Duration Of Visual Impairment Research Articles

Eye Care Utilization among Older Subjects with Visual Impairment in Northwest Ethiopia.

To find out the level of eye care service utilization and its determinants among the elderly visually impaired populations while visiting ophthalmic outreach locations in North-Western Ethiopia, 2021. An ophthalmic outreach-based cross-sectional study was conducted on 852 visually impaired older people. Participants were selected by using a systematic random sampling method from January to July 2021. Data were collected by using an interviewer-administered questionnaire and an ocular examination. The collected data were entered into the Epi Info 7, and analyzed using SPSS 20. A binary logistic regression was fitted. A total of 821 participants, with a response rate of 96.5%, were included in the study. The utilization of eye care services within the past two years prior to the study was 21.1% (95 % CI: 18.2-23.9). Having systemic disease (AOR = 3.2, 95% CI: 1.5-7.0), being a spectacle wearer (AOR = 4.5, 95% CI: 2.0-9.4), having visual impairment at distance (AOR = 2.9; 95% CI: 1.5-5.6), being blind (AOR = 2.9; 95% CI: 1.5-5.6), duration of visual impairment 1 year (AOR = 2.5; 95% CI: 1.3-4.9) were all significantly associated. In this study, utilization of eye care services was low. Being visually impaired at distance, being blind, recent onset of visual impairment, being a spectacle wearer, and having systemic disease were all related to the use of eye care services. The commonest barriers to utilization of eye care services were financial scarcity and long distances between eye care facilities.

Productivity Loss and Predictive Factors Among Visually Impaired Adults in Tertiary Eye Care Centers, Addis Ababa, Ethiopia: A Dual-Center Cross-Sectional Study

Visual impairment has a profound impact on loss of economy and productivity, which can impair health-related quality of life. The purpose of this study was to determine productivity loss and its predictive factors among adults with visual impairment in Addis Ababa tertiary eye care centers, Ethiopia. An institution-based cross-sectional study was conducted between February and July 30, 2021. A total of 425 samples were retrieved using systematic random sampling. Data collection included socio-demographic information, employment status, job absenteeism, presenteeism and reduced work participation. Analysis was done by SPSS version 23, and binary logistic regression was employed for statistical analysis. P-values less than 0.05 were used to state significant associations between dependent and outcome variables. A total of 416 study participants were involved in the study, with a response rate of 97.88%. The mean age was 48±14.3 years. The total productivity loss was $775,325.51, with a median of $358.02. Maximum productivity loss was contributed by reduced workforce participation, which was about $746,337.45, with a median of $1,432.10. Regarding predictor factors, gender, monthly income, degree and duration of visual impairment and support of family to get job were statistically associated with high productivity loss. In general, the current study revealed that there is a profound annual loss of productivity due to visual impairment. The predictor factors for higher productivity loss were gender, monthly income, degree of visual impairment, duration of visual impairment and presence of support from family to get job or achieve better performance on job activities. Rehabilitation for visually impaired adults is recommended to enhance their quality of life by increasing their workplace participation to the maximum potential.

Unilateral Subfrontal Approach for Giant Tuberculum Sellae Meningioma: Single Center Experience and Review of the Literature.

BackgroundMicrosurgical Transcranial approach (mTCA) is the primary choice for the resection of giant Tuberculum Sellae Meningiomas (TSM). The objective of this study is to explore surgical details of unilateral subfrontal approach.MethodsTen patients with giant TSM treated by unilateral subfrontal approach were included from January 2018 to June 2021. Demographic characteristics, surgical data, post-procedure complications and outcomes of patients have been descriptive analyzed, combined with systematic literature review to explore the surgical details and the prognosis of unilateral subfrontal approach.ResultsTen patients include six male and four females, age range from 35 to 77 years, duration of visual impairment from 1 to 12 months, were all performed unilateral subfrontal approach. Nine patients achieved radical resection (Simpson grades I-II) through post-operative imaging confirmation, and Simpson IV resection was performed in the remaining one due to cavernous sinus invasion. The postoperative visual acuity was improved or maintained in 8 patients. Visual acuity decreased in 2 cases, including 1 case of optic nerve atrophy and the other case of optic canal not opening. Five cases with frontal sinus opened were repaired during the operation and there was no postoperative cerebrospinal fluid leakage or intracranial infection. One patient suffered from postoperative anosmia, one patient developed left limb weakness, but their symptoms have improved in the follow-up.ConclusionSummarize the experience of our center and previous literature, unilateral forehead bottom craniotomy is a feasible surgical approach for giant tuberculum sellae meningioma. Intraoperative application of EC glue and pedicled fascia flap to repair the frontal sinus can prevent complications associated with frontal sinus opening. Optic canal unroofing has huge advantage in visual improvement.

Vision-Related Quality of Life among Adult Patients with Visual Impairment at University of Gondar, Northwest Ethiopia.

Purpose The purpose of this study was to assess vision-related quality of life and associated factors among adult patients with visual impairment at the University of Gondar Tertiary Eye Care and Training Center, Northwest Ethiopia. Methods The institution-based cross-sectional study was conducted from April 24 to May 12, 2017, at the University of Gondar Tertiary Eye Care and Training Center among 484 patients with visual impairment. Pretested, structured National Eye Institute Visual Function Questionnaire-25 was used to collect data by interviewing. Data were entered using EPI-INFO version 3.5.1 and analyzed with SPSS version 20. Binary logistic regression was used to determine factors associated with vision-related quality of life. Variables with p value <0.05 in multivariable logistic regression were considered as statistically significant. Result A total of 484 study subjects participated with a response rate of 98.9%. The median age of the participants was 60 years with the interquartile range of 25 years. The proportion of poor vision-related quality of life was 238 (49.2%) (95% CI: 44.2%–53.3%). Age >75 years (AOR = 1.87 (95% CI: 1.02–3.40)), rural residency (AOR = 1.71 (95% CI: 1.13–2.60)), severe visual impairment/blindness (AOR = 2.76 (95% CI: 1.80–4.23)), and history of visual impairment longer than 3 years (AOR = 2.85 (95% CI: 1.61–5.04)) had statistically significant association with poor vision-related quality of life. Conclusion Almost half of the patients with visual impairment had poor vision-related quality of life. Severe visual impairment/blindness, long duration of visual impairment, older age, and rural residency had a statistically significant association with poor vision-related quality of life.

Impact of Visual Impairment and Blindness on Quality of Life of Patients in Owerri, Imo State, Nigeria.

PURPOSE:This study sought to determine the quality of life (QOL) of patients with visual impairment in Federal Medical Centre, Owerri, Imo State, with a view to making recommendations for comprehensive management of patients.MATERIALS AND METHODS:This was a hospital-based, cross-sectional study carried out at the Eye Clinic of Federal Medical Centre, Owerri, Imo State, Southeast Nigeria. New patients aged 18 years and older were consecutively recruited. Data were obtained using a semi-structured questionnaire and a World Health Organization's QOL Scale-Short Form (WHO-QOL-BREF). Participants had comprehensive eye examinations, and data were analyzed using the Statistical Package for the Social Sciences version 22.RESULTS:One hundred and eight (53.7%) females and 93 (46.3%) males with a mean age of 55.92 ± 16.94 years participated in the study. The major causes of visual impairment were uncorrected refractive error, glaucoma, and cataract. Glaucoma (6.5%) was the leading cause of blindness. The overall QOL score was 61.10 ± 19.75, with the lowest mean score in the environmental domain. With increasing visual impairment, there was a 19.1% reduction in QOL. QOL was also affected by age, duration of visual impairment, and history of poor near vision.CONCLUSION:The leading causes of visual impairment and blindness in this study are avoidable and treatable. Health education, appropriate intervention, and support groups should be encouraged. This may serve to reduce the burden of visual impairment and improve the QOL of patients.

Rasch validation of the PHQ-9 in people with visual impairment in South India

BackgroundThe Patient-Health Questionnaire (PHQ-9) is a widely used screening instrument for depression. Recently, its properties as a measure were investigated using Rasch analysis in an Australian population with visual impairment (VI) and it was demonstrated to possess excellent measurement properties, but the response scale required shortening (modified PHQ-9). However, further validation was recommended to substantiate its use with the growing population of VI. Therefore, we aimed to use Rasch analysis to evaluate the measurement properties of the modified PHQ-9 in an Indian population with VI. Methods303 patients with VI (mean age 40.2 years; 71% male) referred to Vision Rehabilitation Centres were administered the PHQ-9 by trained interviewer. Rasch analysis was used to investigate the psychometric properties of the modified PHQ-9. ResultsRasch analysis showed good fit to the model, no misfitting items and an acceptable person separation reliability (0.82). Dimensionality testing supported combining 9 items to create a total score. Targeting was sub-optimal (−1.30 logits); more difficult items are needed. One item (‘trouble falling asleep’) showed notable differential item functioning, DIF (1.18 logits) by duration of VI. LimitationsThe generalisability of these results might be restricted to patients with VI presenting to a tertiary eye care centre. ConclusionsExcept for DIF, the performance of the modified PHQ-9 is consistent with that of the original, albeit in a different cultural context (Indian population with VI). Clinicians/researchers can readily use the modified PHQ-9 without formal training in Rasch procedures given the provision of ready-to-use spreadsheets that convert raw to Rasch-scaled scores. However the conversions will apply only if the sample being tested is similar to that of the present study.

Eenzaamheid en zelfmanagementvaardigheden bij visueel beperkte ouderen

To describe the degree of loneliness among the visually impaired elderly and to make a comparison with a matched reference group of the normally sighted elderly. In addition, we examined self-management abilities (SMAs) as determinants of loneliness among the visually impaired elderly. In a cross-sectional study, 173 visually impaired elderly persons completed telephone interviews. Loneliness and SMAs were assessed with the Loneliness Scale of De Jong Gierveld and the SMAS-30, respectively. The prevalence of loneliness among the visually impaired elderly was higher compared to the reference group (50% vs 29%; p < .001). Multivariate hierarchical regression analysis showed that the SMA self-efficacy, partner status, and self-esteem were determinants of loneliness. Severity and duration of visual impairment had no effect on loneliness. The relationship between SMAs (i.e., self-efficacy) and loneliness is promising, since SMAs can be learned through training. Consequently, self-management training may reduce feelings of loneliness. An adapted version of this paper was published in Journal of Aging and Health, doi: 10.1177/0898264311399758.

The Second Version of the L. V. Prasad-Functional Vision Questionnaire

The L. V. Prasad-Functional Vision Questionnaire (LVP-FVQ) was developed using Rasch analysis to assess self-reported difficulties in performing daily tasks in school children with visual impairment (VI) in India. However, the LVP-FVQ has psychometric problems of inadequate measurement precision and lack of detailed assessment of dimensionality. Furthermore, items pertaining to use of technology are lacking. The aim of this study was to present the development and validation of the second version of LVP-FVQ (LVP-FVQ II). Development of LVP-FVQ II involved extracting items from other similar questionnaires (albeit developed for Western populations) and focus group discussions of children with VI and their parents that resulted in a 32-item pilot questionnaire. Overall, six items from the LVP-FVQ were retained. The questionnaire underwent pilot testing in 25 such children, following which a 27-item LVP-FVQ II emerged, and this was administered to 150 children with VI. Response to each item was rated on a three-category scale. Rasch analysis was used to validate the LVP-FVQ II. Rating scale was used by participants as was intended to. Four mobility-related items required deletion, as these did not contribute toward measurement of a single construct, indicating a secondary dimension. Deletion of the four items resulted in the 23-item unidimensional LVP-FVQ II, with good measurement precision, effective targeting of item difficulty to participant ability, and lack of notable differential item functioning. The LVP-FVQ II has high reliability, indicating that it is effectively able to discriminate between visual disability of school children in India, and is valid across age, gender, duration of VI, and location of residence. Given the superior measurement properties and the interval-level scores, the LVP-FVQ II appears to offer advantages over LVP-FVQ in assessment of difficulties in performing daily tasks in this population. It can be adapted for use in other developing countries.

Factors Associated with the Direction of Ocular Deviation in Sensory Horizontal Strabismus and Unilateral Organic Ocular Problems

PurposeTo evaluate factors associated with the direction of horizontal deviation in the sensory strabismus of patients with unilateral organic amblyopia.MethodsThe medical charts of 53 patients who had been diagnosed with sensory strabismus between 2000 and 2009 were reviewed retrospectively. The underlying ocular disease, time of onset and the duration of vision impairment, refractive error and axial length of the fixing eye, and the direction and angle of deviation were analyzed to determine the distribution of underlying diseases and any factors relevant to determining the direction of the horizontal deviation.ResultsCongenital cataracts were the most common underlying disease, found in 33 patients, followed by acquired cataracts, optic nerve disorders, retinal detachment, glaucoma and lens subluxation. Among the 50 patients with horizontal strabismus, 11 had esotropia and 39 had exotropia. The incidence of esotropia was significantly higher when the fixing eye had hyperopia or emmetropia, than when the eye was myopic. Age of onset of vision deterioration and at diagnosis of sensory strabismus, and the axial length of the fixing eye had no relationship to the direction of horizontal deviation. In addition, the duration of visual impairment had no significant relationship with the direction or extent of horizontal deviation.ConclusionsThe most common cause of sensory strabismus was congenital cataracts and the most frequent type of strabismus was exotropia. With respect to the direction of horizontal strabismus, esotropia occurred significantly more often when the refractive error of the fixing eye was hyperopia or emmetropia than when the fixing eye was myopic.

Loneliness and Self-Management Abilities in the Visually Impaired Elderly

To describe the degree of loneliness among the visually impaired elderly and to make a comparison with a matched reference group of the normally sighted elderly. In addition, we examined self-management abilities (SMAs) as determinants of loneliness among the visually impaired elderly. In a cross-sectional study, 173 visually impaired elderly persons completed telephone interviews. Loneliness and SMAs were assessed with the Loneliness Scale of De Jong Gierveld and the SMAS-30, respectively. The prevalence of loneliness among the visually impaired elderly was higher compared with the reference group (50% vs. 29%; p < .001). Multivariate hierarchical regression analysis showed that the SMA self-efficacy, partner status, and self-esteem were determinants of loneliness. Severity and duration of visual impairment had no effect on loneliness. The relationship between SMAs (i.e., self-efficacy) and loneliness is promising, as SMAs can be learned through training. Consequently, self-management training may reduce feelings of loneliness.

Working memory for spatial construction in blind and sighted individuals

Two experiments were conducted to examine the performance difference on the spatial working memory between blind and sighted subjects by manipulating auditory, visual, and tactile stimuli. The results indicated that blind subjects’ performance with tactile stimuli was no different to that of the sighted subjects with visual stimuli. Duration of visual impairment may be a factor influencing the subjects’ performance. The late-blind subjects could form and organize the spatial information by auditory and tactile modality based on their past visual experience. On the contrary, the congenitally blind subjects restricted themselves to developing their mental imagery. Their performance was worse than the late-blind subjects.

The relationship between visual function, duration and main causes of vision loss and falls in older people with low vision

Falls are an alarming health problem and a major cause of injury among the elderly. The healthcare cost associated with falls is considerable. Visual acuity has been found to be an independent risk factor for falls; however, the results are not unanimous. Moreover, other aspects of visual function such as visual field, contrast sensitivity and depth perception have not been adequately investigated in relation to falls. The aim of this study, therefore, was to determine the relationship between visual function, duration, and main causes of visual impairment, and falls in individuals with low vision. This was a cross-sectional study involving participants attending a public tertiary eye care hospital. Participants were mobile, aged 60 years or above, and had low vision (visual acuity >0.3 LogMAR in the better eye). Details about falls in the previous 12 months and other information were collected, and patients completed a questionnaire about activities of daily living. The duration and main causes of visual impairment, visual acuity, contrast sensitivity, depth perception, and visual field were assessed. Descriptive statistical analyses were performed to characterize the participants' sociodemographic and clinical data. One hundred and twenty seven patients (53%; 67 males) with a mean age of 76.3+/-8.3 years were recruited. Thirty seven percent of the participants (n=47) had mild, 50% (n=64) moderate and 13% (n=16) severe visual impairment (>0.3-0.5; >0.5-1.0; and >1.0 LogMAR respectively). The frequencies of single and multiple falls were 42.5% and 12.6% respectively. Visual acuity, contrast sensitivity, depth perception, visual field, main cause, and duration of visual impairment were not significantly associated with falls (p>0.05). In multiple regression analyses, physical inactivity remained the only variable independently associated with falls in all models except for visual field. Overall, visually impaired people were three times more likely to fall if they were physically inactive. Visual function, duration and main causes of visual impairment are not independently associated with falls in people with low vision. However, a significant relationship between non-participation in physical activity and falls was found. Further work is required to investigate the association between vision-related factors and falls in older people with visual impairment.

Evaluation of minimally invasive therapies and rationale for a prospective randomized trial to evaluate selective intra-arterial lysis for clinically complete central retinal artery occlusion.

To determine the effect of commonly used minimally invasive treatments for clinically complete nonarteritic central retinal artery occlusion (CRAO) and design a prospective randomized trial to evaluate selective intra-arterial lysis for this condition. In this retrospective noncomparative case series, all medical records of patients with a diagnosis of CRAO treated at the Department of Ophthalmology, Ludwig-Maximilians-Universität, Munich, Germany, from 1994 through 1999 were reviewed for treatments administered and course of visual acuity. Best-corrected visual acuity (BCVA) at initial and last visit. We identified 102 patient medical records; 71 were suitable for further analysis. Forty-four (62%) of the 71 patients included were treated with oral acetylsalicylate; 44 (62%), with oral acetazolamide; 32 (45%), with ocular massage; 22 (31%), with isovolemic hemodilution; 19 (27%), with oral pentoxifylline; 8 (11%), with topical beta-blocker; 6 (8%), with paracentesis of the anterior chamber; 4 (6%), with subcutaneous heparin. A mean +/- SD number of treatments of 2.5 +/- 1.4 was administered per patient, and BCVA increased by a mean +/- SD number of Snellen lines of 0.7 +/- 2.8. The BCVA in 11 patients (15%) increased by 3 or more lines. Multivariate stepwise regression did not reveal any single or combination treatment as a significant factor for improvement in BCVA. Patient age and duration of visual impairment before initial examination were not significant predictors of final BCVA. Commonly used minimally invasive treatments of CRAO do not improve the natural course of the disease. A prospective trial by the European Assessment Group for Lysis in the Eye is under way to evaluate selective intra-arterial lysis, and in this trial some of these minimally invasive treatments are used in the control group.

Statistical analysis of visual prognosis following stellate ganglion block treatment on patients with retinal vessel obstruction.

The visual outcome in 308 patients treated for retinal vessel obstruction was examined retrospectively and the effectiveness of each treatment was evaluated using stepwise multiple linear regression analysis and the chi-square test. Visual acuity was used as the parameter for assessing treatment effectiveness and the variables investigated included treatment factors [stellate ganglion block (SGB), urokinase administration, and prostaglandin administration] and patient factors (age, duration of visual impairment before treatment, hypertension, and diabetes mellitus). SGB treatment, the duration of visual impairment, and the presence of diabetes mellitus were significantly correlated with the visual prognosis following treatment. These results support the current hypothesis that SGB is a viable treatment for patients with obstructive disease of the retinal vessels.

Loneliness in low-vision older women.

The purpose of this analysis was to identify predictors of loneliness in women 75 years of age and older with low vision. The sample of 56 women was derived from a larger study of low-vision adults. Women's loneliness, optimism, social support, living arrangement, vision, and perceived health were examined using the revised University of California, Los Angeles, Loneliness Scale, the Life Orientation Test, the Social Support Questionnaire, and a demographic questionnaire. Data were analyzed using descriptive statistics, Pearson correlations, multiple regressions, and t-tests. Optimism and social support satisfaction were found to predict degree of loneliness in the sample. Women who were less optimistic and less satisfied with their social support system experienced higher levels of loneliness. Duration of visual impairment was associated with duration of loneliness. The findings provide nurses with information for identifying low-vision older women who are at risk for loneliness.

Evaluation of the Transcranial Approach to Pituitary Adenomas Based on Quantitative Analysis of Pre and Postoperative Visual Function

Over a 16-year period, 105 patients with pituitary adenoma accompanied by visual disturbance underwent transcranial intracapsular removal of the tumor followed by radiotherapy. Postoperative recovery of visual function in these patients was compared with the results obtained in other institutions after trans-sphenoidal surgery. The severity of preoperative visual impairment was correlated with the duration of visual impairment, the degree of optic atrophy, the extent of suprasellar tumor infiltration, and age. Trans-sphenoidal surgery appears more effective in patients with mild preoperative visual disturbance, whereas the transcranial approach yields better results in patients with moderate to severe preoperative visual deficits.

Visual prognosis following treatment of acute central retinal artery obstruction.

The authors report the visual outcome in 34 consecutive cases of treated acute central retinal artery obstruction. Visual acuity equal to or better than 6/30 was recovered in 35% of the cases. The presenting visual acuity and duration of visual impairment appear to correlate with visual prognosis.