Visual Impairment In Older Adults Research Articles

Surgical treatment of presbyopia II

This review gives an overview of the current multifocal intraocular lenses (IOLs) landscape, in terms of the technology, benefits, and limitations of different premium IOLs, as well as significant clinical outcomes. Cataract is the most common cause of visual impairment in older adults. From 1980, the number of blind and visually impaired people have decreased due to cataract surgery. As the number of surgical procedures increases every year, patient demands have also changed with many patients expecting excellent visual acuity without glasses. Multifocal IOLs can provide spectacle-independence for near, intermediate, and distant vision tasks. Multifocal IOLs can be classified into bifocal, trifocal, and extended depth of focus multifocal IOLs. The ultimate goal of multifocal lenses includes reduced incidence of photic phenomena, and improved uncorrected near, intermediate, and far visual acuities for those working with computers and smartphones, as well as no contrast sensitivity loss. Although some patients have issues with halos and glare, overall patient satisfaction and quality of life are generally high after multifocal IOL implantation. Careful patient selection should be made to satisfy different individual needs.

Presbyopia and Ocular Conditions Causing Near Vision Impairment in Older Adults From the Brazilian Amazon Region

To investigate the prevalence and causes of near vision impairment (NVI) in a population of older adults from the Brazilian Amazon Region. Population-based cross-sectional study. Cluster sampling was used in randomly selecting subjects 45 years of age and older from urban and rural areas of Parintins city, Brazil. Participants underwent ophthalmic examination, including uncorrected (UCNVA), presenting (PNVA), and best-corrected near visual acuity (BCNVA) from each eye; biomicroscopy; funduscopy; and subjective refraction, including testing with additional lenses for near vision optical correction. A principal cause for NVI was assigned by the ophthalmologist and presbyopia was defined as UCNVA ≤ 20/40 changing to > 20/40 with BCNVA. Free-of-charge glasses were provided for those in need. A total of 2384 subjects were enumerated and 2025 had reliable NVA measurements from both eyes. The prevalence of NVI in the better-seeing eye was 96.5% with UCNVA, decreasing to 81.1% with PNVA and to 20.5% with BCNVA. Presbyopia was the principal cause of NVI in 71.8%, followed by cataract (16.5%) and pterygium (2.5%), and was associated with younger age and high schooling. Glasses for near vision were prescribed and provided to 1414 (69.8%) participants. A high prevalence of NVI was detected even in those wearing glasses for near. Prescription and provision of low-cost reading glasses should be considered by Brazilian health authorities to address this easily and promptly correctable form of vision impairment.

Validating the accuracy of an activity monitor in a visually impaired older population.

Activity monitors have been used to objectively measure physical activity and its association with visual impairment in older adults. However, there is limited understanding of the accuracy of activity monitors in people with low vision. This study investigated the accuracy of an activity monitor compared with manual step counting in a low vision population and sought to find the most accurate placement location for the device. We recruited 32 individuals aged 50 years and older with low vision. ActiGraph activity monitors were secured bilaterally on the wrists, ankles, and hips of each participant, who then walked a flat, linear course in their home at a comfortable pace for 4 min, using any necessary assistive device such as a long cane, support cane, or guide dog. Steps were counted using a hand-held tally counter. ActiGraph-measured step data from the 4-min period were downloaded using the standard and low frequency filters at 1 epoch s-1 through ActiLife. Of the 32 participants, 20 (63%) were female, median visual acuity was 1.48 logMAR (6/180 Snellen), average age was 73 (standard deviation, S.D., 9) years, average body mass index was 28.9 (S.D. 7.0) kg m-2 , and 47% of participants used an assistive device. Average distance for the test course was 10.9 (S.D. 3.4) m and participants completed an average of 368 (S.D. 68) steps during the 4 min. The number of steps recorded by the two, bilaterally-worn devices at each location were averaged. Ankle, hip, and wrist activity monitors detected 85% (interquartile range, IQR 76-94%), 56% (IQR 39-85%), and 56% (IQR 43-69%), respectively, of directly-observed steps when using the standard ActiGraph filter. Detected steps more closely matched directly observed steps for all placement sites when the low-frequency ActiGraph filter was applied: 101% (IQR 99-104%) at the ankle, 94% (IQR 85-101%) at the hip, and 83% (IQR 72-94%) at the wrist. Bland-Altman plots showed greater levels of agreement between ActiGraph-recorded and directly-observed steps at faster walking speeds. Our results demonstrate that the most accurate location of activity monitor placement is the ankle and that when using the low-frequency filter the level of agreement becomes more acceptable on the wrist and hip, in this population. Use of the low activity filter can help minimise inaccurate calculation of steps in people with low vision, particularly those who walk slowly.

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.

Prevalence of Vision Impairment in Older Adults in Rural China in 2014 and Comparisons With the 2006 China Nine-Province Survey

To estimate the prevalence of vision impairment and blindness in 2014 among older adults in rural China with comparisons with the 2006 Nine-Province Survey. Population-based, cross-sectional study. Geographical cluster sampling was used in randomly selecting residents from a rural county or semi-rural district within 9 provinces: Beijing, Jiangsu, Guangdong, Heilongjiang, Jiangxi, Hebei, Ningxia, Chongqing, and Yunnan. Persons 50 years of age or older were enumerated through household visits and invited to examination sites for visual acuity testing and examination. Vision impairment and blindness in 2014 was compared with data from the 2006 survey. Among 51 310 examined persons, the prevalence of presenting vision impairment (<20/63 to ≥20/400) in the better-seeing eye ranged from 6.05% to 15.3% across the 9 study sites, with presenting blindness (<20/400) ranging from 0.66% to 5.35%. With best-corrected visual acuity, the prevalence of vision impairment ranged from 1.96% to 8.74%, and blindness from 0.47% to 5.01%. Vision impairment was associated with older age, female sex, and little or no education. The overall prevalence of presenting vision impairment and blindness decreased during the 2006-2014 interval by 6.31% and 29.0%, respectively; and by 16.1% and 38.0%, respectively, after standardization of 2006 prevalence rates to the 2014 population. Substantial progress has been made in the reduction of vision impairment in rural China. Nevertheless, vision impairment remains an important public health problem with substantial geographic disparities and with older age, female sex, and illiteracy as risk factors.

Evaluation of Cognitive Functioning in the Context of Rehabilitation for Visual Impairment in Older Adults: A Case Series

ABSTRACTAims: As the risk of visual impairment increases with age, so does the risk of developing cognitive impairment. Detection of cognitive deficits in people with visual impairments is a challenge and it remains unclear to what extent cognitive issues impact daily habits and the rehabilitation process. The present study aimed to (1) verify the consistency between the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) (“Blind” versions) and the therapist's observations of elderly individuals in low-vision rehabilitation (LVR), and (2) document how cognitive difficulties may influence LVR and the satisfactory carrying-out of life habits. Methods: Six elderly individuals who received LVR completed the MMSE and MoCA (“Blind” versions) and Assessment of Life Habits (LIFE-H). The therapist rated the achievement of rehabilitation objectives, clients' cognitive functioning and its impact on the rehabilitation process. Results: All participants obtained scores within the normative score range for both tests except for one participant on the MoCA. The therapist perceived that four out of six participants had cognitive difficulties significant enough to hinder the rehabilitation process and these persons required more adaptations to therapy. All participants were satisfied with their life habits despite remaining functional limitations and the need for assistance. Conclusions: In this sample, standardized cognitive tests had limited utility to predict the complexity of LVR. Even if present, cognitive difficulties do not preclude rehabilitation for even severe visual impairment in elderly persons and does not imply significantly longer or more intense rehabilitation.

Impact of hearing and visual impairment in older adults with cancer.

10036 Background: Hearing and visual impairment increase the risk of psychological, functional, and cognitive deficits in older adults. However, little is known about their impact in older patients (pts) with cancer. Methods: This is a cross-sectional analysis of 2 prospective studies of pts ≥65 with cancer (Hurria et al. JCO 2011 &amp; 2016) which identified risk factors for chemotherapy (CT) toxicity. Relationships between self-reported hearing/visual impairment (fair, poor or deaf/blind) and the need for assistance in instrumental activities of daily living (IADL, i.e. shopping), or activities of daily living (ADL, i.e. bathing); anxiety; depression and cognitive deficit (&gt;11 on Blessed OMC test) were assessed (adjusted for age, sex, race, education, cancer type/stage, comorbidity, falls &amp; medication). Results: Among 750 pts (median age 72, range 65-94) with solid tumors (28% lung, 27% GI, 30% breast/GYN; 58% stage IV), 28% (n = 213) reported 1 impairment (61% hearing, 39% visual) and 7% (n = 55) both. On multivariate analysis, impaired hearing was associated with IADL dependency, anxiety and depression. Visual impairment was associated with IADL dependency, ADL limitation and depression. Impairment in both was associated with IADL dependency, anxiety, depression and cognitive deficit. Conclusions: Older pts with cancer and hearing/visual impairment are at higher risk of functional, psychological and cognitive deficits. Interventions aimed at improving vision and hearing of older adults with cancer should be studied. [Table: see text]

Prevalence of Undiagnosed Age-Related Macular Degeneration in Primary Eye Care

Age-related macular degeneration (AMD) is the leading cause of irreversible vision impairment in older adults in the United States, yet little is known about whether AMD is appropriately diagnosed in primary eye care. To examine the prevalence of eyes with AMD in patients seen in primary eye care clinics who purportedly have normal macular health per their medical record and the association of AMD with patient and physician characteristics. In this cross-sectional study of primary eye care practices in Birmingham, Alabama, 644 persons 60 years or older with normal macular health per medical record based on their most recent dilated comprehensive eye examination by a primary eye care ophthalmologist or optometrist were enrolled from May 1, 2009, through December 31, 2011. Data analysis was performed from May 1, 2016, through December 20, 2016. Presence of AMD as defined by the Clinical Age-Related Maculopathy Staging system based on color fundus photography and a masked grader. Types of AMD-associated lesions were noted. Patient health and physician characteristics were collected. The sample consisted of 1288 eyes from 644 participants (231 [35.9%] male and 413 [64.1%] female; mean [SD] age, 69.4 [6.1] years; 611 white [94.9%]) seen by 31 primary eye care ophthalmologists or optometrists. A total of 968 eyes (75.2%) had no AMD, in agreement with their medical record; 320 (24.8%) had AMD despite no diagnosis of AMD in the medical record. Among eyes with undiagnosed AMD, 32 (10.0%) had hyperpigmentation, 43 (13.4%) had hypopigmentation, 249 (77.8%) had small drusen, 250 (78.1%) had intermediate drusen, and 96 (30.0%) had large drusen. Undiagnosed AMD was associated with older patient age (odds ratio [OR], 1.06; 95% CI, 1.04-1.09; P < .001), male sex (age-adjusted OR, 1.39; 95% CI, 1.02-1.91; P = .04), and less than a high school education (age-adjusted OR, 2.40; 95% CI, 1.03-5.62; P = .04). Prevalence of undiagnosed AMD was not different for ophthalmologists and optometrists (age adjusted OR, 0.99; 95% CI, 0.71-1.36; P = .94). Approximately 25.0% of eyes deemed to be normal based on dilated eye examination by primary eye care physicians had macular characteristics that indicated AMD revealed by fundus photography and trained raters. A total of 30.0% of eyes with undiagnosed AMD had AMD with large drusen that would have been treatable with nutritional supplements had it been diagnosed. Improved AMD detection strategies may be needed in primary eye care as more effective treatment strategies for early AMD become available in the coming years.

Health Outcomes Associated with Self-Reported Vision Impairment in Older Adults

Introduction To compare the health status of older adults with and without vision impairment, this study employed a disability framework consisting of four stages, progressing from risk factors; through pathology and impairments that result in declining functioning; and eventually to disability. Methods Data from five rounds (1999 to 2008) of the National Health and Nutrition Examination Study were analyzed. Binary and multinomial logistic regression were used to estimate odds ratios, with 95% confidence intervals reflecting the likelihood of negative health outcomes among persons with self-reported fair and poor vision relative to persons with good vision. Results Fair and poor vision status were associated with negative health outcomes across the four health dimensions. Discussion Disparities in health among vision status groups may originate as a result of limitations in daily activities that could lead to changes in diet, health maintenance, and activity levels. Alternatively, disparities may reflect primary pathologies and conditions that are secondarily related to poor vision status. Longitudinal research is suggested in order to assess the order of key events, and to make a more powerful assertion of causality. Implications for practitioners Comparisons of health outcomes by vision status are important because of the potential to identify points in the disability framework where effective interventions could prevent progression to later stages in the disability process.

Age-related macular degeneration treatment: current view (literature review)

Age-related macular degeneration (AMD) – is a damage of the macula, accompanied by a significant and irreversible loss of central vision. It is a major cause of blindness and visual impairment in older adults (&gt;60 years). Damage of the retina always includes both eyes, though the intensity can vary. Early AMD is defined as the presence of drusen and retinal pigmentary abnormalities (RPE); late AMD includes dry AMD (geographic atrophy of the RPE in the absence of neovascular AMD) or neovascular AMD (detachment of the retinal pigment epithelium, hemorrhages, and/or scars). Unfortunately, the etiology and pathogenesis of AMD aren’t fully understood up to now, so treatment options are limited and not always effective. This article briefly reviews the options of initial and late forms of AMD treatment

Combining neuroprotectants in a model of retinal degeneration: no additive benefit.

The central nervous system undergoing degeneration can be stabilized, and in some models can be restored to function, by neuroprotective treatments. Photobiomodulation (PBM) and dietary saffron are distinctive as neuroprotectants in that they upregulate protective mechanisms, without causing measurable tissue damage. This study reports a first attempt to combine the actions of PBM and saffron. Our working hypothesis was that the actions of PBM and saffron in protecting retinal photoreceptors, in a rat light damage model, would be additive. Results confirmed the neuroprotective potential of each used separately, but gave no evidence that their effects are additive. Detailed analysis suggests that there is actually a negative interaction between PBM and saffron when given simultaneously, with a consequent reduction of the neuroprotection. Specific testing will be required to understand the mechanisms involved and to establish whether there is clinical potential in combining neuroprotectants, to improve the quality of life of people affected by retinal pathology, such as age-related macular degeneration, the major cause of blindness and visual impairment in older adults.

Visual impairment and depression among socially vulnerable older adults in Armenia

Objectives: Visual impairment in older adults is a major public health problem. Untreated visual impairment might negatively impact physical and psychological health. This study assessed the association between visual impairment and depression among socially vulnerable older adults (those aged 50 and above) in Armenia.Method: The survey and eye screenings were carried out among 339 participants who were the residents of retirement homes and single older adults in the households. The study team used Golovin–Sivtsev chart and cycloplegic skiascopy to measure visual impairment and Center for Epidemiologic Studies Depression scale to measure depression.Results: The prevalence of visual impairment in the sample was 13.3%. Almost 24.0% of participants reported depression symptoms. Participants living in the retirement homes had substantially higher rates of visual impairment (21.5%) and depression (28.0%) than those living in households (9.3% and 15.0%, respectively). The odds of having depression were higher among those with visual impairment compared to those without after adjusting for confounders (OR = 2.75; 95% CI: 1.29–5.87). Having at least one non-communicable disease was associated with depression (OR = 2.47; 95% CI: 1.28–4.75). Living in the retirement home was marginally significantly associated with having depression. Other confounders included age, gender, education, physical activity, and smoking.Conclusion: Visual impairment was significantly associated with depression in socially vulnerable older adults in Armenia. Timely eye screenings in similar population groups could lead to early detection of visual impairment and prevention of visual loss and associated mental health problems.

Age-related macular degeneration patients’ awareness of nutritional factors

Age-related macular degeneration (AMD) is the leading cause of visual impairment in older adults in the United Kingdom. This study sought to characterise AMD patients who seek the services of the Macular Society, and determine the level and source of their dietary knowledge. A questionnaire was designed, validated, and administered to 158 participants. The questions covered demographic data and knowledge of nutrition and supplementation. The mean age of participants was 79 years; 61% of them were female, and 27% were registered visually impaired. Only 55% of the participants thought diet was important for eye health, 63% felt that they had not received enough information about AMD. The participants reported that their information mainly came from non-professional support groups. Most participants identified healthy food, but could not say why, and were not able to identify carotenoid rich foods. The results of the study will inform design of education and dissemination methods regarding dietary information.

Prevention and Treatment of Age-Related Macular Degeneration: An Update for Pharmacists

Review the current recommendations for the prevention and treatment of age-related macular degeneration (AMD). Articles indexed in PubMed (National Library of Medicine), the Cochrane Reviews and Trials, Dynamed, and Iowa Drug Information Service (IDIS) in the last 10 years using the key words macular degeneration, agerelated macular degeneration (AMD), AMD and treatment, AMD and prevention. Sixty-nine published papers were reviewed, and criteria supporting the primary objective were used to identify useful resources. The literature included practice guidelines, original research articles, review articles, product prescribing information, and supplement product information for the prevention and treatment of AMD. AMD is a leading cause of visual impairment in older adults. At present there is no cure for advanced AMD, but intravitreal vascular endothelial growth factor inhibitors minimize and even reverse vision loss in patients with AMD of the neovascular type. In the Age-Related Eye Disease Study (AREDS), participants with intermediate AMD who received a supplement combination of vitamins C and E, beta-carotene, and zinc had a greater delay in progression to advanced AMD than those participants who received a portion of these supplements. In the second AREDS, AREDS2, the addition of lutein + zeaxanthin, docosahexaenoic acid (DHA) + eicosapentaenoic acid (EPA), or lutein + zeaxanthin and DHA + EPA to the complete AREDS formulation did not further reduce the risk of progression to advanced AMD. Subgroup analyses indicated that additional research with lutein + zeaxanthin supplementation is warranted as it was beneficial in participants with low dietary intake of lutein + zeaxanthin. A formulation without beta-carotene may be best for most patients, especially smokers or former smokers. Health care professionals will want to consider patient-specific information before recommending ocular health supplements.

The Prevalence of Visual Impairment in Older Adults in Mainland China: A Systematic Review and Meta-Analysis

Purpose: This paper presents estimates of the prevalence of blindness and low vision among older adults over 50 years of age in mainland China. Methods: All primary reports of population-based studies that reported the prevalence or incidence of visual impairment among older populations in mainland China were identified. Twenty-four population-based studies were included in this systematic review. Blindness is defined as visual acuity of less than 3/60, or a corresponding visual-field loss to less than 10 degrees in the better eye with the best possible correction; low vision is defined as visual acuity of less than 6/18, but equal to or better than 3/60 in the better eye with the best possible correction. The pooled prevalence estimates of blindness and low vision were calculated assuming a random-effects model. Relative odds with 95% confidence intervals (95% CIs) were calculated, stratified by methodological and socioeconomic variables. Results: The overall pooled prevalence of blindness was 1.7% (95% CI 1.4–2.1). The results of the meta-regression showed the significance of a predictor variable: geographic region. The blindness rates per 100 older adults in various regions were 1.4 (0.9–2.0) in East China, and 1.4 (1.0–2.0) in Central China and 2.5 (1.9–3.2) in Western China. The overall pooled prevalence of low vision was 4.1% (3.4–5.1) and the independent pooled prevalence rates stratified by geographic region were 3.6% (2.6–5.1) in East China, 3.6% (2.4–5.2) in Central China and 5.2% (3.6–7.4) in Western China. Conclusions: Blindness or low vision affects approximately 5.8% Chinese adults older than 50 years. The prevalence of visual impairment, and especially blindness, vary greatly by the developmental status of geographic region.

Adaptive gait changes in older people due to lens magnification

Intervention trials that reduce visual impairment in older adults have not produced the expected improvements in reducing falls rate. We hypothesised that this may be caused by adaptation problems in older adults due to changes in magnification provided by new spectacles and cataract surgery. This study assessed the effects of ocular magnification on adaptive gait in young and older adults. Adaptive gait was measured in 10 young (mean age 22.3 ± 4.6 years) and 10 older adults (mean age 74.2 ± 4.3 years) with the participants' habitual refractive correction (0%) and with size lenses producing ocular magnification of ±1%, ±2%, ±3%, and ±5%. Adaptive gait parameters were measured when participants approached and stepped up onto a raised surface. Adaptive gait changes in the young and older age groups were similar. Increasing amounts of magnification (+1% to +5%) led to an increased distance of the feet from the raised surface, increased vertical toe clearance and reduced distance of the lead heel position on the raised surface (p < 0.0001). Increasing amounts of minification (-1% to -5%) led to the opposite of these changes (p < 0.0001). Adaptation to ocular magnification did not occur in the short term in young or older adults. The observed adaptive gait changes were driven by the magnification changes provided by the size lenses. The raised surface appeared closer and larger with magnification and further away and smaller with minification and gait was adjusted accordingly. Magnification may explain the mobility problems some older adults have with updated spectacles and after cataract surgery.

Prevalence of Vision Impairment in Older Adults in Rural China: The China Nine-Province Survey

Describe the prevalence of visual impairment/blindness among older adults in rural populations in China. Population-based, cross-sectional study. We evaluated 45 747 adults > or =50 years of age. Geographically defined cluster sampling was used in randomly selecting a cross-section of residents from a representative rural county within each of 9 provinces in mainland China. Participants were enumerated through village registers followed by door-to-door household visits. Eligible persons were invited to local examination sites for visual acuity (VA) testing and eye examination. Presenting and best-corrected distance VA. Of 50 395 enumerated eligible persons, 45 747 (90.8%) were examined and tested for VA. The prevalence of presenting visual impairment <20/63 to > or =20/400 in the better eye was 10.8% and blindness (<20/400) was 2.29%. Across the 9 provinces, presenting visual impairment ranged from 6.89% to 15.8%, and blindness from 1.27% to 5.40%. With best-corrected VA, the prevalence of visual impairment was 5.30%, and 1.93% for blindness. The ranges across the 9 provinces were 3.13% to 9.51% for visual impairment and 0.74% to 4.95% for blindness. Visual impairment and blindness were associated with older age, female gender, lack of education, and geographic area (province) with both presenting and best-corrected VA. Visual impairment and blindness are important public health problems in rural China, with significant regional variations in prevalence. Blindness prevention programs targeting the rural elderly should be expanded, particularly in areas with limited access and affordability of eye care services. Special emphasis should be given to reaching women and those without education. Greater attention should also be given to correction of refractive error.

Polypoidal choroidal vasculopathy and neovascular age-related macular degeneration: Same or different disease?

Neovascular age-related macular degeneration (nAMD) is the commonest cause of severe visual impairment in older adults in Caucasian white populations. Polypoidal choroidal vasculopathy (PCV) has been described as a separate clinical entity differing from nAMD and other macular diseases associated with subretinal neovascularization. It remains controversial as to whether or not PCV represents a sub-type of nAMD. This article summarizes the current literature on the clinical, pathophysiological and epidemiological features and treatment responses of PCV and compares this condition to nAMD. Patients with PCV are younger and more likely Asians, and eyes with PCV lack drusen, often present with serosanguinous maculopathy or hemorrhagic pigment epithelial detachment, and have differing responses to photodynamic therapy and anti-vascular endothelial growth factor (VEGF) agents. There are also significant differences in angiographic and optical coherence tomography features between PCV and nAMD. Histopathological studies suggest differences in the anatomical details of the associated vascular abnormalities in the retina and choroids and the relative role of VEGF. There is emerging evidence of common molecular genetic determinants involving complement pathway and common environmental risk factors (e.g. smoking). Such information could further assist clinicians involved in the care of elderly patients with these conditions.

Screening Older Adults for Impaired Visual Acuity: A Review of the Evidence for the U.S. Preventive Services Task Force

Impaired visual acuity is common in older adults. Screening for impaired visual acuity could lead to interventions to improve vision, function, and quality of life. To update the 1996 U.S. Preventive Services Task Force evidence review on benefits and harms of screening for impaired visual acuity in primary care settings in adults age 65 years or older. MEDLINE and the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched for studies published in English from 1996 to July 2008. Randomized trials and controlled observational studies that directly evaluated screening for impaired visual acuity in older adults were selected. To evaluate indirect evidence on screening, investigators included studies of diagnostic test accuracy and systematic reviews, randomized trials, and controlled observational studies of treatments for uncorrected refractive errors, cataracts, and age-related macular degeneration (AMD). Details were abstracted about the patient sample, study design, data analysis, follow-up, and results. Quality was assessed by using predefined criteria. Direct evidence on screening and evidence on accuracy of diagnostic tests were synthesized qualitatively. For benefits and harms of treatments, quantitative estimates for treatment effects from good-quality systematic reviews were reported or relative risks using a random-effects model were calculated. Direct evidence shows that screening for vision impairment in older adults in primary care settings is not associated with improved visual or other clinical outcomes and may be associated with unintended harms, such as increased falls. Effective treatments are available for uncorrected refractive error, cataracts, and AMD. A visual acuity test (for example, the Snellen eye chart) is the standard for screening for vision impairment in primary care, but its diagnostic accuracy is uncertain because no studies compare it against a clinically relevant reference standard. There remains no evidence on accuracy of funduscopic examination. A relatively small number of primary studies and methodological shortcomings made it difficult to reach conclusions with a high degree of confidence. In addition, studies not published in English and studies of community- or home-based screening were not included. More research is needed to understand why direct evidence shows no benefits of screening, even though impaired visual acuity is common and effective treatments are available.

Personal and social resources and adaptation to chronic vision impairment over time

Objectives: To examine the effect of personal (coping strategies and locus of control) and social resources (family and friendship support) on adjustment to chronic vision impairment in older adults at baseline (rehabilitation service application), 6 months, and 18 months later. Method: 313 community dwelling, English speaking older adult applicants to a vision rehabilitation agency in the northeast were interviewed in their homes following informed consent. Results: A larger portion of variability was accounted for in positive compared to negative outcomes. Greater use of acceptance coping, less use of wishfulness coping, lower endorsement of chance locus of control, and higher family support were associated with better baseline adaptation, yet these predictors had little effect on short- or long-term change in adaptation. Higher friendship support predicted increased adaptation to vision loss at both follow-up points. Friendship support was also associated with decreased depression at Time 3, and lower use of wishfulness was related to decreased depression at Time 2. Conclusion: Results showed differential effects for positive versus negative outcome variables, short- versus long-term adaptation, personal and social resources, and within social resources, for family versus friendship support.