Onset Of Visual Impairment Research Articles

The incidence of visual impairment due to retinitis pigmentosa has declined in Finland over the last 40 years.

To study the changes in incidence, age at onset and severity of visual impairment (VI) due to retinitis pigmentosa (RP) in the Years 1980-2019, and the incidence and age at diagnosis of hereditary retinal dystrophy (HRD) diagnoses coded by ICD10 H35.5 in the Years 1998-2019 in Finland. A total of 1606 persons with VI due to RP registered by the Finnish Register of Visual Impairment and total of 4291 HRD diagnoses registered by the Care Register of the Finnish Institute for Health and Welfare were included. VI was classified according to the Finnish national definitions derived from the WHO definitions. The significance of the changes in incidence and age at onset were tested with statistical tests (Kruskal-Wallis, Mann-Whitney U and Cochran-Armitage). Two-tailed p-value below 0.05 was considered significant. The incidence of VI due to RP has decreased from 0.96/100 000 in the 1980s to 0.55/100 000 in the 2010s (p 0.004). The age at onset of VI has increased from 41.6 to 50.3 years. The severity of VI has not changed. The incidence of HRD diagnoses has decreased from 3.66/100 000 in the 2000s to 2.86/100 000 in the 2010s (p 0.024). The age at diagnosis has risen in male patients from 42.1 to 44.5 years (p 0.024). The VI caused by RP in Finland has decreased. It develops at an older age than in the past. We hypothesize that this trend may be attributed to informed decisions by visually impaired persons to refrain from having offspring to prevent the transmission of hereditary mutations. The severity of VI due to RP has remained relatively unchanged. The incidence of HRD diagnoses has decreased, and the diagnosis occurs at an older age among men.

Diffusion-weighted magnetic resonance imaging in early central retinal artery occlusion.

Restricted retinal diffusion (RDR) has recently been recognized as a frequent finding on standard diffusion-weighted imaging (DWI) in central retinal artery occlusion (CRAO). However, data on early DWI signal evolution are missing. Consecutive CRAO patients with DWI performed within 24 h after onset of visual impairment were included in a bicentric, retrospective cross-sectional study. Two blinded neuroradiologists assessed randomized DWI scans for the presence of retinal ischemia. RDR detection rates, false positive ratings, and interrater agreement were evaluated for predefined time groups. Sixty eight CRAO patients (68.4 ± 16.8 years; 25 female) with 72 DWI scans (76.4% 3 T, 23.6% 1.5 T) were included. Mean time-delay between onset of CRAO and DWI acquisition was 13.4 ± 7.0 h. Overall RDR detection rates ranged from 52.8% to 62.5% with false positive ratings in 4.2%-8.3% of cases. RDR detection rates were higher in DWI performed 12-24 h after onset, when compared with DWI acquired within the first 12 h (79.5%vs 39.3%, p < 0.001). The share of false positive ratings was highest for DWI performed within the first 6 h of symptom onset (up to 14.3%). Interrater reliability was "moderate" for DWI performed within the first 18 h (κ = 0.57-0.58), but improved for DWI acquired between 18 and 24 h (κ = 0.94). DWI-based detection of retinal ischemia in early CRAO is likely to be time-dependent with superior diagnostic accuracy for DWI performed 12-24 h after onset of visual impairment.

Self-esteem and locus of control of individuals with visual impairments before and during the COVID-19 pandemic: A latent class analysis

This study aims to investigate the effect of lockdowns on self-esteem and the locus of control (LoC) of individuals with visual impairments. This research question is important to be answered, as there is no previous research on the topic, and the findings of this study add significant elements to our knowledge on the subject. It is the first time that a study examines the effect of the pandemic on the self-esteem and LoC of individuals with visual impairments. The sample of the research consisted of 321 individuals with visual impairments; 176 of them participated in the pre-COVID period, 50 in the first wave of COVID period, and 95 in the second wave of COVID period. Two research instruments were used: the Rosenberg Self-Esteem Scale and the Rotter Internal–External LoC Scale. High self-esteem and a more internal LoC are positively associated with the pre-COVID period and negatively associated with first- and second-wave COVID periods. The participants with high self-esteem and internal LoC are most likely males, people with blindness, people who work, people who have a university degree, and people who frequently move independently. However, the individuals with low self-esteem and a more external LoC are most likely older people or people with higher age at onset of visual impairment. The first- and second-wave COVID periods are negatively associated with self-esteem and LoC of individuals with visual impairments.

The Impact of Visual Impairment on Healthcare Use among Four Medical Institution Types: A Nationwide Retrospective Cohort Study in Korea.

The aim of this study was to determine the effect of visual impairment (VI) onset on the use of healthcare services across four types of institutions in South Korea. We utilized data from the National Health Insurance Service database from 2006 to 2015 for 714 persons who experienced VI onset in 2009-2012 and for 2856 matched persons for a 1:4 ratio of matching controls. We compared trends in healthcare use and expenditures for eye diseases at clinics, hospitals, general hospitals, and tertiary teaching hospitals using 3 years of data prior to and after the onset of VI. The inpatient and outpatient healthcare expenditures of individuals with VI were higher than those without VI, peaking at the pre-VI onset period in tertiary teaching hospitals. During the pre-VI onset period, the proportion of healthcare expenditures attributed to eye diseases ranged 11%-40.8% among individuals with VI, but 1.9%-11% among individuals without VI at the four types of institutions. The differences in healthcare use between the pre- and post-VI periods were primarily observed in tertiary teaching hospitals for inpatient care. There was a peak in utilization of outpatient care in the year preceding VI onset at tertiary teaching hospitals, clinics, and hospitals, but there was a decrease in outpatient care over time during the post-VI period. Our findings suggest economic burden of healthcare in tertiary teaching hospitals during pre-VI onset period and a potential lack of regular management and continuity of care in post-VI periods.

Retinal diffusion restrictions in acute branch retinal arteriolar occlusion

This study sought to investigate the occurrence of retinal diffusion restrictions (RDR) in branch retinal arteriolar occlusion (BRAO) using standard brain diffusion-weighted imaging (DWI). Two radiologists assessed DWI MRI scans of BRAO patients for RDR in a retrospective cohort study. Inter- and intrarater reliability were calculated using Kappa statistics. Detection rates of RDR were compared among MRI scans with varying field strength, sequence type and onset-to-DWI time intervals. 85 BRAO patients (63.1 ± 16.5 years) and 89 DWI scans were evaluated. Overall sensitivity of RDR in BRAO was 46.1% with visually correlating low ADC signal in 56.1% of cases. Localization of RDR matched distribution of fundoscopic retinal edema in 85% of patients. Inter- and intra-rater agreement for RDR in BRAO was κinter = 0.64 (95% CI 0.48–0.80) and κintra = 0.87 (95% CI 0.76–0.96), respectively. RDR detection rate tended to be higher for 3T, when compared to 1.5T MRI scans (53.7% vs. 34.3%%; p = 0.07). RDR were identified within 24 h up to 2 weeks after onset of visual impairment. RDR in BRAO can be observed by means of standard stroke DWI in a substantial proportion of cases, although sensitivity and interrater reliability were lower than previously reported for complete central retinal artery occlusion.

Emotional valence and arousal induced by auditory stimuli among individuals with visual impairment

Despite significant vision loss, humans can still recognize various emotional stimuli via a sense of hearing and express diverse emotional responses, which can be sorted into two dimensions, arousal and valence. Yet, many research studies have been focusing on sighted people, leading to lack of knowledge about emotion perception mechanisms of people with visual impairment. This study aims at advancing knowledge of the degree to which people with visual impairment perceive various emotions – high/low arousal and positive/negative emotions. A total of 30 individuals with visual impairment participated in interviews where they listened to stories of people who became visually impaired, encountered and overcame various challenges, and they were instructed to share their emotions. Participants perceived different kinds and intensities of emotions, depending on their demographic variables such as living alone, loneliness, onset of visual impairment, visual acuity, race/ethnicity, and employment status. The advanced knowledge of emotion perceptions in people with visual impairment is anticipated to contribute toward better designing social supports that can adequately accommodate those with visual impairment.

The Differential Impact of Age on Vision-Related Quality of Life across the Visual Impairment Spectrum

Visual impairment (VI) can have a detrimental impact on vision-related quality of life (VRQoL), butitis still unclear how this relationship varies with age across the VI spectrum. We determined the age-stratified, cross-sectional, and longitudinal associations between VI severity and VRQoL. The baseline and follow-up Singapore Chinese Eye Studies (SCES-1/-2; 2009-2011 and 2015-2017). A total of 3068 SCES-1 participants (mean age [standard deviation {SD}]: 59.5 [9.8] years; 50.2% female) and 1919 SCES-2 participants (mean age [SD]: 56.8 [8.3] years; 49.9% female). Visual impairment was defined as visual acuity (VA) of > 0.3 logarithm of the minimum angle of resolution (logMAR) units; VI severity as mild-moderate (logMAR scores less than the median of all individuals with VI) and severe (logMAR scores median or greater); and VI incidence as VI absence at baseline, but evident at follow-up. Age was stratified into 40 to 49 years, 50 to 64 years, and ≥65 years. Rasch-transformed scores from the 32-item Impact of Visual Impairment (IVI) questionnaire were used to measure the "Reading," "Mobility," and "Emotional" domains of VRQoL. Multiple linear regression models determined the age-stratified associations of prevalent and incident VI with all 3 VRQoL outcomes, adjusted for potential confounders. Of the 807 persons with prevalent VI, 55.9% had mild-moderate and 44.1% had severe VI. Compared with no VI, age-stratified analyses showed that VRQoL decrements were significant only in the older age groups (mild-moderate VI: 6.2% and 8.1% reduction in Mobility and Reading scores in those aged ≥ 65 years; severe VI: 8.5% to 13.4% reductions in the 3 VRQoL scores in those aged ≥ 50 years). This interaction with older age became more pronounced with incident VI (N= 168), where decrements in all 3 VRQoL domains were evident only in those aged ≥65 years compared with persons without incident VI. Our results suggest that the VI-VRQoL associations are driven mainly by older individuals aged ≥65 years, highlighting the need for effective regular screening and early intervention modalities to prevent the presence and onset of VI, and subsequent VRQoL declines, in these individuals.

An Exploratory Study of General Self-Efficacy and Employment in Adults with Retinitis Pigmentosa

Introduction: In this study, the author examined the association between general self-efficacy (GSE) and employment status in working-age adults with retinitis pigmentosa (RP; N = 183). The author further examined the associations between employment status and factors that were previously found to be linked to employment outcomes in individuals with visual impairments: educational attainment, mobility tool use (i.e., use of dog guide or cane), ability to drive, age, gender, and age at onset of visual impairment. Methods: Multiple logistic regression was used to analyze cross-sectional data collected online in 2015. Results: Findings indicated that individuals with RP who have a bachelor’s degree or higher had significantly higher odds of being employed ( p &lt; .01) and that individuals with RP who use a cane or dog guide had significantly lower odds of being employed ( p &lt; .01). Although not statistically significant, findings further indicated that individuals with RP who have higher GSE had higher odds of being employed ( p = .07) and that individuals who are able to drive had 130% higher odds of being employed ( p = .06). Discussion: Results demonstrated an association between GSE and employment status, after controlling for factors that were previously linked to employment outcomes in individuals with visual impairment. Implications for practitioners: Self-efficacy is an alterable cognitive construct and may be the target of interventions to increase employment outcomes for adults with RP or other eye conditions.

Down-regulation of microRNA-216a confers protection against yttrium aluminium garnet laser-induced retinal injury via the GDNF-mediated GDNF/GFRα1/RET signalling pathway

Retinal injury plays a leading role in the onset of visual impairment. Current forms of treatment are not able to ameliorate scarring, cell death and tissue and axon regeneration. Recently, microRNA-216a (miR-216a) has been reported to regulate snx5, a novel notch signalling pathway component during retinal development. This study aims to elucidate the role of miR-216a in yttrium aluminium garnet (YAG) laser-induced retinal injury by targeting glial cell line-derived neurotrophic factor (GDNF) via GDNF/GDNF family neurotrophic factor receptor α1 (GFRα1)/rearranged during transfection (RET) signalling pathway. Wistar male rats were first randomly assigned into control and model groups. Immunohistochemistry was performed to detect the GDNF positive expression rate and terminal deoxynucleotidyl transferase-mediated dUTP nick end labelling (TUNEL) staining for apoptotic index (AI) of retinal tissue. Retinal neurons were divided into normal, blank, negative control (NC), miR-216a mimic, miR-216a inhibitor, siRNA-GDNF and miR-216a inhibitor?siRNA-GDNF groups. Dual luciferase reporter assay was conducted in order to identify the targeting relationship between GDNF and miR-216a. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) and western blot were used for the analysis of mRNA and protein levels of miR-216a and related genes. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to determine cell proliferation and flow cytometry was used to observe cell cycle and apoptosis. Results show that the model group had an increased GDNF positive rate, AI of retinal tissue and mRNA and protein levels of cellular oncogene fos (c-fos), vascular endothelial growth factor (VEGF), brain-derived neurotrophic factor (BDNF), GDNF, GFRα1 and bcl-2-associated X protein (bax), declined miR-216a level and mRNA and protein levels of RET and bcl-2 compared with the control group. GDNF was verified as the target gene for miR-216a. Compared with the blank and NC groups, the miR-216a mimic and siRNA-GDNF groups had higher mRNA and protein levels of c-fos, VEGF and bax, cell number in the G1 phase and increased cell apoptosis but reduced BDNF, GDNF, GFRα1, RET and bcl-2 expression, cell proliferation and cell numbers in the S phase, while the opposite trend was observed in the miR-216a inhibitor group. Taken together, our findings demonstrate that elevated GDNF levels can reduce the retinal injury, whereby down-regulated miR-216a aggravates the YAG laser-induced retinal injury by targeting the GDNF level through the GDNF/ GFRα1/RET signalling pathway.

Competencies of Students with Visual Impairment in using the White Cane in their Learning Environment: a Case Study at Wenchi Senior High in Ghana

Purpose: This study investigated the competencies of students with visual impairment at Wenchi Senior High School, Ghana, in familiarising themselves with their learning environment using the cane. Method: A case study design was adopted for the study. A mixed method approach was utilized in this study. A quantitative approach was used to assess students’ competencies in using the cane while qualitative approach was adopted to probe challenges related to using the cane. Results: Students had reached higher stages on the Conscious Competence Matrix and were by and large competent in using the white cane in their learning environment. However, personal and environmental factors were marring their progress. The personal factors included difficulties with fine motor skills and onset of blindness. The external factors were lack of mobility trainers and canes, as well as barriers within the physical environment. There is generally a positive correlation between onset of visual impairment and specific cane skills. Conclusion and Implications: It is recommended that resource persons devote more time to developing the competencies of students in cane techniques, especially in skills related to identification of obstacles. Modifying the physical environment, as well as providing more canes and additional mobility trainers, will be useful in facilitating the movement of visually impaired students within the school. Limitations: A major limitation is the lack of objective assessment of residual vision and motor impairment. Residual vision likely played a crucial role during the competency test.

Bardet Biedl syndrome in South Africa: A single founder mutation.

Bardet Biedl syndrome (BBS) is a multisystem disorder characterised by obesity, polydactyly, intellectual disability and loss of vision due to a progressive retinopathy. Although typically a highly heterogeneous autosomal recessive disease, homozygosity for single mutation in BBS 10 has been identified in a significant number of affected individuals tested in South Africa (SA).Objectives. To delineate the ethnic distribution and clinical phenotype in a cohort of SA BBS patients with the K243IfsX15 mutation in BBS 10 and discuss the implications for genetic testing of and counselling for this disorder in SA. This was a descriptive cross-sectional study collating clinical and laboratory data retrospectively in a genetically homogenous subgroup of BBS patients from SA. A total of 76 patients from 74 families were tested. Homozygosity for the K243IfsX15 BBS 10 mutation was found in 50 families (67%) and heterozygosity for the same mutation in an additional two affected individuals. With the exception of one patient of mixed ancestry, all were black South Africans from different language groups. This is in keeping with the observation that BBS is more common in this ethnic group compared with white and coloured patients in SA, first made by Prof. Beighton nearly 3 decades ago. A subset of 15 patients available for detailed phenotyping confirmed consistency with well-described features of the disorder, with some overlap with other ciliopathies. The onset of visual impairment was early in our cohort, before the age of 8 years, cognitive impairment was significant, and renal and cardiac abnormalities were infrequently encountered.Conclusion. The high frequency of homozygosity for a single mutation in an ethnic subset of the SA population is strongly suggestive of a founder effect. This has allowed establishment of a diagnostic test with a high yield in our local population. Better understanding of the phenotype will improve earlier recognition of the disorder to allow for appropriate intervention. Testing can confirm but not negate a clinical diagnosis, and can permit carrier and prenatal testing in informative families.

Variables Influencing Emotional Intelligence of Visually Impaired Students in Higher Education

Purpose: Emotional Intelligence is a set of abilities which enables people to understand emotions more accurately and solve problems in their emotional lives. The present study attempted to identify variables influencing emotional intelligence (EI) of visually impaired students studying in higher educational institutions. Method: A survey method of descriptive research design was adopted. 60 visually impaired students pursuing higher education were selected through purposive sampling. Their emotional intelligence (EI) was measured using ‘Mangal Emotional Intelligence Inventory’ (MEII). The collected data was analysed using differential and descriptive statistics to identify the influence of selected demographic variables on EI. Results: The study results revealed that demographic variables did not have significant impact on the EI of students with visual impairment studying in higher educational institutions, except at the onset of visual impairment. Those who had lost their vision later in life seemed to have more EI than those who were congenitally blind. Conclusion: Suitable training programmes should be planned to promote the emotional intelligence of those who are visually impaired since birth, because most behaviour is learnt through visual clues.

The Recreation and Leisure Pursuits of Employed Adults with Visual Impairments in Nigeria: Part 2

Introduction Indoor and outdoor activities play an important role in enhancing the health and well-being of people with and without disabilities in developed countries. The status of recreational activities, however, is not a priority in many developing countries—those in which people struggle daily to eke out a living. This study investigates the recreation and leisure experiences of employed adults with visual impairments (those who are blind or have low vision) who live and work in Nigeria—one of the world's most populous developing nations. Methods We developed a questionnaire that assessed recreation and leisure among a sample of 172 adults with visual impairments living and working in Nigeria. Statistical analysis procedures included descriptive and nonparametric methods. The Mann-Whitney U-test compared the difference between the mean ranks of five recreational experience measures (dependent variables) within the independent groups. Results Gender, degree of visual impairment, age at onset of visual impairment, educational attainment, annual income, and postsecondary education were all characteristics that evidenced significant differences ( p &lt; .05) in the participants’ recreation and leisure experiences that were evaluated. Discussion Male respondents with visual impairments and those with higher earning power were engaged more often in recreation and leisure than were female respondents or those with less robust financial situations. Furthermore, recreational activities were most important to quality of life for respondents who had at least one postsecondary degree. Individuals with low vision reported higher levels of satisfaction than those who are blind. Implications for practitioners It is imperative for stakeholders to explore opportunities that will increase the level of participation in recreation of people with visual impairments of both genders and all degrees of financial earning power in developing nations. The value of postsecondary education is underscored.

A Quantitative Analysis of the Work Experiences of Adults with Visual Impairments in Nigeria

Introduction Worldwide, people with visual impairments often struggle to gain employment. This study attempts to closely evaluate the work experiences of employed individuals with visual impairments living in one of the world's most populous developing nations, Nigeria. Methods The researchers developed a questionnaire that assessed personal and professional experiences among a sample of 172 adults with visual impairments living and working in Nigeria. Statistical analysis procedures included descriptive and nonparametric methods. The Mann-Whitney U test compared the difference between the mean ranks of 12 work-experience measures (dependent variables) within the independent groups. Results Gender, degree of visual impairment (total blindness or low vision), age at onset of visual impairment (childhood or adulthood), educational attainment, and marital status were all characteristics that evidenced significant differences (p &lt;.05) in the participants’ work experiences evaluated by the present study. However, there were also instances where there were no significant differences in the independent groups among several of the 12 work-experience measures (p &gt; .05). Discussion Annual income, hours worked per week, confidence level performing current work, and future job opportunities were found to be significant based on participants’ gender, education, or marital status. There was overall consistency among participants in the sample (regardless of degree of visual impairment or age at onset of visual impairment). Implications for practitioners In this sample, advanced education equated to higher salaries and greater confidence in performing work. The importance of postsecondary education was affirmed in terms of future earnings and confidence.

The Increased Cost of Medical Services for People Diagnosed With Primary Open-Angle Glaucoma: A Decision Analytic Approach

Glaucoma accounts for more than 11% of all cases of blindness in the United States, but there have been few studies of economic impact. We examine incremental cost of primary open-angle glaucoma considering both visual and nonvisual medical costs over a lifetime of glaucoma. A decision analytic approach taking the payor's perspective with microsimulation estimation. We constructed a Markov model to replicate health events over the remaining lifetime of someone newly diagnosed with glaucoma. Costs of this group were compared with those estimated for a control group without glaucoma. The cost of management of glaucoma (including medications) before the onset of visual impairment was not considered. The model was populated with probability data estimated from Medicare claims data (1999 through 2005). Cost of nonocular medications and nursing home use was estimated from California Medicare claims, and all other costs were estimated from Medicare claims data. We found modest differences in the incidence of comorbid conditions and health service use between people with glaucoma and the control group. Over their expected lifetime, the cost of care for people with primary open-angle glaucoma was higher than that of people without primary open-angle glaucoma by $1688 or approximately $137 per year. Among Medicare beneficiaries, glaucoma diagnosis not found to be associated with significant risk of comorbidities before development of visual impairment. Further study is necessary to consider the impact of glaucoma on quality of life, as well as aspects of physical and visual function not captured in this claims-based analysis.

Analysis of user characteristics related to drop-off detection with long cane

This study examined how user characteristics affect drop-off detection with the long cane. A mixed-measures design with block randomization was used for the study, in which 32 visually impaired adults attempted to detect the drop-offs using different cane techniques. Younger cane users detected drop-offs significantly more reliably (mean +/- standard deviation = 74.2% +/- 11.2% of the time) than older cane users (60.9% +/- 10.8%), p = 0.009. The drop-off detection threshold of the younger participants (5.2 +/- 2.1 cm) was also statistically significantly smaller than that of the older participants (7.9 +/- 2.2 cm), p = 0.007. Those with early-onset visual impairment (78.0% +/- 9.0%) also detected drop-offs significantly more reliably than those with later-onset visual impairment (67.3% +/- 12.4%), p = 0.01. No interaction occurred between examined user characteristics (age and age at onset of visual impairment) and the type of cane technique used in drop-off detection. The findings of the study may help orientation and mobility specialists select appropriate cane techniques in accordance with the cane user's age and onset of visual impairment.

Change in quality of life after rehabilitation: prognostic factors for visually impaired adults

The overall aim of rehabilitation for visually impaired adults is to improve the quality of life and (societal) participation. The objectives of this study were to obtain the short-term and long-term outcome of a comprehensive rehabilitation programme on quality of life for visually impaired adults, and prognostic baseline factors responsible for differences in outcome between certain groups of patients. The questionnaire was administered to 129 visually impaired adults (mean age 42.1 years). Quality of life was measured with the Visual Functioning Questionnaire, developed by the National Eye Institute (NEI-VFQ-25). Measurements were conducted during the observational programme (baseline measurement), and 3 months and 1 year after finishing rehabilitation. The change between subsequent measurements of the four dependent variables was measured, and the longitudinal relationship between vision-related quality of life on the one hand and possible prediction factors on the other was evaluated by means of random coefficient analyses. If the factor scores 1 year after rehabilitation were compared with baseline scores, the Mental Health and Dependency scale showed a significant improvement. For participants who received rehabilitation, age seemed to be a significant prediction variable for all factors. Additionally, functional vision score, and time at onset of visual impairment were predictors for the factor 'Pain and Discomfort'. The results indicate that only age was a predictor for all domains of quality of life. Future research should aim at confirming these results. Ultimately, these findings should lead to adjustments in the rehabilitation programme.

A case of acute loss of vision as the presenting symptom of Crohn's disease

An adolescent boy aged 17 years presented with sudden onset of visual impairment, which was rapidly diagnosed as bilateral anterior uveitis by an ophthalmologist. A systemic review noted episodes of nonbloody diarrhea, weight loss of 3 kg and a diminished appetite during the previous 10 months. The patient's family history revealed an older brother with Crohn's disease. Visual acuity test, slit-lamp examination, ophthalmologic fundoscopy and endoscopic evaluation of the upper and lower gastrointestinal tract with biopsy. Multifocal Crohn's disease, involving the terminal ileum and cecum, in addition to the stomach and duodenum. Treatment with topical corticosteroids, in the form of ophthalmic drops and oral budesonide ileal-release capsules. Once remission was achieved, it was maintained with mercaptopurine.

Impact of history or onset of chronic medical conditions on higher‐level functional capacity among older community‐dwelling Japanese adults

Background: Many studies have examined the impact of chronic medical conditions on the age‐related decline in basic activities of daily living (BADL) and the instrumental activities of daily living (IADL), but less is known concerning the influence of chronic disease on physical, cognitive, social, and economic aspects of higher‐level functional capacity.Methods: Subjects comprised 793 and 725 persons aged 65–84 years, living in an urban and a rural Japanese community, respectively. A baseline interview established any history of chronic medical conditions. Four years later, a second interview again assessed chronic disease, and higher‐level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence.Results: Multiple logistic regression analysis revealed that declines in total score and/or any of three subscales of the TMIG Index of Competence were significantly associated with a history of chronic disease, the onset of visual impairment and the development of hearing impairment, even after controlling for the subject's age, gender, educational attainment, and baseline TMIG Index of Competence. Episodes of stroke were significantly associated with declines in IADL. Hypertension, diabetes mellitus, and heart disease were also significantly associated with a decrease in functional competence, although each affected a different subscale of the TMIG Index of Competence.Conclusions: The present results underline the importance of controlling chronic medical conditions through a physically active lifestyle and an appropriate medical regimen in order to limit the age‐related decline in functional capacity.

Functional Outcomes Reported by Consumers of the Independent Living Program for Older Individuals who are Blind

This study surveyed 940 elders regarding their perceptions of the services they received under the Independent Living Program for Older Individuals Who Are Blind (Title VII, Chapter 2 of the Rehabilitation Act, 1973, as amended). Significant differences were found in perceived outcomes based on the elders’ gender, age, living arrangements, and age at onset of visual impairment. The results have programmatic and service delivery implications for staff who conduct program evaluation.