Self-reported Visual Impairment Research Articles

Association of long-term exposure to air pollutants with sensory impairment in middle-aged and elderly adults: a nationwide study in China

ABSTRACT Few studies have examined the impact of ambient air pollutants on sensory impairments (SIS) in adults. Using a nationally representative study of 13,505 participants from 125 Chinese cities, we investigated the association of air pollutants with SIS among middle-aged and elderly adults. The SIS were evaluated by self-reported visual impairment (VI) and/or hearing impairment. Residential exposure to particulate matter (PM) ≤ 2.5 μm (PM2.5), ≤ 10 μm (PM10), and ≤ 1 μm (PM1), nitrogen dioxide, and sulfur dioxide were estimated using a satellite model. Each 10 μg/m3 increase in PM2.5 (adjusted odds ratio, aOR 1.015, 95% CI:1.00–1.032) and PM1 (1.035, 1.007–1.064) was associated with SI. Moreover, a significant association with VI was found for annual PM10, PM2.5, and PM1. The association was stronger in individuals who had chronic diseases. Long-term exposure to PM2.5 and PM1, was associated with SIS among adults, underscoring the importance of improving air quality to prevent SIS.

Association of Visual Impairment With Neuropsychiatric Symptoms of Dementia.

Visual impairment is a risk factor for cognitive impairment and hallucinations in older adults, but associations with other neuropsychiatric symptoms (NPS) of dementia have not been examined. We analyzed cross-sectional data from the Aging, Demographics, and Memory Study (ADAMS), a nationally representative sample of the US population aged 70+ years. Vision was measured by self-report and using a near card. Dementia was ascertained through cognitive testing with expert consensus, and NPS were screened using the Neuropsychiatric Inventory. We used logistic regression to measure the association between visual impairment and prevalent NPS adjusting for sociodemographic factors and comorbidities. Analyses incorporated sample weights to account for the complex survey design of ADAMS. Of 624 participants with dementia, 332 (53%) had self-reported visual impairment and 193 (31%) had best-corrected acuity of 20/40 or worse. In unadjusted models, self-reported visual impairment was significantly associated with hallucinations (OR 2.88; 95% CI 1.12-7.44), depression (OR 2.79; 95% CI 1.7-4.57), and agitation (OR 1.61; 95% CI 1.05-2.48). Reduced visual acuity was associated with hallucinations (OR 10.13; 95% CI 2.93-34.98), psychosis (OR 6.69, 95% CI 2.53-17.7), and mania (OR 5.92, 95% CI 1.77-19.82). However, these associations did not remain significant after covariate adjustment. Visual impairment was associated with hallucinations, depression, agitation, psychosis, and mania in patients with dementia, but at least some of this relationship is explained by age, comorbidities, and other factors.

Concordance between Self-Reported Visual Difficulty and Objective Visual Impairment: The National Health and Aging Trends Study

ObjectiveTo examine the performance of self-reported visual difficulty (VD) in predicting objective visual impairment (VI) in older adults and explore factors that influence discordance in these classifications. DesignCross-sectional analysis of the National Health and Aging Trends Study (2022). MethodsParticipants reporting blindness or difficulties with distance or near vision were characterized as having VD. Presenting binocular distance visual acuity (VA), near VA, and contrast sensitivity (CS) were assessed. Objective VI was defined as having VI in either distance VA (worse than 20/40), near VA (worse than 20/40), or CS (worse than 1.55 logCS). Receiver operating characteristic analysis was used to compare performance of VD in predicting objective VI. To investigate factors that influence discordance, we limited our sample to adults with objective VI and employed a multivariable logistic regression model to identify factors associated with not reporting VD. Similar analyses were performed to explore factors associated with reporting VD in adults without objective VI. Results4,999 adults were included in the 2022 cohort. VD achieved an area under the curve (AUC) of 56.0 (95% CI: 55.2, 56.9) in predicting objective VI, with a sensitivity of 15.8 (95% CI: 14.2, 17.5) and specificity of 96.3 (95% CI: 95.5, 96.9). Characteristics associated with not reporting VD in adults with objective VI included: female gender (odds ratio [OR]: 0.64 [95% CI: 0.42, 0.99]), Hispanic ethnicity (OR: 0.49 [95% CI: 0.31, 0.78), higher income (≥75k, OR: 1.99 [95% CI: 1.14, 3.45]), having ≥4 comorbidities (OR: 0.46 [95% CI: 0.29, 0.72]), and having depressive symptoms (OR: 0.49 [95% CI: 0.25, 0.93]). Meanwhile, factors associated with self-reporting VD in the absence of objective VI included Hispanic ethnicity (OR: 2.11 [95% CI: 1.15, 3.86]), higher income (≥75k, OR: 0.27 [95% CI: 0.12, 0.63]), and having anxiety symptoms (OR: 3.05 [95% CI: 1.56, 5.97]). ConclusionsSelf-reported visual difficulty is a distinct measure assessing disability and has limited ability in predicting objective VI. Caution is advised when utilizing self-reported visual difficulty as a surrogate measure for objective VI in epidemiological studies, though it may still be an effective way to capture risk of current or future disability.

A Prospective Association Between Sensory Impairment and Cognitive Performance Among Older Community-Dwelling Adults: The Role of Depressive Symptoms.

We examined whether vision impairment (VI) and hearing impairment (HI) and dual sensory impairment (DSI) affect cognitive performance and whether depression mediates that effect. We examined 55,340 participants from the Survey of Health, Aging and Retirement in Europe, which assessed 32,325 participants in 2011 (baseline, Time 1), 2015 (follow-up, Time 2), sociodemographic data and health factors, self-reported VI, HI, and DSI at baseline, depression, and cognitive performance after four years. A multiple mediator model was tested using bootstrapping and resampling. At baseline, 22.9% had VI, 10.2% HI, and 10.4% had DSI. We found a significant negative association between VI (b = -0.023, p = .001) and DSI (b = -0.083, p = .001) and cognitive performance; both were also associated with depression, which was linked with poor cognition. VI or DSI among older adults are associated with poor cognitive function directly and indirectly by increasing depression symptoms.

The Risk of Cardiovascular Disease Risk Among Adults with Vision Impairment from Low-, Middle- and High-Income Countries

ABSTRACT Purpose The limited evidence for cardiovascular disease (CVD) among adults with vision impairment (VI) has often been from developed countries using self-reported VI. This study evaluated the association of objectively-determined VI with the risk of CVD among adults from low-, middle-, and high-income countries. Methods Data were from 32,268 adults aged 30–74 years without CVD or blindness from China, Ghana, India, Mexico, Russian Federation, South Africa, and the United States during 2007–2010. VI and severe VI was defined as presenting visual acuity worse than 6/18, and 6/60, respectively. The Framingham risk algorithm was used to estimate the risk for incident CVD. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals. Results The mean age of participants was 46.4 years, with half of them being women (49.3%). The age-adjusted prevalence of VI ranged from 1.1% (United States) to 14.2% (South Africa) while severe VI ranged from 0.4% (United States) to 4.5% (Ghana). In models adjusting for country, sociodemographic factors, waist girth, healthcare use, activities of daily living and other health-related factors, VI was associated with CVD risk ≥ 10% (OR = 1.69, 95% CI: 1.22–2.36). This observed association was largely consistent across countries (p = 0.119). The observed CVD risk was similar among adults with moderate or severe VI (OR = 0.95, 95% CI: 0.50–1.83). CVD risk was higher among adults with VI who were <65 years old (OR = 1.89, 95% CI: 1.36–2.63) or were employed (OR = 2.24, 95% CI: 1.58–3.16). Conlusions This cross-national study shows that individuals with VI are at high risk for future CVD.

A global survey of visual symptoms in female carriers of choroideremia and X-linked retinitis pigmentosa

PurposeTo investigate self-reported visual impairment in a large cohort of female carriers of X-linked retinal diseases around the world, using the validated Michigan Retinal Degeneration Questionnaire (MRDQ). DesignCross-sectional global survey study MethodsAn online survey collecting demographic and MRDQ data was distributed to self-reported female carriers of X-linked retinal diseases, and healthy controls (females with no eye disease). Respondents indicated their visual symptoms relating to everyday activities in seven visual domains: central vision, colour vision, contrast sensitivity, scotopic function, photopic peripheral vision, mesopic peripheral vision, and photosensitivity. Mann-Whitney test was used to compared visual disability scores between female carriers and healthy controls. ResultsTwo-hundred and thirty-seven female carriers of X-linked retinal diseases (74.3% choroideremia and 25.7% X-linked retinitis pigmentosa) and 100 age-matched healthy controls completed the questionnaire (median age: 51 vs. 47.5 years of age, respectively). Most female carriers resided in the USA (53.6%) and Australia (17.3%), whilst healthy controls were mostly from Australia (93%). Female carriers had significantly worse visual disability, compared to controls. Female carriers who were older than 50 years had significantly worse visual function impairment for all domains, except photosensitivity, when compared to carriers less than 50 years of age. ConclusionsThis study has shown that female carriers of choroideremia and X-linked RP report significantly worse visual symptoms, compared to healthy controls. Future studies are required to correlate MRDQ responses with clinical findings, to determine the degree of retinal changes required to impact female carriers’ quality of life.

Hearing and vision impairment and social isolation over 8 years in community-dwelling older adults

BackgroundLittle is known about the long-term impact of hearing and vision impairment on social isolation. This study quantifies the association between hearing, vision, and concurrent hearing and vision impairment (dual sensory impairment) and social isolation over 8 years among older adults.MethodsData were from the National Health and Aging Trends Study (NHATS), a cohort study (2011 – 2019) of U.S. Medicare beneficiaries aged 65 years and older. Social isolation was measured by a binary indicator incorporating four domains: living arrangement, core discussion network size, religious attendance, and social participation. Hearing, vision, and dual sensory impairments were measured by self-report and modeled categorically (no impairment [ref.], hearing impairment only, vision impairment only, dual sensory impairment). Associations between sensory impairments and odds of social isolation over 8 years were assessed using multivariate generalized logistic mixed models and adjusted for demographic and health characteristics.ResultsAmong 5,552 participants, 18.9% self-reported hearing impairment, 4.8% self-reported vision impairment, and 2.3% self-reported dual sensory impairment. Over 8 years, hearing impairment only was associated with 28% greater odds of social isolation. Participants with hearing impairment only were more likely to live alone and have limited social participation.ConclusionGreater clinical awareness of hearing impairment as a risk factor for social isolation can increase opportunities to identify and aid older adults who may benefit from resources and interventions to increase social connection and mitigate social isolation.

Vision Impairment and Psychosocial Function in US Adults

Vision impairment and psychosocial function, including symptoms of depression and anxiety and social isolation, are a major cause of morbidity in the US. However, there is a lack of nationally representative studies assessing associations between both objective and subjective vision impairment with psychosocial function following the COVID-19 pandemic. To provide updated national estimates on the associations of vision impairment with depressive and anxiety symptoms and social isolation in US adults 65 years and older. This was a cross-sectional analysis of the National Health and Aging Trends Study round 9 (2019) and 11 (2021), a nationally representative sample of Medicare beneficiaries aged 65 years and older. Binocular distance visual acuity, near visual acuity, and contrast sensitivity were tested. Objectively measured vision impairment was defined as having vision impairment in either distance visual acuity (worse than 20/40), near visual acuity (worse than 20/40), or contrast sensitivity (worse than 1.55 logCS). Self-reported vision impairment was defined based on participants' report on their vision status. Data were analyzed in May 2023. Depressive and anxiety symptoms assessed via the Patient Health Questionnaire. Social isolation was defined based on living arrangement, communication frequency, and activity participation responses. Among 2822 community-dwelling adults sampled from a population of 26 182 090, the mean (SD) age was 78.5 (5.6) years; 1605 individuals (54.7%) were female; 1077 (32.3%) had objectively measured vision impairment, and 203 (6.4%) had self-reported vision impairment. In adjusted models, all outcomes were significantly associated with objectively measured vision impairment, including depressive symptoms (odds ratio [OR], 1.81; 95% CI, 1.26-2.58), anxiety symptoms (OR, 1.74; 95% CI, 1.13-2.67), and severe social isolation (OR, 2.01; 95% CI, 1.05-3.87). Similarly, depressive symptoms (OR, 2.37; 95% CI, 1.44-3.88) and anxiety symptoms (OR, 2.10; 95% CI, 1.09-4.05) but not severe social isolation symptoms (OR, 2.07; 95% CI, 0.78-5.49) were significantly associated with self-reported vision impairment. In this study, vision impairment was associated with several psychosocial outcomes, including symptoms of depression and anxiety and social isolation. These findings provide evidence to support prioritizing research aimed at enhancing the health and inclusion of people with vision impairment.

Self-Reported Vision Loss, Health Status, and Social Participation Among Middle-Aged and Older Adults-Evidence From China.

Social participation is crucial for enhancing senior's well-being and promoting their integration into society. Using nationwide data investigated in China, this study explored the association between self-reported visual impairment, health level, and social participation among Chinese middle-aged old adults. It has been found that (a)the probability and frequency of social participation among middle-aged and older adults with self-reported vision loss were significantly lower than those without vision problems; (b)self-reported vision loss was negatively associated with self-rated health and mental health status, and both were positively associated with social participation; and (c)self-rated health and mental health played a mediating role between vision loss and social participation. The findings suggest that under the framework of active aging, universal vision screening programs and rehabilitation plans for the older adults with visual impairment are exceedingly significant to promote their participation in social activities, thereby enhancing their quality of life.

VISION LOSS AND PSYCHOSOCIAL FUNCTIONING: WHAT’S THE CONNECTION?

Abstract This study assessed the associations between vision impairment (VI) and psychological and social function in older adults. We conducted a cross-sectional analysis of the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older. VI was measured using categorical and continuous scales. Depression and anxiety symptoms were assessed via the Patient Health Questionnaire for Depression and Anxiety (PHQ-4) questionnaire. Social isolation and severe social isolation were defined based on responses to questions on living arrangement, frequency of communication with others, and participation in activities. Results showed that depressive symptoms, social isolation, and severe social isolation were more prevalent in adults with any objective VI measure compared to those without impairment. In adjusted models, objective vision measures were not associated with higher odds of depression or anxiety symptoms, though both outcomes were strongly associated with self-reported VI (OR: 1.82 [95% CI: 1.27 – 2.60], OR: 1.81 [95% CI: 1.30 – 2.53], respectively). In contrast, worse distance and near acuity (per 0.1 logMAR), and worse contrast sensitivity (per 0.1 logCS units) were associated with higher risk of being severely socially isolated (RRR: 3.79 [95% CI: 1.13 – 12.78], 3.26 [95% CI: 1.16 - 9.17], 2.82 [95% CI: 1.11 – 7.18], respectively), however, no associations were found with self-reported VI. This study demonstrates that worse vision is associated with symptoms of depression, anxiety, and social isolation among older US adults. Approaches are needed to enhance the psychological and social well-being of individuals with VI.

Characteristics associated with blindness or visual impairment within the adolescent demographic: a national cohort analysis

BackgroundPsychosocial metrics associated with self-reported blindness or visual impairment for adolescents in the National Survey of Drug Use and Health (NSDUH) have not been fully characterized. This retrospective cohort analysis of the latest NSDUH aimed to determine novel characteristics associated with self-reported visual loss among adolescents in the United States. MethodsData from the NSDUH2020, a publicly available, federally validated database, were analyzed. Self-reported severe visual impairment or blindness was defined as being truly blind or having serious difficulty seeing even when wearing corrective lenses (s-rSVI). Inclusion criteria were all cases of s-rSVI in adolescents aged 12-17 years. NSDUH weights were used to accommodate complex survey design, nonresponse rates, and population variance. Weighted percentages, asymptotic two-sided Rao-Scott χ2 analyses, and multivariable binary logistic regression were performed. Statistical significance was considered reached at P < 0.05. ResultsA total of 5,667 adolescents aged 12-17 years were surveyed, and s-rSVI occurred in 236 cases (weighted percentage, 3.48%). Within our final risk model, characteristics associated with enhanced odds of s-rSVI based on multivariable logistic regression analysis were female sex, Asian and Latino race/ethnicity (relative to non-Hispanic White), and self-reported serious difficulty hearing and concentrating (all P < 0.05). ConclusionsThis national retrospective cohort analysis highlights risk factors associated with s-rSVI for adolescents within the 2020 NSDUH. Clinicians and policymakers should consider at-risk demographics for s-rSVI during development and enhancement of screening programs, population health initiatives, and healthcare policy issues.

Prevalence of self-reported visual impairment among people in Canada with and without diabetes: findings from population-based surveys from 1994 to 2014.

Diabetes, a leading cause of visual impairment, is on the rise in Canada. We assessed trends in the prevalence of visual impairment among people in Canada with and without diabetes to inform the development of strategies and policies for the management of visual impairment. We analyzed self-reported data from respondents aged 45 years and older in 7 cycles of nationwide surveys (National Population Health Survey and Canadian Community Health Survey) from 1994/95 to 2013/14. The age- and sex-standardized prevalence of visual impairment was calculated. We assessed comparisons by levels of education and income, using sex-standardized prevalence owing to sparse data. Among people in Canada with diabetes, the age- and sex-standardized prevalence of visual impairment was 7.37% (95% confidence interval [CI] 5.31%-9.43%) in 1994/95 and 1996/97 combined, decreasing to 3.03% (95% CI 2.48%-3.57%) in 2013/14, giving a standardized prevalence ratio of 0.41 (95% CI 0.30-0.56) comparing 2013/14 with 1994/95 and 1996/97 combined. Among people in Canada without diabetes, visual impairment prevalence decreased from 3.72% (95% CI 3.31%-4.14%) in 1994/95 and 1996/97 combined to 1.69% (95% CI 1.52%-1.87%) in 2013/14, with a standardized prevalence ratio of 0.45 (95% CI 0.40-0.52). Decreased sex-standardized prevalence of visual impairment was observed among people with high and low education levels and incomes among those with and without diabetes. Visual impairment prevalence was roughly 2 times higher among those with versus without diabetes in all survey years; from 1994 to 2014, visual impairment prevalence decreased among those with and without diabetes irrespective of education and income levels. These results suggest effective collective efforts by clinicians, researchers, the public and government.

Trends in Geographic Distribution of Visual Disability – United States, 2010-2019

ABSTRACT Purpose We aimed to describe changes in the geographic distribution of self-reported visual impairment (VI) over the last decade (2010–2019) in the U.S. Methods Our study was an analysis of publicly available data collected between 2010 and 2019 from the Census Bureau American Community Survey. Results The mean overall prevalence of self-reported VI from 2010 to 2019 was 2.31% in the United States, and there was a significant increase in VI over the past decade from 2.25% in 2010–2014 to 2.37% in 2015–2019 (p < .001). VI was significantly higher in rural counties (3.58%), compared to urban (3.10%) or metropolitan counties (2.18%) (p < .001). In terms of geographic region, the South of the United States had the highest rate of VI (2.63%) (p < .001). For age groups > 17-years-old in the 2010–2019 data, women had higher rates of VI compared to men. Conclusions Prevalence of self-reported visual impairment has risen and disproportionately affects certain communities. This includes individuals living in the South, in rural counties, and women.

Associations of intrinsic capacity, fall risk and frailty in old inpatients.

This study explored the associations of intrinsic capacity (IC), fall risk, and frailty in geriatric inpatients. A total of 703 hospitalized patients aged 75 years or older were recruited for this retrospective observational study from Zhejiang Hospital using a comprehensive geriatric assessment. The IC composite score was constructed from the scores of the Chinese version of the Mini-Mental State Examination, Short Physical Performance Battery, Short Form Mini Nutritional Assessment, 15-item Geriatric Depression Scale, and self-reported hearing and vision impairment. Adverse outcomes were recorded as the fall risk and frailty using the Morse Fall Scale and the Clinical Frailty Scale. Spearman's correlation coefficient analyses and multivariate logistic regression models were used to explore the associations between IC, high fall risk, and frailty. Declined IC composite scores were associated with increased risks of falls [odds ratio (OR) = 0.64, 95% confidence interval (CI): 0.57-0.72] and frailty (OR = 0.45, 95%CI: 0.37-0.54) among older hospitalized patients after adjusting for the related potential confounders. In addition, decreased cognitive, vitality, locomotion, and psychological scores were associated with increased adverse health conditions, with ORs ranging from 0.26 to 0.70. Vision impairment was observed to increase the risk of frailty (OR = 0.42, 95%CI: 0.23-0.76) after adjusting for the related potential confounders. This study indicated that declined IC was associated with fall risk and frailty in older inpatients. Further prospective studies are needed to explore the longitudinal associations between baseline IC and subsequent risk of falls and frailty.

Dynamic associations between vision and hearing impairment and depressive symptoms among older Chinese adults

BackgroundWhether the impact of vision impairment (VI)/hearing impairment (HI) on depressive symptoms changes over time has not been investigated. This study aimed to examine the complex dynamic associations between VI/HI and depressive symptoms to design effective prevention strategies for older Chinese adults. MethodsData were from the China Health and Retirement Longitudinal Study (CHARLS). The study identified self-reported VI, HI, depressive symptoms, and other covariates (including social isolation). Logistic regression models were used to analyze the dynamic associations across three waves, with the assessment of multiplicative and additive interactions. ResultsOf the 8519 participants in wave 1 (mean [SD] age, 62.0 [8.0] years, 49.5 % male), 38.5 % had depressive symptoms. After adjusting for covariates including social isolation, VI and HI were significantly associated with depressive symptoms across all three waves. Specifically, the adjusted odds ratio (AOR) of VI increased from 2.08 (95 % CI: 1.89 to 2.29) in wave 1 to 2.15 (95 % CI: 1.90 to 2.44) in wave 3; while the AOR of HI increased from 1.80 (95 % CI: 1.58 to 2.04) in wave 1 to 2.11 (95 % CI: 1.75 to 2.51) in wave 3. The additive interactions between VI and HI on depressive symptoms in each wave (e.g., RERI [95 % CI]: 7.90 [2.51 to 12.30] in wave 1) were significant without adjusting for social isolation. ConclusionThe study suggests that VI and HI are consistently associated with depressive symptoms among older adults in China over a four-year period, and their influences on mental health deserve more attention.

Functional disability in Thai older persons with self-reported visual impairment

This study aims to investigate what causes persons with self-reported visual impairment in Thailand to have different levels of functional disability. The study sample included 6327 older persons aged 60 and above, extracted from the ‘2021 Survey of Older Persons in Thailand’ project. A multinomial logistic model was employed to investigate the relationship between demographic characteristics, living arrangements, and household conditions with the level of functional disability. The study found that gender had only a mild effect on functional disability level, while age had a high influence on every functional disability category. Interestingly, older persons living with their children were more likely to lose their functional ability than those living with other family members. This pattern indicates the dependency of older persons with visual impairment in Thailand on their children. In addition, older persons with self-reported visual impairment with a bedroom on the upper floor and those who had no rails in the house to support their movement were less likely to have a high level of functional disability than other groups of older persons. This may be a strategy for a family to help older persons with visual impairment to be able to perform activities of daily living (ADL) by arranging for them to live in a location in the house that is easy for them to be mobile and perform ADL as recommended in the social model of disability.

Association of changes in self-reported vision and hearing impairments with depressive symptoms in middle-aged and older adults: Evidence from a nationwide longitudinal study in China

ObjectiveThis study assessed the longitudinal relationship between changes in self-reported vision impairment (VI) and hearing impairment (HI), and depressive symptoms in adults aged ≥45 years. MethodsData from the China Health and Retirement Longitudinal Study for 2015 and 2018 were used, with a sample size of 10,050. VI and HI were self-reported. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D10) was used to assess depressive symptoms. Total scores and clinically significant depressive symptoms (CES-D10 scores ≥ 10) were used as outcomes and analyzed using generalized estimating equations with identity link and logit link functions. ResultsOf all changes in HI with good vision, only persistent HI was associated with higher CES-D10 scores (OR 95% CI: 1.09–3.30). Both new-onset and persistent VI with good hearing were associated with CES-D10 scores (OR 95% CI, new-onset: 1.70–3.52; persistent: 1.58–2.78) and clinically significant depressive symptoms (OR 95% CI, new-onset: 1.41–2.56; persistent: 1.36–2.27). Persistent dual sensory impairment (DSI) was associated with the highest CES-D10 scores (OR 95% CI: 3.63–5.97) and the highest risk of clinically significant depressive symptoms (OR 95% CI: 1.78–2.85). Those who self-reported improvements in vision and hearing still had higher CES-D10 scores (OR 95% CI: 1.35–2.83) and a higher risk of clinically significant depressive symptoms (OR 95% CI: 1.03–2.02) than those maintaining good vision and hearing. ConclusionSelf-reported VI and DSI are closely associated with depressive symptoms. Because VI and DSI are modifiable, interventions for them could also prevent depressive symptoms.

The prevalence, incidence, and persistence of self-reported visual impairment among Chinese population with diabetes mellitus: evaluation from a nationally representative survey, 2015-2018.

Our aim was to investigate the prevalence, incidence, and persistence of visual impairment (VI) and their correlates among the Chinese population with diabetes mellitus (DM) over 3 years. The China Health and Retirement Longitudinal Survey is the first nationally representative longitudinal survey of the Chinese population. A cross-sectional analysis of prevalent VI in 2015 consisted of 2,173 participants with DM. A longitudinal observation of incident and persistent VI consisted of 1,633 participants from 2015 to 2018. Risk factors of VI were identified via univariate and multivariate logistic regression analyses. Among our study population with DM, 11.8% reported VI in 2015, 4.5% had persistent VI from 2015 to 2018, and 8.9% developed VI in 2018. Factors identified to be correlated to VI (p < 0.05) were older age, being a woman, lower educational attainment, living in a rural area, application of DM medication and non-pharmacological treatment, receiving DM-related tests, use of spectacles, and poorer health status. This most recent national data provides a baseline for future public health initiatives on VI among the Chinese population with DM. With multiple risk factors identified, these could provide concurrent targets for various public health strategies and interventions with the aim of reducing the burden of VI among the population with DM in China.

Using Objective Vision Measures to Explore the Association of Vision Impairment With Cognition Among Older Adults in the United States

To evaluate the association between vision impairment (VI) and cognitive function using objective measures. Cross-sectional analysis with a nationally representative sample. The association between VI and dementia was investigated in a US population-based, nationally representative sample of Medicare beneficiaries, the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries aged ≥65 years, using objective vision measures. Exposures included distance VI (>20/40), near VI (>20/40), contrast sensitivity impairment (CSI) (<1.55), any objective VI (distance and near visual acuity, or contrast), and self-reported VI. The main outcome measure was dementia status defined based on survey reports, interviews, and cognitive tests. A total of 3026 adults were included in this study; the majority were female (55%) and White (82%). The weighted prevalence rates were 10% for distance VI, 22% for near VI, 22% for CSI, 34% for any objective VI, and 7% for self-reported VI. Across all measures of VI, dementia was more than twice as prevalent in adults with VI compared to their peers without (P < .001 for all). In adjusted models, all measures of VI were associated with higher odds of dementia (distance VI: OR 1.74, 95% CI 1.24-2.44; near VI: OR 1.68, 95% CI 1.29-2.18; CSI: OR 1.95, 95% CI 1.45-2.62; any objective VI: OR 1.83, 95% CI 1.43-2.35; self-reported VI: OR 1.86, 95% CI 1.20-2.89). In a nationally representative sample of older US adults, VI was associated with increased odds of dementia. These results suggest that maintaining good vision and eye health may help preserve cognitive function in older age, although more research is needed to investigate the potential benefits of interventions that focus on vision and eye health on cognitive outcomes.

The Effect of Self-Reported Visual Impairment and Sleep on Cognitive Decline: Results of the Hispanic Community Health Study/Study of Latinos.

Visual impairment could worsen sleep/wake disorders and cognitive decline. To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site. HCHS/SOL Miami-site participants ages 45-74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations. Sleepiness (β= 0.04; p < 0.01) and insomnia (β= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (β= -0.16; p < 0.001) and on average 7-years later (β= -0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (β= -0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations. Self-reported visual impairment was independently associated with worse cognitive function and decline.