Visual Impairment In Older Adults Research Articles

Comparison of Surgical Times Between Manual and Robot-Assisted Epiretinal Membrane Peeling.

Epiretinal membranes (ERM) pose a common challenge in vitreoretinal pathology, often causing vision impairment in older adults. The Preceyes Surgical System (PSS) supports the surgical removal of ERM through robot-assisted membrane peeling (RA-MP). This study compares surgical times and iatrogenic hemorrhages between manual membrane peeling (MMP) and RA-MP using PSS. Nine patients underwent RA-MP with PSS, whereas 16 patients (18 eyes) underwent MMP for comparative analysis. Surgical durations were categorized into RA-MP, manual forceps utilization in PSS surgeries (mRA-MP), and traditional MMP. Cumulative manual manipulation duration (cMMP), instrument grasps, and intraoperative hemorrhages were statistically analyzed using the Mann-Whitney U test. RA-MP showed significantly longer peeling times compared to MMP (P < 0.001). Flap initiation grasps were similar between methods (P = 0.86), RA-MP demonstrated a significant reduction in peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001). Although RA-MP resulted in fewer hemorrhages, the difference did not reach statistical significance relative to MMP (P = 0.08). Although RA-MP tended to extend surgical time, it offered advantages in reducing tissue trauma and intraoperative hemorrhages. Further research is needed to explore the learning curve for novice surgeons and evaluate the safety profile of RA-MP. RA-MP may offer potential advantages over manual surgery, particularly in terms of reduced tissue trauma and intraoperative hemorrhages. Despite its longer duration compared with manual techniques, RA-MP may lead to fewer grasping maneuvers and lower rates of hemorrhages, thereby enhancing the safety and precision of vitreoretinal surgeries.

Evolution and Future of Serious Game Technology for Older Adults

Serious games play a key role in the medical field, particularly in enhancing cognitive abilities in the elderly. However, the sensory organs of the elderly decline over time, and the intervention effect of traditional serious games for older adults.. The objective of this study is to identify the evolution and current problems of serious game technology for the elderly by using bibliometric analysis. We selected 319 relevant documents from 2013 to 2024 from the Web of Science (WOS) database. This study uses Publish or Perish (Windows GUl Edition) and VOSviewer(1.6.20) for performance analysis and scientific charting. We deeply analyze the early trends, emerging technologies, and publication trends, including citations and journals, subject areas, and regional and institutional. Here, we identified serious games for older adults rely heavily on visual presentation, often utilizing screens for screening, rehabilitation, and therapeutic interventions. This may cause further visual impairment in older adults who are experiencing visual decline. In addition, we proposed the combination of rich tactile feedback and external devices as one of the effective solutions to the current problems for future research.

The association between cataract surgery and mental health in older adults: a review

Background: Although cataract surgery has been proposed as a potentially modifiable protective factor for enhancing emotional well-being in cataract patients, studies examining the relationship between anxiety or depression and cataract surgery have yielded inconsistent findings. This review summarizes existing evidence to establish whether cataract surgery is associated with depression and anxiety in older adults. Methods: A literature search was conducted across PubMed, Medline, Web of Science, and Embase databases. An initial screening by abstracts and titles was performed, followed by a review and assessment of the methodological quality of the relevant full papers, and final inclusion of 44 studies were deemed eligible for inclusion in this review. Results: Among 44 included studies, 36 studies (81.8%) were observational studies concerning the association of cataract surgery or cataracts with anxiety or depression, four studies (9.1%) were interventional studies, and four studies (9.1%) were reviews. Cataract surgery notably enhances the mental health of individuals with impaired vision. However, the multifaceted nature of psychological well-being, influenced by various factors, suggests that cataract surgery may not address all aspects comprehensively. Additionally, preoperative anxiety and depression significantly impact cataract surgery outcomes. Conclusion: Vision impairment in older adults is closely associated with increased symptoms of depression and anxiety. While surgical intervention for cataracts improves these symptoms, it might be less effective for mental disorders with multifactorial causes. Notably, anxiety or depression poses challenges to successful preoperative and intraoperative cataract surgeries.

The Association between Diabetic Retinopathy and Macular Degeneration: A Nationwide Population-Based Study.

Age-related macular degeneration (AMD), particularly its exudative form, is a primary cause of vision impairment in older adults. As diabetes becomes increasingly prevalent in aging, it is crucial to explore the potential relationship between diabetic retinopathy (DR) and AMD. This study aimed to assess the risk of developing overall, non-exudative, and exudative AMD in individuals with DR compared to those without retinopathy (non-DR) based on a nationwide population study in Taiwan. A retrospective cohort study was conducted using the Taiwan National Health Insurance Database (NHIRD) (2000-2013). A total of 3413 patients were placed in the study group (DR) and 13,652 in the control group (non-DR) for analysis. Kaplan-Meier analysis and the Cox proportional hazards model were used to calculate the hazard ratios (HRs) and adjusted hazard ratios (aHRs) for the development of AMD, adjusting for confounding factors, such as age, sex, and comorbid conditions. Kaplan-Meier survival analysis indicated a significantly higher cumulative incidence of AMD in the DR group compared to the non-DR group (log-rank test, p < 0.001). Adjusted analyses revealed that individuals with DR faced a greater risk of overall AMD, with an aHR of 3.50 (95% CI = 3.10-3.95). For senile (unspecified) AMD, the aHR was 3.45 (95% CI = 3.04-3.92); for non-exudative senile AMD, it was 2.92 (95% CI = 2.08-4.09); and for exudative AMD, the aHR was 3.92 (95% CI = 2.51-6.14). DR is a significant risk factor for both overall, senile, exudative, and non-exudative AMD, even after adjusting for demographic and comorbid conditions. DR patients tend to have a higher prevalence of vascular comorbidities; however, our findings indicate that the ocular pathologies inherent to DR might have a more significant impact on the progression to AMD. Early detection and appropriate treatment of AMD is critically important among DR patients.

Prevalence of visual impairment in patients sustaining proximal hip fracture after a simple fall

According to epidemiological studies, the 30% of aged 75 years and older is having impaired vision and most of the cases these patients are not in contact of the hospital care staff and community eye services. The visual assessment of older people is essential and helps to minimize the issues related to fall that led to critical problem. The proper vision is required for regain independence and improve the patient’s overall wellbeing. This kind of situation is leading the individual to unintentional injury which is higher among the visually impaired people compared to fully sighted population. Moreover, there are two major reasons for visual impairment that are more susceptible.The study aims to analyze the prevalence of visual impairment in patients sustaining proximal hip fracture after a simple fall at SCB Medical College and Hospital, Cuttack, Odisha.The current study has been conducted at SCB Medical College and Hospital, Cuttack, Odisha. All inpatients of the orthopaedic rehabilitation wards were recuperating from the surgical repair of a fractured neck of femur aged 75 years and above. and all the visual impairment assessed at Ophthalmology OPD. Moreover, the investigator has also invited the patients who sustained their fracture after a simple slip, trip and fall. Apart from this, the mental test of these participants was also done to analyze the ability. In this test the score of seven and above was considered for allowing the patients to take part in the study. There was a full ocular examination of anterior and posterior segment performed by the ophthalmologist using the slit-lamp bio microscope and indirect ophthalmoscope.Visual impairment of criteria 1 sensitivity was 93% and specificity was 91%. Moreover, the likelihood ratio of positive results was 11 and negative result was 0.05. For the criteria 2 the sensitivity was 97% and specificity was 86%. Moreover, the likelihood of positive results was 6 and negative result was 0.02. Apart from this detection of potentially remedial visual impairment sensitivity was 69% and specificity was 91%. The likelihood ratio of positive result was 8 and negative result was 0.2.The vision test and proper ocular examination were underestimated the extent of vision impairment in older adults. As per the outcome of the study, the visual impairment is common in elderly patients with a history of falls. Moreover, the study has suggested that to measure the visual acuity of all elderly patients recuperating from a proximal hip fracture after a simple fall.

Exploring Lipid Abnormalities in Senile Cataract: A Cross-Sectional Investigation

Background: Age-related cataracts (ARC) are a common cause of vision impairment in older adults. Previous studies have suggested that abnormal Lipid profile and oxidative stress may contribute to the development and progression of ARC.&#x0D; Aim: The aim of this study was to compare the serum Lipid profile levels in patients with ARC and healthy controls.&#x0D; Materials and Methods: This was a case-control study involving 50 patients with ARC and 50 age and gender-matched controls. Serum Lipid profile levels were measured using standard methods. The data were analyzed using t-test. A P-value of less than 0.05 was considered statistically significant.&#x0D; Results: The results showed that the mean serum level of HDL Cholesterol was significantly lower in the ARC group than in the control group, while the mean serum level of triglyceride was significantly higher in the ARC group than in the control group.&#x0D; Conclusion: This study indicates that altered lipid profile may be a risk factor for ARC.

Analyzing shifts in age-related macular degeneration research trends since 2014: A bibliometric study with triple-map Sankey diagrams (TMSD).

Age-related macular degeneration (AMD) is the primary cause of vision impairment in older adults, especially in developed countries. While many articles on AMD exist in the literature, none specifically delve into the trends based on document categories. While bibliometric studies typically use dual-map overlays to highlight new trends, these can become congested and unclear with standard formats (e.g., in CiteSpace software). In this study, we introduce a unique triple-map Sankey diagram (TMSD) to assess the evolution of AMD research. Our objective is to understand the nuances of AMD articles and show the effectiveness of TMSD in determining whether AMD research trends have shifted over the past decade. We collected 7465 articles and review pieces related to AMD written by ophthalmologists from the Web of Science core collection, accumulating article metadata from 2014 onward. To delve into the characteristics of these AMD articles, we employed various visualization methods, with a special focus on TMSD to track research evolution. We adopted the descriptive, diagnostic, predictive, and prescriptive analytics (DDPP) model, complemented by the follower-leading clustering algorithm (FLCA) for clustering analysis. This synergistic approach proved efficient in identifying and showcasing research focal points and budding trends using network charts within the DDPP framework. Our findings indicate that: in countries, institutes, years, authors, and journals, the dominant entities were the United States, the University of Bonn in Germany, the year 2021, Dr Jae Hui Kim from South Korea, and the journal "Retina"; in accordance with the TMSD, AMD research trends have not changed significantly since 2014, as the top 4 categories for 3 citing, active, and cited articles have not changed, in sequence (Ophthalmology, Science & Technology - Other Topics, General & Internal Medicine, Pharmacology & Pharmacy). The introduced TMSD, which incorporates the FLCA algorithm and features in 3 columns-cited, active, and citing research categories-offers readers clearer insights into research developments compared to the traditional dual-map overlays from CiteSpace software. Such tools are especially valuable for streamlining the visualization of the intricate data often seen in bibliometric studies.

Protective role of IL-17-producing γδ T cells in a laser-induced choroidal neovascularization mouse model

BackgroundVision loss in patients with wet/exudative age-related macular degeneration (AMD) is associated with choroidal neovascularization (CNV), and AMD is the leading cause of irreversible vision impairment in older adults. Interleukin-17A (IL-17A) is a component of the microenvironment associated with some autoimmune diseases. Previous studies have indicated that wet AMD patients have elevated serum IL-17A levels. However, the effect of IL-17A on AMD progression needs to be better understood. We aimed to investigate the role of IL-17A in a laser-induced CNV mouse model.MethodsWe established a laser-induced CNV mouse model in wild-type (WT) and IL-17A-deficient mice and then evaluated the disease severity of these mice by using fluorescence angiography. We performed enzyme-linked immunosorbent assay (ELISA) and fluorescence-activated cell sorting (FACS) to analyze the levels of IL-17A and to investigate the immune cell populations in the eyes of WT and IL-17A-deficient mice. We used ARPE-19 cells to clarify the effect of IL-17A under oxidative stress.ResultsIn the laser-induced CNV model, the CNV lesions were larger in IL-17A-deficient mice than in WT mice. The numbers of γδ T cells, CD3+CD4+RORγt+ T cells, Treg cells, and neutrophils were decreased and the number of macrophages was increased in the eyes of IL-17A-deficient mice compared with WT mice. In WT mice, IL-17A-producing γδ T-cell numbers increased in a time-dependent manner from day 7 to 28 after laser injury. IL-6 levels increased and IL-10, IL-24, IL-17F, and GM-CSF levels decreased in the eyes of IL-17A-deficient mice after laser injury. In vitro, IL-17A inhibited apoptosis and induced the expression of the antioxidant protein HO-1 in ARPE-19 cells under oxidative stress conditions. IL-17A facilitated the repair of oxidative stress-induced barrier dysfunction in ARPE-19 cells.ConclusionsOur findings provide new insight into the protective effect of IL-17A in a laser-induced CNV model and reveal a novel regulatory role of IL-17A-producing γδ T cells in the ocular microenvironment in wet AMD.

Development and validation of a risk prediction model for visual impairment in older adults

ObjectivesThis study aimed to determine the risk factors that affect visual impairment in older adults for developing and evaluating a visual impairment risk prediction model. MethodsIn this hospital-based unmatched case-control design study, we enrolled 586 participants (411 in the training set and 175 in the internal test set) from the ophthalmology clinic and physical examination center of a teaching hospital in Liaoning Province, China, from June to December 2020. Visual impairment was defined as best-corrected visual acuity <6/18 (The WHO definition). Possible influencing factors of visual impairment were assessed, including demographic factors, socioeconomic factors, disease and medication factors, and lifestyle. A visual impairment risk prediction model was developed using binary logistic regression analysis. The area under the ROC curve (AUC) was used to evaluate the effectiveness of the proposed prediction model. ResultsSix independent influencing factors of visual impairment in older adults were identified: age, systolic blood pressure, physical activity scores, diabetes, self-reported ocular disease history, and education level. A visual impairment risk prediction model for older adults was developed, showing powerful predictive ability in the training set and internal test set with AUCs of 0.87 (95%CI 0.83–0.90) and 0.81 (95%CI 0.74–0.88), respectively. ConclusionsThe risk prediction model for visual impairment in older adults had high predictive power. Identifying older adults at risk for developing visual impairment can help healthcare workers to adopt appropriate targeted programs for early education and intervention to prevent or delay visual impairment and prevent injuries due to visual impairment in older adults.

Prevalence of refractive error among Dongarias and use of Folding Phoropter (FoFo) as a field device enabling implementation research in this indigenous community. Tribal Odisha Eye Disease Study (TOES) Report # 13.

To evaluate the prevalence of uncorrected refractive error (URE) among Dongarias-a particularly vulnerable tribal group in Rayagada, Odisha, India and evaluate if folding phoropter (FoFo) can help achieve on-site correction of URE. This was a cross-sectional study. FoFo was used for people with URE. Spherical equivalent (SE) spectacles based on the FoFo refraction were dispensed when distance visual acuity improved to > 6/12. Others were referred to fixed eye centres. Multivariable logistic regression evaluated the relationship of URE with sociodemographic characters and factors predicting acceptance of FoFo. In the study, 7.5% (95% confidence interval [CI]:7-8) people had URE, and included 4% with severe vision impairment and 36% with moderate visual impairment. URE was less common in children. Simple hyperopia was more common in females (25.3% vs 19.3%); compound myopic astigmatism was more common in males (27.4% vs 20.2%). People older than 50 years (p <0.0001) and females (p <0.0001) were more likely to have URE. Ninety-four people accepted FoFo on-site refraction and received SE spectacles; the acceptance was better in the younger (15-29 years old) and literate people (p <0.0001). URE was the second most common cause of visual impairment in older adults and was higher in females. Within its technological limit, FoFo could be used in the field for correcting URE and obviating the need for travel, thus bridging the know-do gap for the marginalised Dongaria community.

Self-reported glaucoma prevalence and related factors, contribution to reported visual impairment, and functional burden in a cross-sectional study in Colombia

PurposeDescribe the self-reported prevalence of glaucoma in Colombian older adults, emphasizing the most important risk factors and associated daily-life functional alterations.MethodsThis a secondary analysis of the Health, Wellness, and Aging survey conducted in the year 2015. Diagnosis of glaucoma was obtained from self-report. Functional variables were assessed through activities of daily living questionnaires. A descriptive analysis followed by bivariate and multivariate regression models adjusting for confounding variables was conducted.ResultsSelf-reported prevalence of glaucoma was 5.67%, with higher rate in women, OR 1.22 (1.13–1.40) p = .003, older age OR 1.02 (1.01–1.02) p < .001, and with higher education OR 1.38 (1.28–1.50) p < .001. Glaucoma was independently associated with diabetes OR 1.37 (1.18–1.61) p < .001 and hypertension 1.26 (1.08–1.46) p = .003. It also showed statistically significant correlations with poor SRH OR 1.15 (1.02–1.32) p < .001, self-reported visual impairment 1.73 (1.50–2.01) p < .001, and impairment in money management OR 1.59 (1.16–2.08) p = .002, grocery shopping OR 1.57 (1.26–1.96) p < .001 and preparing meals OR 1.31 (1.06–1.63) p = .013 and having had falls during the last year OR 1.14 (1.01–1.31) p = 0.041.ConclusionOur findings suggest the self-reported prevalence of glaucoma in older adults in Colombia to be higher than reported data. Glaucoma and visual impairment in older adults represent a public health concern, since glaucoma was associated with adverse outcomes like functional loss and risk of falling, affecting the quality of life and their participation in society.

The Importance of Public Health Surveillance for Vision Impairment in Older Adults

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Stigma Among Older Adults With Age-Related Vision Impairments

Introduction: Limited research has examined the experience and psychosocial effect of vision impairment in older adults. We examine the relationship between vision impairment and stigma using guided interviews among older adults with age-related eye disease. Methods: Thirty-six participants with vision impairment were recruited from glaucoma ( n = 18) (better eye visual fields mean deviations: &gt;5 and &lt;15 decibels) or retina ( n = 18) (better eye visual acuity: &lt;20/40 and &gt;20/400) clinics of the Johns Hopkins Wilmer Eye Institute between 2015 and 2020. Participants completed interviews to examine stigma surrounding age-related vision impairment. Interviews were transcribed and analyzed using directed content analysis. Results: Content analyses of interview transcripts revealed underlying stigma within our cohort. Starting with categories of (1) interpersonal relationships and (2) evolving self-perception, specific domains of stigma were realized in this study. Although both enacted (external) stigma and perceived stigma were acknowledged by a subset of participants, few endorsed internalized stigma. In the face of stigma, participants demonstrated notable resiliency in adapting to and living with age-related vision impairment, captured in an additional category of (3) behavioral adaptations. Discussion: In-depth interviews revealed that older adults with vision impairment confront specific domains of stigma, including enacted and perceived stigma. Features protective against internalized stigma included older age, community support, and assistive technologies. Implications for Practitioners: A recognition of the subtypes of stigma that older adults with age-related vision impairment face is necessary to tailor support and target interventions.

Hearing and Vision Impairment in Older Adults: Implications for Cognitive, Mental, and Brain Health

Sensory impairment impacts over 55% of Americans aged 60 years or older and may have important downstream consequences for the cognitive health of older adults. This session will present evidence for a relationship between sensory impairment and accelerated cognitive decline, increased risk of incident dementia, and increased mental and physical fatigability from two observational cohort studies. Additionally, this session will investigate the possible nature of these relationships. It may be that sensory impairment is a marker of dementia-related pathological changes in the brain, with potential ramifications for risk prediction and stratification. Alternatively, sensory impairment may have a direct impact on the aging brain, a potential causal mechanism liking sensory impairment and brain health, with implications for disease prevention. As part of this session, we will present evidence for associations between central auditory processing, a potential risk marker, and brain volumes measured with structural magnetic resonance imaging (MRI), and retinal vasculature density, as measured with optical coherence tomography. We will conclude by describing associations between age-related macular degeneration, a leading cause of blindness, and neurocognitive test performance and regional changes in brain atrophy and connectivity.

Exploring Associations Between Health Literacy and Visual Impairment in Older Adults With Age-Related Macular Degeneration (AMD)

Abstract Date Presented 04/13/21 This study explored associations between health literacy and severity of visual impairment in older adults with age-related macular degeneration (AMD). The Short Test of Functional Health Literacy in Adults was used to assess health literacy for timed and untimed testing conditions. A one-way analysis of variance was used for analysis. Timed, 73% of participants had inadequate health literacy. Untimed, 100% of participants had adequate health literacy. All scores improved with the time limit removed. Time may be underrecognized factor of reading performance in older adults with AMD. Primary Author and Speaker: Jennifer Fortuna Contributing Authors: Tina Fletcher, Catherine Candler, and Karen Dunlap

Vision Measures in Aging Cohorts: Gaps and Opportunities

There is wide variation in the methods used to assess vision across existing aging cohort studies. While subjective vision measures are valuable in capturing individuals’ perspectives, objective criteria are often needed to fully characterize visual impairment in older adults. In addition, visual function extends beyond acuity; contrast sensitivity, visual fields, and depth perception are known to impact daily functioning, and are needed to comprehensively assess visual function. Broader uptake of subjective and objective vision measures, and harmonization of vision measures across datasets is needed to robustly examine the role of visual impairment on aging and health outcomes. In this presentation, we will draw on work using data from the National Health and Aging Trends Study, Health and Retirement Study, and Health, Aging and Body Composition Study, among others, to illustrate uses of vision data in aging cohort studies, and examine the gaps and opportunities for improvement in vision measures. Part of a symposium sponsored by Sensory Health Interest Group.

Exploring Associations Between Health Literacy and Visual Impairment in Older Adults with Age-Related Macular Degeneration (AMD)

Background: Age-related macular degeneration (AMD) is the leading cause of vision loss for Americans 65 years of age and older. Central vision loss makes reading challenging. Health literacy assessments that measure skills in basic literacy are often too demanding for people with AMD. The impact of central vision loss on functional health literacy has yet to be explored in the literature.

Role of Optical Coherence Tomography Angiography in the Diagnosis and Management of Wet Age-Related Macular Degeneration

Abstract Background Neo-vascular age-related macular degeneration (nAMD) (an advanced form of macular degeneration) is the main cause of visual impairment in older adults related to AMD. WHO has estimated that approximately 8 million people will be affected by AMD by the year 2020. Optical coherence tomography angiography (OCTA) is a novel imaging modality that permits direct visualization of the retinal and choroidal vasculature in vivo. In OCTA, high-frequency and dense volumetric scanning are made to detect blood flow by analyzing the signal decorrelation between scans. Compared with stationary areas of the retina, the movement of erythrocytes within a vessel makes a decorrelated signal. Unlike traditional angiography, OCTA does not necessitate the use of exogenous dyes, so avoiding potential side effects, such as nausea or other more serious adverse events. However, the role of OCTA as a diagnostic tool has not been largely investigated. Particularly, very few clinical studies have assessed the accuracy of OCTA imaging for the diagnosis of nAMD. Aim of the Work To highlight the benefits of using OCT-A in the diagnosis and management of wet AMD and compare it with the conventional angiographic standard, fundus fluorescein angiography (FFA). Subjects and Methods An interventional prospective comparative study will be conducted on 40 eyes diagnosed with wet AMD. Optical coherence tomography angiography and FFA will be done for all eyes. Analysis of the data obtained from the OCT-A will be done and compared with the standard FFA. Conclusion AMD is the leading cause of vision loss. Early detection and treatment is required. AMD is diagnosed by fundus examination, FA, and OCTA. OCTA and FA imaging provide complementary information about pathological changes in chorioretinal diseases. OCTA is highly sensitive for identifying AMD, CNV, and CNV activity; however, it cannot fully replace FA in the diagnosis of AMD.

Giving Support and Suicidal Ideation in Older Adults with Vision-Related Diagnoses

ABSTRACTObjectives: Visual impairment in older adults may increase risk for depression and suicide. Research suggests that giving support to others may be associated with lower depressive symptoms in older adults, but much of the research has been in non-clinical populations. Furthermore, there is limited research on giving support and suicide risk.Methods: Using a sample of older adults with vision-related diagnoses (N = 101), this study investigated the association between informal support giving (unpaid support given to family, friends, or neighbors) and formal support giving (volunteering) on depressive symptoms and suicidal ideation. Linear regressions examined the relation between support giving and depression, and logistic regressions examined the relation between support giving and suicidal ideation.Results: Greater informal support giving was related to lower likelihood of reported suicidal ideation (OR: .82, 95% CI: .68-.99, p = .04), whereas volunteer activity was not significantly related to suicidal ideation. Neither volunteer behavior nor informal support giving was related to depressive symptoms.Conclusions: Providing informal support was associated with lower likelihood of endorsing suicidal ideation in older adults with vision impairment.Clinical Implications: Informal support giving may be a target for decreasing suicidal ideation among older adults with health impairments.

National survey of blindness and visual impairment in Guatemala, 2015.

To estimate the prevalence of blindness and visual impairment in older adults living in Guatemala. Participants ³50 years of age were selected using random cluster sampling and evaluated using the Rapid Assessment of Avoidable Blindness method. Visual acuity was measured, and the lens was examined. If presenting visual acuity was <20/60, it was also tested with a pinhole and fundoscopy was performed. Blindness and visual impairment were classified as moderate visual impairment (presenting visual acuity <20/60 to 20/200), severe visual impairment (presenting visual acuity <20/200 to 20/400), or blindness (presenting visual acuity <20/400). The primary cause of blindness or visual impairment in each eye was determined, and if the cause was cataracts, the barriers to treatment were assessed. The study included 3,850 people ³50 years of age, of whom 3,760 (97.7%) were examined. The age- and sex-adjusted prevalence of blindness was 2.9% (95% confidence interval, 2.0%-3.8%), while 5.2% (4.0%-6.4%) presented with severe visual impairment, and 27.6% (23.3%-32.0%) presented with moderate visual impairment. Cataracts were the leading cause of blindness (77.6%), followed by other posterior segment diseases (6.0%). Cataracts caused 79.4% of cases of severe visual impairment, while uncorrected refractive errors caused 67.9% of cases of moderate visual impairment. Following cataract surgery, 75% of participants had a presenting visual acuity of 20/200 or better, and in 19.0% of participants, visual acuity was not better than 20/200 with correction. Cost was the main barrier to cataract surgery (56.7%). The prevalence of blindness in older adults is higher in Guatemala than in most Central American countries. Most cases of blindness and visual impairment were either preventable or treatable. Increased availability of affordable, high-quality cataract treatment would have a substantial impact on blindness prevention.