displayed mild extracellular space staining. Disturbed proteostasis regulated by collagen XVIII might be responsible for the RPE degeneration, increased protein aggregation, ultimately leading to choroidal neovascularization.

Happy Living in Darkness! Indoor Lighting in Relation to Activities of Daily Living, Visual and General Health in 75-Year-Olds Living at Home

ABSTRACTLighting has been identified as a significant environmental attribute for promoting vision and general health among older people, enabling successful aging at home, but it has received little attention in the literature. Indoor lighting levels, self-reported vision and general health, and activities of daily life were measured in 114 healthy 75-year-old Norwegians. Despite very low levels of indoor lighting, the subjects were happy and healthy. There is a large discrepancy between self-assessed health and recommended lighting levels, and low awareness of the effect of lighting on age-related vision loss or daily living in the future. Knowledge of how to utilize indoor lighting to ensure healthy and safe aging in the home is needed.

Low Vision Rehabilitation, Age-Related Vision Loss, and Risk: A Critical Interpretive Synthesis.

Given the centrality of risk in geriatric rehabilitation, it is critically important to attend to how conceptualizations of risk shape research, policies, and rehabilitation practices. This paper presents a critical interpretive synthesis (CIS) of literature addressing risk and low vision rehabilitation for older adults with age-related vision loss (ARVL) to identify key guiding assumptions regarding risk and discuss implications for what gets attended to, and not attended to, within research and rehabilitation. This CIS combined guidelines proposed by Dixon-Woods and colleagues (2006-Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, 35) and Alvesson and Sandberg (2011-Generating research questions through problematization. Academy of Management Review, 36, 247-271; 2013-Constructing research questions: Doing interesting research. London: Sage). The iterative review process involved 3 steps: literature search and selection, data extraction, and syntheses to identify boundary assumptions. The dataset included 83 research and practice description articles. Older adults with ARVL were constructed as "at risk" for various adverse outcomes, particularly dependency and self-harm, and as posing risks to others. An epidemiological approach to risk based in assumptions aligned with a technico-scientific perspective was dominant, with risk conceptualized as an embodied, individual-level phenomenon that is to be determined and managed through objective screening and expert monitoring. Key concerns include a lack of: attention to the tensions created when rehabilitation research and practice attempt to promote independence while simultaneously reducing risk, incorporation of aging adults' perspectives on risk, and analysis of environmental factors that shape risks. Research that starts by valuing older adults' experiences and attends to context can inform rehabilitation practices that support health-promoting, risk-taking, and facilitate collaborative approaches to risk management.

Enacted and re-enacted in life and letters: the identity of the Jack Tar, 1930 to date

ABSTRACTThis article explores the Jack Tar persona during the twentieth century. In particular, it focuses on the age-related nature of this naval identity, and the complex and changeable relationship it generated between notions of hedonism and respectability. This is assessed through the accounts of trainees at HMS Ganges, one of the navy’s great training establishments. It argues that these boys exploited the idea of the Jack Tar, with its individualistic and self-gratifying connotations, to extract maximum empowerment in terms of contemporary working-class adolescence. This amounted to an idealised, class-specific and age-related vision of manliness that was, moreover, consolidated through their use of the square rig uniform. In reality, though, this identity could never be comprehensively mastered. Civilian society did not always endorse the conviction boys had in its potency and, as they entered adulthood and marriage, the need to perform a respectable selfhood gradually took precedence. In the act of autobiography, though, many retired naval ratings reconnected themselves with - and often defined themselves through - the charismatic identity that had helped to draw them into naval service. The Jack Tar persona was, therefore, the organizing category for a specific working-class youth culture, and the touchstone for lives reimagined in memoir.

A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services

ObjectiveTo investigate the effectiveness of a low vision self-management programme (LVSMP) in older adults. MethodsParticipants (n=153) were existing clients of a national low vision rehabilitation organisation randomly allocated to usual services (n=60) or usual services plus LVSMP (n=93). The LVSMP was an 8-week group programme facilitated by low vision counsellors. The primary outcome was vision-specific quality of life (QoL) measured using the Impact of Vision Impairment (IVI) questionnaire. Secondary outcomes emotional well-being, self-efficacy and adaptation to vision loss were measured using the depression, anxiety, stress scale (DASS), general self-efficacy scale (GSES), and short form adaptation to age-related vision loss scale (AVL12). ResultsAt one and six month follow-up assessments, no significant between-group differences were found for vision-specific QoL, emotional well-being, adaptation to vision loss or self-efficacy (p>0.05). Univariate and multivariate analyses revealed no impact of the intervention on outcome measures. ConclusionsIn contrast to previous work, our study found limited benefit of a LVSM programme on QoL for older adults accessing low vision services. Practice implicationsWhen implementing self-management programmes in low vision rehabilitation settings, issues of client interest, divergence of need, programme accessibility and fidelity of intervention delivery need to be addressed.

Cognitive Impairment and Age-Related Vision Disorders: Their Possible Relationship and the Evaluation of the Use of Aspirin and Statins in a 65 Years-and-Over Sardinian Population.

Neurological disorders (Alzheimer’s disease, vascular and mixed dementia) and visual loss (cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy) are among the most common conditions that afflict people of at least 65 years of age. An increasing body of evidence is emerging, which demonstrates that memory and vision impairment are closely, significantly, and positively linked and that statins and aspirin may lessen the risk of developing age-related visual and neurological problems. However, clinical studies have produced contradictory results. Thus, the intent of the present study was to reliably establish whether a relationship exist between various types of dementia and age-related vision disorders, and to establish whether statins and aspirin may or may not have beneficial effects on these two types of disorders. We found that participants with dementia and/or vision problems were more likely to be depressed and displayed worse functional ability in basic and instrumental activities of daily living than controls. Mini mental state examination scores were significantly lower in patients with vision disorders compared to subjects without vision disorders. A closer association with macular degeneration was found in subjects with Alzheimer’s disease than in subjects without dementia or with vascular dementia, mixed dementia, or other types of age-related vision disorders. When we considered the associations between different types of dementia and vision disorders and the use of statins and aspirin, we found a significant positive association between Alzheimer’s disease and statins on their own or in combination with aspirin, indicating that these two drugs do not appear to reduce the risk of Alzheimer’s disease or improve its clinical evolution and may, on the contrary, favor its development. No significant association in statin use alone, aspirin use alone, or the combination of these was found in subjects without vision disorders but with dementia, and, similarly, none in subjects with vision disorders but without dementia. Overall, these results confirm the general impression so far; namely, that macular degeneration may contribute to cognitive disorders (Alzheimer’s disease in particular). In addition, they also suggest that, while statin and aspirin use may undoubtedly have some protective effects, they do not appear to be magic pills against the development of cognitive impairment or vision disorders in the elderly.

Aging and Age-Related Diseases of the Ocular Lens and Vitreous Body

Reduced quality of life and financial burden due to visual impairment and blindness begin to increase dramatically when individuals reach the age of 40. The major causes of age-related vision loss can be traced to changes to the structure and function of the lens, one of the tissues responsible for focusing light on the retina. Age-related nuclear cataracts, which are caused by aggregation and condensation of proteins, diminish vision because they impede the transmission and focusing of light on the retina. In addition to the slow-developing age-related form, cataracts often develop rapidly as a complication of ocular surgery, such as following vitrectomy or as a consequence of vitreous gel degeneration. Posterior capsular opacification, which can develop following cataract removal, is caused by proliferation and inappropriate accumulation of lens epithelial cells on the surfaces of intraocular lenses and the posterior lens capsule. Presbyopia is a loss of accommodative amplitude and reduced ability to shift focus from far to near objects. Onset of presbyopia is associated with an increase in lens hardness and reduced ability of the lens to change shape in response to ciliary muscle contraction. Avenues of promising research that seek to delay or prevent these causes of low vision are discussed in light of our current understanding of disease pathogenesis and some challenges that must be met to achieve success.

Human brain compensates for age-related color vision loss

Human brain compensates for age-related color vision loss

Positive display polarity is advantageous for both younger and older adults

The effect of display polarity on visual acuity and proofreading performance was investigated for younger and older adults. An advantage of positive polarity (dark characters on light background) over negative polarity (light characters on dark background) was expected for younger adults, but the effects on older adults were ambiguous. Light scatter due to residues in the senescent lens and vitreous humour could reverse the typical advantage of positive polarity. However, age-related changes lead to a decline in retinal illuminance. Brighter positive polarity displays should help to compensate for this decline and, accordingly, lead to better performance than darker negative polarity displays. Participants conducted a visual acuity test with black optotypes on white background or white optotypes on black background and performed a proofreading task in the same polarity. A positive polarity advantage was found for both age groups. The presentation in positive polarity is recommended for all ages. Practitioner summary: In an ageing society, age-related vision changes need to be considered when designing digital displays. Visual acuity testing and a proofreading task revealed a positive polarity advantage for younger and older adults. Dark characters on light background lead to better legibility and are strongly recommended independent of observer's age.

Occupational Therapy Interventions to Improve Performance of Daily Activities at Home for Older Adults With Low Vision: A Systematic Review

The impact of age-related vision loss on older adults' independence at home is profound. The purpose of this systematic review was to identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities at home for older adults with low vision. We searched and screened abstracts from multiple electronic databases and identified 17 studies that fulfilled our inclusion and exclusion criteria. Three themes in intervention approaches emerged: multicomponent intervention, single-component intervention, and multidisciplinary intervention. Strong evidence of effectiveness was found in studies that applied a multicomponent approach; these interventions involved teaching knowledge and skills that older adults with low vision need to help overcome the disablement process. Evidence also suggests that multiple sessions of training with low vision devices and special viewing skills to compensate for vision loss are necessary to have a positive effect on daily activities. Finally, multidisciplinary intervention that focused on personal goals yielded greater positive outcomes than interventions that were not personalized.

Factors That Influence the Occupational Engagement of Older Adults with Low Vision: A Scoping Review

Introduction: Prior research has provided occupational therapists with an understanding of the negative impact of low vision on self care, leisure and productivity. In order to guide future low-vision rehabilitation services, an understanding of the factors that influence the occupational engagement of older adults with age-related vision loss (ARVL) is also needed. Method: A scoping review of the literature was conducted in order to identify those factors that have been shown to influence the occupational engagement of older adults with ARVL, and to identify future research needs. Findings: As identified in this scoping review, five types of factors were shown to influence occupational engagement for older adults with ARVL including: demographic variables, emotional components, behavioural components, diagnostic components, and environmental aspects. Conclusion: Although findings pertaining to personal factors can inform practice, few studies explored the influence of environmental factors on occupational engagement. Given that occupation is a result of person-environment transactions, it is important that future research more fully explores environmental influences in order to enable occupational therapists to deliver services that optimize the occupational performance of seniors with ARVL.

The cataract and glucosuria associated monocarboxylate transporter MCT12 is a new creatine transporter

Creatine transport has been assigned to creatine transporter 1 (CRT1), encoded by mental retardation associated SLC6A8. Here, we identified a second creatine transporter (CRT2) known as monocarboxylate transporter 12 (MCT12), encoded by the cataract and glucosuria associated gene SLC16A12. A non-synonymous alteration in MCT12 (p.G407S) found in a patient with age-related cataract (ARC) leads to a significant reduction of creatine transport. Furthermore, Slc16a12 knockout (KO) rats have elevated creatine levels in urine. Transport activity and expression characteristics of the two creatine transporters are distinct. CRT2 (MCT12)-mediated uptake of creatine was not sensitive to sodium and chloride ions or creatine biosynthesis precursors, breakdown product creatinine or creatine phosphate. Increasing pH correlated with increased creatine uptake. Michaelis-Menten kinetics yielded a Vmax of 838.8 pmol/h/oocyte and a Km of 567.4 µm. Relative expression in various human tissues supports the distinct mutation-associated phenotypes of the two transporters. SLC6A8 was predominantly found in brain, heart and muscle, while SLC16A12 was more abundant in kidney and retina. In the lens, the two transcripts were found at comparable levels. We discuss the distinct, but possibly synergistic functions of the two creatine transporters. Our findings infer potential preventive power of creatine supplementation against the most prominent age-related vision impaired condition.

Canadian research contributions to low vision rehabilitation: A quantitative systematic review

Purpose: Low vision rehabilitation research is a quickly growing area, due in part to the increase in the demand for services geared at older adults with age-related vision loss. Various professions collaborate to provide such rehabilitation services; however, it is currently unclear which profession takes the leading role in advancing the frontiers of low vision rehabilitation research. A recent review article proposed that in Canada, this role is held by physicians. The present study was conducted to replicate these findings under conditions of a systematic review.
 Method: A search of seven databases and a hand-search of four vision rehabilitation journals identified articles on low vision rehabilitation whose first author had an affiliation at a Canadian institution. Data on professional credentials, funding source, and study content was tabulated.
 Results: Of the 1,870 references, data from 215 eligible articles were extracted. The top four author credentials were optometrists (with or without PhD; 56 papers, 26.0%), followed by researchers with PhDs only (48 papers, 22.3%), researchers with master’s degrees (43 papers, 20.0%), and medical doctors (with or without PhD; 39 papers, 18.1%). Vision rehabilitation journals published 38 per cent of all papers, followed by ophthalmology (27%) and optometry journals (22%). Publications in the past 11 years amounted to over 50 per cent of the output over the 64-year publication history in this field in Canada, 70 per cent of which were based in universities.
 Conclusion: The results reflect the mosaic structure of low vision rehabilitation research in Canada, highlighting collaborations among researchers, clinicians, funding sources and rehabilitation agencies. Given its multidisciplinary nature, low vision rehabilitation research seems to be driven by collaboration among the professions.

Flavonoid Intake and Eye Health

In the modern era of evidence-based scientific medicine, there is little recognition of centuries of shaman observational evidence. Yet it is extremely difficult to conduct long duration controlled studies of large populations. The controversy surrounding the issue of flavonoid bioactivity and alleged benefits for eye health is also plagued by natural product industry marketing efforts that rely on small, often poorly designed studies. Ample laboratory evidence exists from in vitro and in vivo studies that provide plausible mechanistic evidence for flavonoid interactions relevant to visual function. Lacking are large randomized double-blind placebo-controlled studies in older subjects who have early signs of vision impairment. These studies could link flavonoid intake and bioavailability to efficacy in prevention of age related vision disorders that develop over decades. Support for clinical trials remains to be found before a full “recommendation” can be made regarding the value of diets high in flavonoids for eye health.

Randomized Controlled Trial on the Effects of CCTV Training on Quality of Life, Depression, and Adaptation to Vision Loss

In addition to performance-based measures, vision-related quality of life (QOL) and other subjective measures of psychosocial functioning are considered important outcomes of training in the visually impaired. In a multicenter, masked, randomized controlled trial, subjective effects of training in the use of closed-circuit televisions (CCTV) were investigated. Patients (n = 122) were randomized either to a treatment group that received usual delivery instructions from the supplier combined with concise outpatient training, or to a control group that received delivery instructions only. Subjective outcomes were the low vision quality-of-life questionnaire (LVQOL), EuroQOL 5 dimensions, adaptation to age-related vision loss (AVL), and the Center of Epidemiologic Studies Depression scales. Linear mixed models were used to investigate treatment effects. Differential effects of patient characteristics were studied by implementing higher order interactions into the models. From baseline to follow-up, all patients perceived significantly less problems on the reading and fine work dimension (-28.8 points; P < 0.001) and the adaptation dimension (-4.67 points; P = 0.04) of the LVQOL. However, no treatment effect was found based on the intention-to-treat analysis. This study demonstrated the effect of receiving and using a CCTV on two vision-related QOL dimensions; however, outpatient training in the use of CCTVs had no additional value. (trialregister.nl number, NTR1031.).

Robustness of Personality and Affect Relations Under Chronic Conditions: The Case of Age-Related Vision and Hearing Impairment

Relations between personality and affect are generally regarded as robust. Extraversion is closely linked to positive affect (PA), but not to negative affect (NA), whereas neuroticism is closely linked to NA, but not to PA. We argue in this work that the stress experience associated with age-related vision and hearing impairment may alter this commonly found pattern as compared with sensory unimpaired (UI) older adults. We analyzed data from a sample of severely visually impaired (VI; N = 121), severely hearing impaired (HI; N = 116), and a control condition of sensory UI (grand age mean: 82 years; N = 150). Based on a structural equation modeling approach, we found that the relationship between extraversion and PA was higher in the UI as compared with the sensory impaired groups. In contrast, the strong linkage between neuroticism and NA was not affected by sensory status. Furthermore, we observed a meaningful negative relation between extraversion and NA only in the VI group. Findings support the argument that the relationship between personality and affect deserves qualification when chronic vision and hearing impairment is present.

Sensory and demographic characteristics of deafblindness rehabilitation clients in Montréal, Canada

Demographic changes are increasing the number of older adults with combined age-related vision and hearing loss, while medical advances increase the survival probability of children with congenital dual (or multiple) impairments due to pre-maturity or rare hereditary diseases. Rehabilitation services for these populations are highly in demand since traditional uni-sensory rehabilitation approaches using the other sense to compensate are not always utilizable. Very little is currently known about the client population characteristics with dual sensory impairment. The present study provides information about demographic and sensory variables of persons in the Montreal region that were receiving rehabilitation for dual impairment in December 2010. This information can inform researchers, clinicians, educators, as well as administrators about potential research and service delivery priorities. A chart review of all client files across the three rehabilitation agencies that offer integrated dual sensory rehabilitation services in Montreal provided data on visual acuity, visual field, hearing detection thresholds, and demographic variables. The 209 males and 355 females ranged in age from 4months to 105years (M=71.9, S.D.=24.6), indicating a prevalence estimate for dual sensory impairment at 15/100000. Only 5.7% were under 18years of age, while 69.1% were over the age of 65years, with 43.1% over the age of 85years. The diagnostic combination that accounted for 31% of the entire sample was age-related macular degeneration with presbycusis. Their visual and auditory measures indicated that older adults were likely to fall into moderate to severe levels of impairment on both measures. Individuals with Usher Syndrome comprised 20.9% (n=118) of the sample. The age distribution in this sample of persons with dual sensory impairment indicates that service delivery planning will need to strongly consider the growing presence of older adults as the baby-boomers approach retirement age. The distribution of their visual and auditory limits indicates that the large majority of this client group has residual vision and hearing that can be maximized in the rehabilitation process in order to restore functional abilities and social participation. Future research in this area should identify the specific priorities in both rehabilitation and research in individuals affected with combined vision and hearing loss.

Vision and visual plasticity in ageing mice

Little is known about neuronal changes during ageing in the visual system of mice which are increasingly being used as animal models for human visual disorders. Measuring the optomotor response to moving gratings, visual acuity of C57BL/6-mice was 0.39 cycles/degree (cyc/deg) until 12 months of age and declined to 0.27 cyc/deg (by 30%) at 26 months. In the visual water task, a cortex-dependent task based on visual discrimination learning, visual acuity remained stable at 0.58 cyc/deg up to 21 months and then declined to 0.48 cyc/deg (by 19%) at 27 months. Visual cortical activity recorded by optical imaging declined by 33% between seven and 23 months of age. After monocular deprivation and daily testing of the optomotor response, visual acuity of the open eye increased by 29% in 4 to 7-month-old animals, while the increase was only 13% in 23-month-old mice. Interestingly, interindividual variability generally increased with age, so that some 23-month-old mice retained visual acuity and interocular plasticity like 4 or 7-month-old animals. In summary, reduced visual function was accompanied by a reduction of both visual cortical responses and interocular plasticity indicating a central nervous system component in age-related vision loss in mice.