Presenting Distance Visual Acuity Research Articles

Near vision impairment and effective refractive error coverage for near vision in Andhra Pradesh, India – The Akividu Visual Impairment Study (AVIS)

ABSTRACT Clinical relevance Near Vision Impairment (NVI) is common in developing countries. A substantial proportion of NVI can be addressed by providing spectacles. Innovative eye care programmes are needed to address NVI. Population-based epidemiological studies can provide vital data to plan such eye care service delivery models. Background To report the prevalence of NVI and effective Refractive Error Coverage (eREC) for near vision in West Godavari and Krishna districts in Andhra Pradesh, south India. Methods A population-based cross-sectional study was carried out using a Rapid Assessment of Visual Impairment methodology. Presenting and pinhole distance visual acuity were assessed followed by near vision assessment using a N notation chart at a fixed distance of 40 cm. If the presenting near vision was worse than N8, the best corrected near visual acuity was recorded with age appropriate near vision correction. NVI was defined as presenting near vision worse than N8 among those without distance vision impairment (6/18 or better in the better eye). Effective Refractive Error Coverage for near was calculated as the proportion of individuals with an adequate correction to the total participants, including those with inadequate, adequate, and no correction for near vision. Results Data of 2,228 participants aged ≥40 years were analysed. The mean age of these participants was 54.0 ± 10.4 years; 53.8% were women; 44.5% had no formal education. The prevalence of NVI was 27.1% (95% CI: 25.2–29.0%). NVI significantly associated with 70 and above age group (adjusted OR: 1.97; 95% CI: 1.45-3.70). Participants with formal education had lower odds for NVI (adjusted OR: 0.75; 95 % CI: 0.68-0.83). The eREC for near vision was 48.0%. Conclusion NVI affects over a quarter of people aged ≥40 years in the West Godavari and Krishna districts of Andhra Pradesh. However, eREC is under 50% and there is scope for improving this by establishing eye care services to achieve universal eye health for all.

Prevalence of and risk factors for myopia among urban and rural children in Northeast China: protocol for a school-based cross-sectional study

IntroductionThe worldwide prevalence of myopia is high and continues to increase. In this study, a school screening programme for myopia will be implemented using the whole-process information method. The purpose...

#5761 THE ASSOCIATION OF EGFR SLOPE WITH VISUAL IMPAIRMENT, RETINAL VESSEL DENSITY, AND EYE PATHOLOGIES IN THE EYE DETERMINANTS OF COGNITION (EYEDOC) STUDY

Abstract Background and Aims Previous studies have identified chronic kidney disease (CKD) as a risk factor for poor ocular health. However, the effect of faster decline in estimated glomerular filtration rate (eGFR) on visual function, retinal markers, and eye conditions is unclear. We therefore examined the association of eGFR slope with visual function measures, retinal vessel density (VD), and common ocular pathologies in a bi-racial general population cohort. Method We studied 823 participants with normal kidney function or mild CKD (eGFR ≥ 60 ml/min per 1.73 m²) at baseline from the Eye Determinants of Cognition (EyeDOC) Study. Exposure was change in eGFR (ml/min per 1.73 m² per year) over 4 study visits between 1996 and 2019, calculated using linear mixed-effect models with unstructured covariance matrix. Outcomes (recorded between 2017 and 2019) were visual function (near visual acuity, presenting distance visual acuity, contrast sensitivity), retinal VD in the superficial, intermediate, and deep capillary plexus layers, and common ocular pathologies, such as retinopathy, age-related macular degeneration, and glaucoma. We used linear regression to model the associations of eGFR slope with visual function and retinal VD. We used logistic regression to study the association of eGFR slope with ocular pathologies. All models were adjusted for age, sex, race, education, smoking, body mass index, diabetes, hypertension, and hyperlipidemia. The models for retinal VD were additionally adjusted for signal strength index. Results In our study cohort, the mean age was 79 (±4) years with 62% females and 48% African Americans. The prevalence of diabetes and hypertension was 38% and 82%, respectively. The mean [SD] eGFR slope was −1.6 [0.6] ml/min per 1.73 m² per year. A faster eGFR decline of 1 ml/min per 1.73 m² per year was significantly associated with worse near visual acuity (0.04 logMAR [95% Confidence Interval 0.003; 0.08], p = 0.03), worse contrast sensitivity (−0.03 log [−0.05; −0.001], p = 0.01), lower VD in the deep capillary plexus layer (−0.99% per mm² [−1.96; −0.02], p = 0.04), and higher odds of retinopathy (odds ratio 2.44 [1.06; 6.63], p = 0.04). Associations of eGFR slope with the remaining measures of visual function and eye conditions were not significant. Conclusion In our bi-racial general population cohort with an eGFR ≥ 60 ml/min per 1.73 m² at baseline, a faster decline in eGFR was associated with worse visual function, reduced retinal vascular health, and higher odds of retinopathy. Our results support the potential usefulness of eGFR slope for risk assessment of ocular outcomes, even in patients with normal kidney function or mild CKD.

Population Prevalence of Vision Impairment in US Adults 71 Years and Older

Existing estimates of the prevalence of vision impairment (VI) in the United States are based on self-reported survey data or measures of visual function that are at least 14 years old. Older adults are at high risk for VI and blindness. There is a need for up-to-date, objectively measured, national epidemiological estimates. To present updated national epidemiological estimates of VI and blindness in older US adults based on objective visual function testing. This survey study presents a secondary data analysis of the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study of Medicare beneficiaries 65 years and older. NHATS includes community-dwelling older adults or their proxies who complete in-person interviews; annual follow-up interviews are conducted regardless of residential status. Round 11 NHATS data were collected from June to November 2021, and data were analyzed in August 2022. In 2021, NHATS incorporated tablet-based tests of distance and near visual acuity and contrast sensitivity with habitual correction. National prevalence of impairment in presenting distance visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), presenting near visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), and contrast sensitivity (>1 SD below the sample mean). Prevalence estimates stratified by age and socioeconomic and demographic data were calculated. In the 2021 round 11 NHATS sample, there were 3817 respondents. After excluding respondents who did not complete the sample person interview (n = 429) and those with missing vision data (n = 362), there were 3026 participants. Of these, 29.5% (95% CI, 27.3%-31.8%) were 71 to 74 years old, and 55.2% (95% CI, 52.8%-57.6%) were female respondents. The prevalence of VI in US adults 71 years and older was 27.8% (95% CI, 25.5%-30.1%). Distance and near visual acuity and contrast sensitivity impairments were prevalent in 10.3% (95% CI, 8.9%-11.7%), 22.3% (95% CI, 20.3%-24.3%), and 10.0% (95% CI, 8.5%-11.4%), respectively. Older age, less education, and lower income were associated with all types of VI. A higher prevalence of near visual acuity and contrast sensitivity impairments was associated with non-White race and Hispanic ethnicity. More than 1 in 4 US adults 71 years and older had VI in 2021, higher than prior estimates. Differences in the prevalence of VI by socioeconomic and demographic factors were observed. These data could inform public health planning.

Visual factors associated with physical activity in schoolchildren

ABSTRACT Clinical relevance Physical activity is an essential part of childhood physical and mental development. Recent research identified visual problems associated with a sedentary lifestyle in children in Ireland. Background This study explored the association between visual function in children and their engagement with physical activities outside school. Methods Participants were 1,626 schoolchildren (728 aged 6–7-years, 898 aged 12–13-years) in randomly selected schools in Ireland. Before data collection, parents/legal guardians of participants completed a standardised questionnaire reporting physical activity as no activity (mostly on screens), light activity (occasional walking/cycling), moderate activity (<3 hrs/week engaged in sports), or regular activity (>3hrs/week engaged in sports). Measurements included logMAR monocular visual acuities (with spectacles and pinhole), in the distance (3 m) and near (40 cm), stereoacuity (TNO stereo-test), cover test, and cycloplegic autorefraction (1% cyclopentolate). Results Controlling for confounders (socioeconomic disadvantage and non-White ethnicity), linear regression analysis revealed presenting distance visual acuity, near visual acuity, and stereoacuity were significantly better amongst participants who reported regular physical activity rather than moderate, light or no activity in both 6–7-year-old and 12–13-year-old participants. Absence of clinically-significant refractive error (>−0.50D < 2.00D) was associated with regular physical activity. Participants presenting with visual impairment (better-eye vision <6/12) (odds ratio = 5.78 (2.72–12.29)), amblyopia (pinhole acuity ≤6/12 plus an amblyogenic factor) (odds ratio = 5.66 (2.33–13.76)), and participants at school without their spectacles (odds ratio = 2.20 (1.33–3.63)), were more likely to report no activity. Conclusions Children regularly engaged in physical activities, including sports; had better visual and stereoacuity; and were less likely to need spectacles. Visual impairment, amblyopia, and refractive error were associated with no physical activity. Spectacle wear compliance was associated with regular physical activity. Regular physical activity is an essential factor in childhood vision and addressing visual impairment in children is vital to increasing participation in sports and exercise. Socioeconomically disadvantaged and non-White communities would benefit most from these measures.

The Fujian eye cross sectional study: objectives, design, and general characteristics

PurposeTo describe the objective and design of the Fujian Eye Study and to introduce the general characteristics and vision condition of this study.MethodsThe Fujian Eye Study (FJES) is a population-based cross-sectional survey on the public eye health status of residents over 50 years old in the entire Fujian Province of Southern China, which contains both urban and rural areas and coastal and inland regions. 10,044 participants were enrolled using a two-stage cluster sampling design and underwent a questionnaire and a series of standard examinations both physical and ocular. The main subgroups of data collection included age, sex, region, refractive error, education background, income, eating habits, smartphone usage in the dark, complaints of eye discomfort, history of chronic diseases, consumption of tobacco, alcohol, or tea.Results8211 (81.8%) participants were finally included and were divided into urban populations (4678 subjects) and rural populations (3533 subjects) and coastal residents (6434 subjects) and inland residents (1777 subjects); 4836 participants were female. The mean age was 64.39 (SD 8.87) years (median 64 years; range 50–98 years). 227 (3.33%) had vision impairment (VI), 195 (2.87%) had low vision and 14 (0.21%) were blind. The mean presenting near visual acuity (PNVA) was 0.28 (0.17), the mean presenting distance visual acuity (PDVA) was 0.61 (0.30), and the mean best corrected visual acuity (BCVA) was 0.82 (0.28).ConclusionsThe FJES collected detailed questionnaire information and overall ocular and physical examinations, which provide the opportunity to identify risk factors and images of VI and eye diseases and to evaluate their associations with chronic diseases and basic personal information.

Associations of Visual Function With Cognitive Performance in Community-Based Older Adults: The Eye Determinants of Cognition Study.

Given the detrimental impacts of visual and cognitive impairment separately, in older adults, understanding their coexistence could inform strategies against age-related cognitive changes. Participants from Washington County (White) and Jackson (Black) sites of the Atherosclerosis Risk in Communities Study were recruited who differed on racial, regional, urbanicity, and community-based factors. Presenting distance visual acuity (DVA; representing vision loss due to disease or lack of eye-care), corrected DVA (representing optimal correction for refractive loss of vision), and contrast sensitivity were measured. Factor scores for global cognition, memory, executive function, and language domains were calculated for 3 visits. We quantified the associations of vision measures with change in cognitive scores, stratified by community/race, using generalized estimating equations. In 982 participants, mean (standard deviation [SD]) baseline age was 74 (4) years, with 37% males and 45% Jackson/Black participants. As hypothesized, after accounting for potential confounders, in the better-eye, worse presenting DVA was associated with greater 10-year decline rate in global cognition, memory, and executive function in Washington County/White participants (eg, global cognition: -0.08 SD [95% confidence interval: -0.12, -0.04]). Worse corrected DVA was associated with greater 10-year decline rate in executive function in Washington County/White participants (-0.10 SD [-0.15, -0.04]). Better contrast sensitivity was associated with lower 10-year decline rate in global cognition and executive function in Washington County/White participants (eg, global cognition: 0.10 SD [0.06,0.14]). None of these associations were confirmed in Jackson/Black participants. Our study supports a functional link between some vision measures and cognition in older adults, but in only 1 of the 2 communities studied.

Design, methodology, and baseline of whole city-million scale children and adolescents myopia survey (CAMS) in Wenzhou, China

BackgroundMyopia is the most common visual impairment in children and adolescents worldwide. This study described an economical and effective population-based screening pipeline and performed the project of a million scale children and adolescents myopia survey (CAMS), which will shed light on the further study of myopia from the level of epidemiology and precision medicine.MethodsWe developed a novel population-based screening pattern, an intelligent screening process and internet-based information transmission and analysis system to carry out the survey consisting of school children in Wenzhou, China. The examination items include unaided distance visual acuity, presenting distance visual acuity, and non-cycloplegic autorefraction. Myopia and high myopia were defined as spherical equivalent (SE) ≤ − 1.00 diopters (D) and SE ≤ − 6.00 D, respectively. Next, the reports of the vision checking were automatically sent to parents and the related departments. The CAMS project will be done two to four times annually with the support of the government. An online eyesight status information management system (OESIMS) was developed to construct comprehensive and efficient electronic vision health records (EVHRs) for myopia information inquiry, risk pre-warning, and further study.ResultsThe CAMS completed the first-round of screening within 30 days for 99.41% of Wenzhou students from districts and counties, in June 2019. A total of 1,060,925 participants were eligible for CAMS and 1,054,251 (99.37% participation rate) were selected through data quality control, which comprised 1305 schools, and 580,609, 251,050 and 170,967 elementary, middle, and high school students. The mean age of participants was 12.21 ± 3.32 years (6–20 years), the female-to-male ratio was 0.82. The prevalence of myopia in elementary, middle, and high school students was 38.16%, 77.52%, and 84.00%, respectively, and the high myopia incidence was 0.95%, 6.90%, and 12.98%.ConclusionsThe CAMS standardized myopia screening model involves automating large-scale information collection, data transmission, data analysis and early warning, thereby supporting myopia prevention and control. The entire survey reduced 90% of staff, cost, and time consumption compared with previous surveys. This will provide new insights for decision support for public health intervention.

Vision Impairment, Poor Diet, and Food Insecurity in the United States

Abstract Objectives To test the hypotheses that poor diet and food insecurity are associated with both measured and self-reported vision impairment (VI). Methods We analyzed data from adults age ≥50 years in the National Health and Nutrition Examination Survey (NHANES) between 1999–2008 in the United States (US). To assess diet quality, Healthy Eating Index 2015 scores (HEI-2015) were applied to participants’ 24-hour recall dietary intake. Participants were categorized as having full, marginal, low, or very low food security using the US Food Security Survey Module. Presenting VI (PVI) was defined as presenting distance visual acuity worse than 20/40 in the better-seeing eye. Self-reported VI (SRVI) was defined as vision reported as fair, poor, or very poor. Accounting for NHANES’ complex survey design, separate logistic regression models were constructed to assess the associations between HEI-2015 quintile and PVI, HEI-2015 quintile and SRVI, food insecurity category and PVI, and food insecurity category and SRVI. Models were adjusted for age, gender, race, education, income, cigarette use, alcohol use, body mass index, and physical activity. Results Of the 10078 adults in this analysis, mean age was 63.4 years, 54% were women, and 80% were white. Mean HEI-2015 score (from 0–100) was 52.5. The prevalence of full food security was 89.9%, that of PVI was 7.2%, and that of SRVI was 20.1%. In adjusted logistic regression models, those with HEI-2015 scores in the lowest quintile (poor diet) had significantly higher odds of SRVI (OR: 1.29; 95% confidence interval [CI]: 1.04–1.61), but not PVI (OR: 1.13; CI: 0.86–1.49) compared to those in the fifth quintile. Compared to full food security, marginal (OR: 1.31; CI: 0.97–1.76), low (OR: 1.61; CI: 1.17–2.23), and very low (OR: 2.71; CI: 1.75, 4.20) food security was associated with increased odds of PVI. Similarly, marginal (OR: 1.58; CI: 1.23–2.02), low (OR: 1.46; CI: 1.11–2.92), and very low (OR: 1.85; CI: 1.41, 2.41) food security were associated with increased odds of SRVI compared to full security. Conclusions In this nationally representative sample of US adults age 50 years and older, poorer overall diet quality was associated with greater prevalence of SRVI. In a dose-response pattern, increasingly severe food insecurity was associated with greater prevalence of both PVI and SRVI. Funding Sources None

The prevalence and causes of low vision and blindness amongst learners at the Akropong School for the Blind in Ghana

Background: Low vision and blindness have significant implications, resulting in a generally reduced quality of life amongst the sufferers. Aim: To determine the prevalence and causes of low vision and blindness amongst learners at the Akropong School for the Blind. Setting: The study was conducted in Akropong School for the Blind, Ghana. Methods: A cross-sectional study design was used. Eye examinations included measurements of presenting distance visual acuity (PDVA) with the Tumbling ‘E’ distance LogMAR chart. Anterior and posterior segments were examined with an ophthalmoscope and a slit lamp. Results: Two hundred and sixty-eight ( N = 268) learners comprising 157 (58.6%) males and 111 (41.4%) females took part in this study and their ages ranged from 4 to 43 years (mean and standard deviation [SD] = 15.79 ± 6.15 years). The results indicated that 76.1% were classified as blind and 23.9% of the learners had low vision. The leading cause of low vision was glaucoma (39.1%) followed by pseudophakia (21.9%) and retinopathy (18.8%). The most common causes of low vision and blindness based on pathology found on ocular anatomical structures were corneal opacity/phthisis bulbi (35.5%), followed by glaucoma (25%), cataract (13.4%) and retinopathy (10.8%). Conclusion: The leading causes of low vision and blindness identified in this study were because of avoidable diseases such as corneal opacity/phthisis bulbi and glaucoma. This highlighted the need for adequate primary eye care services, equitable eye health workforce distribution and eye health awareness in Ghana to help prevent low vision and blindness.

Dual Sensory Impairment and Cognitive Performance, MCI, and Dementia in Older Adults: The ARIC Neurocognitive Study

Dual sensory impairment (DSI) affects 11.3% of adults aged ≥80 years. Hearing and vision impairments are each associated with cognitive decline and dementia, but DSI’s impact is unknown. All-cause dementia and mild cognitive impairment (MCI) were adjudicated using longitudinal cognitive information. Ten neurocognitive tests were summarized using latent variable methods. Hearing was measured using pure tone better-ear thresholds (0.5-4 kHz) and vision with better-eye presenting distance visual acuity and/or contrast sensitivity. In 881 adults (79±4 years, 44% black, 64% female), DSI (vs. no hearing or vision impairment) was cross-sectionally associated with -0.17 standard deviations (SD) [95% confidence interval (CI): -0.32, -0.02] lower global cognitive score and an 87% increased odds (95% CI: 1.01, 3.45) of combined MCI/dementia, after full adjustment for demographic and clinical factors. Future longitudinal research should elucidate the mechanism underlying this association to determine if treatment can delay cognitive decline and MCI/dementia in older adults.

Near vision impairment among the elderly in residential care\u2014the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

Background/objectiveTo report on the prevalence and risk factors for near vision impairment (NVI) among the elderly in residential care in Telangana State in India.MethodsIndividuals aged ≥60 years were recruited from 41 ‘home for the aged’ centres in Hyderabad, India. All participants had complete eye examinations including presenting and best-corrected visual acuity assessment for distance and near. NVI was defined as binocular presenting near vision worse than N8 (6/15) among those who had a normal presenting distance visual acuity of 6/18 in the better eye.ResultsOf the 826 participants, the mean age was 74.4 years (standard deviation—8.4 years), 525 (63.6%) were women, 715 (86.6%) had at least school education. The prevalence of NVI was 51.2% (95% CI: 47.7–54.7) based on presenting vision. On applying multiple logistic regression analysis, the odds of NVI were higher in 80 years and older age (OR: 2.17; 95% CI: 3.44–13.6). Those with school education (OR: 0.58: 95% CI: 0.36–0.94) and higher education (OR: 0.38; 95% CI: 0.21–0.69) had lower odds for NVI. Similarly, those with self-reported diabetes (OR: 0.69; 95% CI: 0.49–0.97), those using spectacles (OR: 0.09; 95% CI: 0.05–0.16), and those who had undergone cataract surgery (OR: 0.51; 95% CI: 0.36–0.74) had lower odds for NVI.ConclusionsNVI was common among the elderly in residential care in homes for the aged in Hyderabad, India. As most of this NVI is correctable, a routine screening programme and dispensing of spectacles can be undertaken to address this vision loss.

Prevalence and associated factors of visual impairment among adults at Debre Berhan town, North Shewa, Ethiopia

BackgroundVisual impairment refers to presenting distance visual acuity worse than 6/18 in the worst eye. It remains a global challenge that greatly affects the mobility, social participation and the quality of life of the people. This study was aimed to determine the prevalence and associated factors of visual impairment among adults aged ≥ 18 years.MethodsA community-based cross-sectional study was conducted at Debre Berhan town. Systematic random sampling method was employed to select the study participants from adult’s aged ≥18 years. Data was collected by interview with a pre-tested semi structured questionnaire. Both anterior and posterior segment ocular examinations were done by Optometrists and Ophthalmologist. After all ocular examinations adult’s aged ≥18 years with presenting Visual acuity of < 6/18 in the worst eye were considered as visually impaired. Multivariate logistic regression was used to identify the determinant factors and p value less than 0.05 was considered as statistically significant.ResultsA total of 416 participants were enrolled in the study with a 98.6% response rate. The prevalence of visual impairment among adults aged ≥ 18 years was 16.8% (95% CI, 13.5–20.2%). Among the overall prevalence of visually impaired adults 27 (6.49%) had bilateral VI and 43 (10.34%) had monocular VI. Aged > 64 years (AOR = 12.18, 95%CI: 4.47–33.20), illiterates AOR = 3.02, 95% CI: 1.36–6.72), previous eye trauma (AOR = 4.44, 95% CI: 1.64–12.04), family size > 5 (AOR: 4.44, 95% CI: 1.43–13.75) and family history of eye problem (AOR = 7.02, 95% CI: 1.95–25.22) had statistically significant association with visual impairment.ConclusionsPrevalence of visual impairment among adults was found to be a significant public health problem. Older age, illiterates, previous eye trauma, large family size and family history eye problem were positively associated with visual impairment.

Influence of Distance and Near Visual Impairment on Self-Reported Near Visual Functioning in a Multinational Study

To assess the influence of distance and near visual impairment on self-reported near visual functioning (VF) in a multinational study. Population-based cross-sectional study. Participants aged 35 years or older were selected randomly with cluster sampling at 7 sites: rural sites in Nepal (Kaski) and India (Madurai), a semirural site in China (Shunyi), semiurban sites in South Africa (Durban) and Niger (Dosso), and urban sites in the United States (Los Angeles) and China (Guangzhou). Binocular presenting distance and near visual acuity (VA) were measured with a logarithm of the minimum angle of resolution tumbling E chart at 4 m and 40 cm, respectively. A 12-item near VF questionnaire interview was administered by trained local interviewers, with responses scored from 100 to 0 as visual disability increased. Multiple linear regression was used to investigate the association of age, gender, education, and VA with overall eyesight, difficulty with activities, and social functioning subscale scores. Visual functioning subscale scores. The study sample consisted of 6851 questionnaire respondents. The VF subscale scores decreased significantly with worse distance and near VA, and even mildly impaired VA could result in reduced VF. Lower VF subscale scores were associated with older age at 4 sites, female gender at 3 sites, and greater education at 2 sites. The influence of near VA was greater than distance VA at 3 sites, and at 1 site, distance VA was more influential than near VA. With study site included in the regression modeling, lower scores for the overall eyesight subscale (compared with the Shunyi reference site) were found in Guangzhou, Kaski, and Durban; lower difficulty in activities scores were found in Kaski and Durban, but better scores were found in Guangzhou and Madurai; and social functioning scores were lower in Kaski, Durban, and Dosso. Along the entire VA spectrum, lower levels of distance and near VA led to significant reductions in VF subscale scores, with wide variation both within and between study sites. The impact of near vision on VF should receive greater emphasis with further investigation in various socioeconomic and cultural settings.

Prevalence and causes of vision loss in sub-Saharan Africa in 2015: magnitude, temporal trends and projections

BackgroundThis study aimed to assess the prevalence and causes of vision loss in sub-Saharan Africa (SSA) in 2015, compared with prior years, and to estimate expected values for 2020.MethodsA systematic...

Presbyopia and Other Eye Conditions in Teachers in Ghana.

The aim of this paper is to assess the eye health needs of school teachers in the Asutifi districts of Ghana. Presenting distance visual acuity was measured in each eye. Those with visual acuity of <6/12 in one or both eyes had subjective refraction. All underwent basic eye examination and near functional vision was assessed for teachers aged ≥35 years using the Near Activity Visual Questionnaire (NVAQ). Teachers with uncorrected presbyopia were given a near correction and NVAQ was assessed again at two weeks. Three hundred teachers were examined with mean (SD) age of 36.5 (9.7) years, 54.3% were male and 6.3% (95% CI: 3.8 to 9.8%) had a presenting acuity of <6/12 in one or both eyes. The estimated prevalence of moderate visual impairment was 0.7% (95% CI: 0.08 to 2.4%). Lens opacities (50%) and refractive error (18%) were the main causes of visual loss. Seventy-five out of 136 (55.1%, 95% CI: 46.6 to 63.4%) of teachers aged ≥35 years were presbyopic, 45.3% (95% CI: 36.9 to 53.7%) of whom had presbyopic correction. Lack of awareness was the major barrier to presbyopic correction. Median Rasch score for teachers given presbyopic correction (n = 39) decreased by 60.6% from 46.0 (IQR: 10.7 to 72.8) to 18.1 (IQR: 0 to 58.9) and overall satisfaction with near vision improved at follow up. Prevalence of presbyopia was high, and spectacles improved satisfaction with near vision.

Prevalence and types of refractive errors, and spectacle coverage in Sri Lankan adults: The Sri Lanka National survey of blindness and visual impairment

Introduction Uncorrected refractive errors are the commonest cause of visual impairment globally. Despite this, the proportion of affected individuals who wear spectacles can be low, particularly in low and middle- income countries. No data were available for Sri Lanka. Objectives To estimate the prevalence of refractive errors and investigate their risk factors among adults aged 40 years and above. Another purpose was to calculate spectacle coverage and identify subgroups with low coverage. Methods Cluster random sampling was used to obtain a nationally representative sample. Presenting distance visual acuity was measured using a logMAR chart, with distance spectacle correction if usually worn. All underwent autorefraction and an optician measured best-corrected visual acuity after subjective refraction. Participants who had undergone cataract surgery were excluded. Spectacle coverage was assessed amongst participants with a visual acuity of Results 5,779/6,713 (86.1%) enumerated adults were examined; 5,179 had refraction data. 67% had a refractive error: hyperopia 49.6%; myopia 17.4%. Refractive errors increased with age. Being aged 60 years and above and Sinhala ethnic group were independent risk factors. Spectacle coverage was 17.7% overall, being lower in females and the non-literate. Based on the findings, 1.66 million adults require spectacles for distance correction. Conclusions Refractive errors are very common in Sri Lankan adults, and there is a large unmet need for spectacles. Affordable services for refractive errors need to be scaled up, focusing on the most underserved subgroups in the population.

Prevalence and Associated Factors of Uncorrected Refractive Error in Older Adults in a Population-Based Study in France

Uncorrected refractive error (URE) is a common cause of visual impairment, but its prevalence in groups of older adults who could be pragmatic targets for improving optical correction remains unknown. To estimate the prevalence of URE in older adults, particularly in those with age-related eye disease and those who are unable to attend an outpatient clinic, and to identify the factors associated with URE. This population-based cross-sectional analysis included 707 adults 78 years or older from the Alienor Study in Bordeaux, France. Data were collected from February 12, 2011, through December 21, 2012, and analyzed from November 1, 2017, through July 7, 2018. Uncorrected refractive error was defined as the presenting distance visual acuity in the better-seeing eye improved by at least 5 letters on the Early Treatment Diabetic Retinopathy Study chart (≥1 line on the logMAR chart) using the best-achieved optical correction. Multivariate logistic regressions were used to determine the factors associated with URE. The study population of 707 adults 78 years or older (64.8% women; mean [SD] age, 84.3 [4.4] years) had a prevalence of URE of 38.8% (95% CI, 35.2%-42.5%). Prevalence was high for participants with eye disease (range, 35.0% [95% CI, 28.4%-42.0%] to 44.1% [95% CI, 27.2%-62.1%], depending on the disease) and those without eye disease (30.1%; 95% CI, 24.0%-36.7%). Prevalence was higher in participants who were examined at home (because they could not come to the clinic) than in those examined at the clinic (49.4% [95% CI, 42.8%-55.9%] vs 33.5% [95% CI, 29.2%-37.9%]; P < .001). Having an eye examination performed at home (odds ratio [OR], 1.64; 95% CI, 1.13-2.37), living alone (OR, 0.65; 95% CI, 0.47-0.90), and having the perceptions that the ophthalmologist consultation fees are too expensive (OR, 1.94; 95% CI, 1.12-3.36) and that declining visual acuity is normal with aging (OR, 1.47; 95% CI, 1.04-2.08) were all associated with URE. These study results show that the prevalence of URE was high in this population and suggest that preventive strategies aimed at enhancing optical correction could be directed to all older adults and to specific groups by implementing at-home eye examinations for those who have difficulties attending an outpatient clinic and by focusing on those with eye disease who probably already have a regular ophthalmologic follow-up. More studies are needed to evaluate prevalence of URE in different populations and countries with various eye care systems.

Association between visual status and mental health status in Thai rural elderly: a community-based study.

To evaluate the association between visual impairment (VI) and mental health or social engagement in older adults living in rural Thailand. Data for this cross-sectional study were drawn from a community survey conducted in 2015 in Saraburi Province, Thailand. Participants were 327 adults aged ≥50y. VI was assessed using presenting distance visual acuity. Mental health and social engagement were evaluated in face-to-face interviews using validated questionnaires. After determining the prevalence of VI and relevant sociodemographic characteristics, multivariate regression analysis was used to evaluate the impact of VI on mental health and social engagement. The prevalence of VI was 18.3%. Major causes were refractive error (58.3%) and cataract (35%). Factors associated with VI in the crude analysis were: older age [odds ratio (OR) 8.08], unemployment (OR 2.72), widowhood (OR 2.47), being divorced/separated (OR 3.27), smoking (OR 2.09) and disability in activities of daily living (OR 2.35). Protective factors were undergoing eye screening at least once a year (P=0.029) and obesity (P=0.005). VI was significantly associated with low social engagement (adjusted OR 4.13) but not with poor mental health (P>0.05). Although VI older adults reported less participation in social activities, there is no significant association between VI and poor mental health. Annual eye examinations may prevent VI in older adults. Information about employment and anti-smoking should be targeted to older adults with VI.

A rating scale is a proper method to evaluate changes in quality of life due to dry eye symptoms

PurposeTo determine which utility value assessment method is more suitable to evaluate changes in the quality of life due to dry eye symptoms.MethodsDry eye outpatients with a presenting visual acuity of 20/25 or better in the worse-seeing eye were recruited. Presenting distance visual acuity, tear film break-up time, Schirmer I test and fluorescein were assessed. The severity of dry eye symptoms was assessed using the Ocular Surface Disease Index (OSDI), and utility values were measured using the time trade-off (TTO), standard gamble (SG1 and SG2) and rating scale (RS) methods. Different utility values were compared with each other. The most appropriate utility value method to evaluate quality-of-life changes solely due to dry eye symptoms is determined by calculating the correlation between the OSDI score and different utility values.ResultsA total of 104 patients were enrolled. The three sections of OSDI in the order of high to low scores were as follows: “environmental trigger,” “eye discomfort” and “visual function.” The utility scores measured with TTO, SG1, SG2 and RS were 0.95 ± 0.11, 0.96 ± 0.10, 0.99 ± 0.07 and 0.89 ± 0.10, respectively. The utility scores evaluated by the TTO, SG1, SG2 and RS methods were significantly different from each other (p < 0.05). Only the utility scores measured with RS were significantly correlated with the composite OSDI score, “environmental trigger” and “eye discomfort” section scores (p < 0.05).ConclusionsRS is more sensitive than TTO and SG for the evaluation of altered quality of life due to dry eye symptoms.