Vision In Older People Research Articles

The incidence of falls after first and second eye cataract surgery: a longitudinal cohort study.

ObjectiveTo compare fall incidence, and visual acuity and refractive status, before surgery and after first and second eye cataract surgery.Design, settingProspective observational study in eight tertiary referral ophthalmology clinics in public hospitals in Sydney, Melbourne, and Perth.ParticipantsPeople aged 65 years or more referred for bilateral age‐related cataract surgery during 2013–16, followed for maximum of 24 months after study entry or until six months after second eye surgery, whichever was shorter.Main outcome measuresPrimary outcome: age‐ and sex‐adjusted incidence of falls. Secondary outcomes: visual acuity and refractive error.ResultsThe mean age of the 409 included participants was 75.4 years (SD, 5.4 years); 220 were women (54%). Age‐ and sex‐adjusted fall incidence prior to surgery was 1.17 (95% CI, 0.95–1.43) per year, 0.81 (95% CI, 0.63–1.04) per year after first eye surgery, and 0.41 (95% CI, 0.29–0.57) per year after second eye surgery. For the 118 participants who underwent second eye surgery and participated in all follow‐up visits, age‐ and sex‐adjusted incidence before (0.80 [95% CI, 0.55–1.15] falls per year) and after first eye surgery (0.81 [95% CI, 0.57–1.15] falls per year) was similar, but was lower after second eye surgery (0.32 [95% CI 0.21–0.50] falls per year). Mean habitual binocular visual acuity (logMAR) was 0.32 (SD, 0.21) before surgery, 0.15 (SD, 0.17) after first eye surgery, and 0.07 (SD, 0.15) after second eye surgery.ConclusionsFirst eye surgery substantially improves vision in older people with cataract, but second eye surgery is required to minimise fall incidence. Timely cataract surgery for both eyes not only optimises vision in older people with cataract, but also reduces their risk of injury from falls.

Periodontal Diseases and Age-Related Macular Degeneration: Is There a Link? A Review.

Age-related macular degeneration (AMD) induces irreversible loss of vision in older people. The exact physiopathology remains unclear, but numerous studies highlight the role of inflammation and multiple risk factors. Recent data show an altered periodontal condition subject to AMD. Periodontal diseases lead to the destruction of tooth-supporting tissues, mainly caused by the periodontal infection inducing a chronic inflammation. Periodontal diseases are known to be associated with several extraoral diseases such as diabetes, polyarthritis (rheumatoid arthritis), cardiovascular disease, and preeclampsia. To assess emerging evidence suggesting an association between periodontitis and AMD. To support this review, we performed a literature search using PubMed, Cochrane, and Google Scholar databases, completed by manual searches in periodontology journals. We included only the original studies published before July 2017 reporting data on periodontal diseases and AMD. No restrictions were made on the language. Persons with AMD showed more periodontal diseases, fewer teeth, and more alveolar bone loss than those without AMD. Also, a significant association was observed between periodontal diseases and AMD, but only in the youngest individuals studied. According to the studies included in this review, periodontal disease may be a plausible risk factor for AMD and may have a potential role in the earlier stages of this eye disease. Further studies should be encouraged for better understanding of this potential new relationship.

Community screening for visual impairment in older people.

Community screening for visual impairment in older people.

Social Inequality and Visual Impairment in Older People

Visual impairment is the leading cause of age-related disability, but the social patterning of loss of vision in older people has received little attention. This study's objective was to assess the association between social position and onset of visual impairment, to empirically evidence health inequalities in later life. Visual impairment was measured in 2 ways: self-reporting fair vision or worse (moderate) and self-reporting poor vision or blindness (severe). Correspondingly, 2 samples were drawn from the English Longitudinal Study on Ageing (ELSA). First, 7,483 respondents who had good vision or better at Wave 1; second, 8,487 respondents who had fair vision or better at Wave 1. Survival techniques were used. Cox proportional hazards models showed wealth and subjective social status (SSS) were significant risk factors associated with the onset of visual impairment. The risk of onset of moderate visual impairment was significantly higher for the lowest and second lowest wealth quintiles, whereas the risk of onset of severe visual impairment was significantly higher for the lowest, second, and even middle wealth quintiles, compared with the highest wealth quintile. Independently, lower SSS was associated with increased risk of onset of visual impairment (both measures), particularly so for those placing themselves on the lowest rungs of the social ladder. The high costs of visual impairment are disproportionately felt by the worst off elderly. Both low wealth and low SSS significantly increase the risk of onset of visual impairment.

Trajectories of vision in older people: the role of age and social position.

Visual impairment becomes more prevalent with age. Rather than a uniform decline in vision with age, the strength and direction of change varies between people. This study applies an analytical method that posits multiple trajectories in eyesight, allowing for a more specific description of developmental course of this health outcome and its relationship with social position. The analysis uses the responses of 2956 respondents, aged 60 years and over, followed over 8 years (five observations) as part of the English longitudinal study of ageing. At each observation respondents self-reported their general vision. Optimal matching (sequence analysis), hierarchical clustering, and multinomial logistic regression were used to describe the sequential data, produce a typology of vision trajectories, and examine the socio-demographic characteristics associated with different trajectories. Eight distinctive clusters of trajectories were identified. The probability of reporting different types of vision trajectory varies with a change in age; however, the magnitude of the age effect is associated with social position. Visual impairment in older people is an increasingly relevant area for policy focus, with the rapid growth and diversity of the older population. Identifying factors underpinning the patterning of changes in visual function is essential for developing evidence-based policy, which both meets the needs of those most at risk and increases cost-effectiveness of public health interventions.

Health risk appraisal in older people 6: factors associated with self-reported poor vision and uptake of eye tests in older people.

BackgroundAlthough free eye testing is available in the UK from a nation-wide network of optometrists, there is evidence of unrecognised, tractable vision loss amongst older people. A recent review identified this unmet need as a priority for further investigation, highlighting the need to understand public perceptions of eye services and barriers to service access and utilisation. This paper aims to identify risk factors for (1) having poor vision and (2) not having had an eyesight check among community-dwelling older people without an established ophthalmological diagnosis.MethodsSecondary analysis of self-reported data from the ProAge trial. 1792 people without a known ophthalmological diagnosis were recruited from three group practices in London.ResultsAlmost two in ten people in this population of older individuals without known ophthalmological diagnoses had self-reported vision loss, and more than a third of them had not had an eye test in the previous twelve months. In this sample, those with limited education, depressed mood, need for help with instrumental and basic activities of daily living (IADLs and BADLs), and subjective memory complaints were at increased risk of fair or poor self-reported vision. Individuals with basic education only were at increased risk for not having had an eye test in the previous 12 months (OR 1.52, 95% CI 1.17-1.98 p=0.002), as were those with no, or only one chronic condition (OR 1.850, 95% CI 1.382-2.477, p<0.001).ConclusionsSelf-reported poor vision in older people without ophthalmological diagnoses is associated with other functional losses, with no or only one chronic condition, and with depression. This pattern of disorders may be the basis for case finding in general practice. Low educational attainment is an independent determinant of not having had eye tests, as well as a factor associated with undiagnosed vision loss. There are other factors, not identified in this study, which determine uptake of eye testing in those with self-reported vision loss. Further exploration is needed to identify these factors and lead towards effective case finding.

Effects of Induced Astigmatism on Foot Placement Strategies when Stepping onto a Raised Surface

PurposeLarge changes in spectacle prescription can increase falls risk in older people. We investigated the effect of induced astigmatism (a common cause of distorted or blurred vision in older people) on locomotor stepping patterns to determine whether the orientation of astigmatic changes could have differential effects on gait safety when negotiating steps and stairs.Methods10 older adults (mean age 76.0±6.4 years) walked up to and stepped onto a raised block whilst wearing their spectacle prescription and when blurred with ±3.00D cylinders at axes 45°, 90°, 135° and 180°. Gait measurements included foot placement before the block, toe clearance over the block edge and foot placement on the block.ResultsInduced astigmatism with axes at 90°, providing magnification in the horizontal meridian only, caused no change in stepping pattern. Induced astigmatism with axes at 180° caused foot placement changes in the anterior or posterior direction according to whether magnification was positive or negative in the vertical meridian (block perceived higher or lower respectively). Induced astigmatism with axes oblique at 45° and 135° (causing the block to be perceived as a parallelogram sloping downwards either to the right or left) caused gait changes in the anterior and posterior, vertical and lateral directions. Changes in lateral foot placement appeared to be an attempt to maintain constant foot clearance levels over the block edge by stepping over the perceived ‘lower’ side of the ‘sloping’ block.ConclusionsAstigmatic changes with oblique axes had the greatest effect on gait. Clinicians, including optometrists, physiotherapists, occupational therapists and nurses should counsel older patients about the effects of astigmatism on gait safety. Furthermore, partial prescribing of astigmatic corrections should be considered to reduce the risk of falling.

A pilot study of lighting and low vision in older people

We investigated the influence of lighting on performance at activities of daily living in 24 older people with low vision from cataract and/or macular degeneration. Participants carried out four everyday tasks, each at three illuminances: 50 lux, 200 lux, and 800 lux. Both objective performance and subjective preference were recorded. Subjects tend to perform better under brighter conditions, but the average results masked large individual variations. Indeed, most participants showed a large effect of lighting on performance in at least one task, but the optimal light level varied idiosyncratically from one subject to another. The best approach to provide optimal lighting for older people with low vision may be to individually assess their preference and performance at different light levels.

Lowered vision as a risk factor for injurious accidents in older people

Poor vision in older people is often related to increased fall risk. However, the association of the severity between visual deficit and risk for all kind of injurious accidents has not been widely studied. The aim of this study was to examine whether visual loss is associated with higher incidence of injurious accidents and whether walking speed or physical activity play a mediating role in the association. 416 persons aged 75 and 80 years at baseline underwent visual acuity measurements. Visual acuity (VA) <0.3 in the better eye, with spectacle correction when necessary, was defined as visual impairment, VA >or=0.3 but <or=0.5 as lowered vision, and VA>0.5 as normal VA. Hospital records of accidents resulting in injury were monitored for 10 years after baseline. During the 10-year follow-up, 239 (58%) participants suffered at least one injurious accident. The risk for injurious accidents in a multivariate model adjusted for age, gender, eye-related diseases, diabetes and cardiovascular diseases among participants with lowered vision was 1.45 (95% CI 1.08- 1.94), compared with that for people with normal visual acuity. Participants with visual impairment did not have an increased risk for injurious accidents (HR 1.20, 95% CI 0.82-1.75). Furthermore, neither walking speed nor physical activity had a mediating effect on the relationship between visual loss and accidents. Lowered vision is a risk factor for injurious accidents in older people independent of mobility and physical activity. Interestingly, more severe visual impairment did not increase the risk. Early intervention strategies, for example, proper correction of refractive errors or cataract extraction, may potentially prevent injurious accidents in older people.

Vision screening of older people

A recent systematic review found that between 20% and 50% of older people in the UK have undetected reduced vision and in most cases this is caused by refractive error or cataracts, and is correctable. Two approaches to improve the detection of these problems are to better publicise optometric services and to carry out community-based vision screening of older people. Screening programmes should pass the Wilson criteria and a consideration of these highlights three inter-related questions: 'Is vision screening effective at detecting correctable low vision in older people?'; 'Which tests should be included?' and 'Which venues are most appropriate?' We carried out a systematic review to investigate these questions. For the first question, only one study was found which met our selection criteria. The 'gold standard' eye examination in this study lacked several important components, and the vision screening method that was used was not found to be very effective. The review revealed other studies, which, although not meeting our selection criteria, included relevant information. The screening studies highlight the lack of agreement on the content of a gold standard eye examination and of the test(s) that should be used to screen vision. Visual function in older people is not adequately described by high contrast visual acuity (VA), nor by self-reports of visual difficulties. Other tests that may be relevant include visual field testing, low contrast VA, contrast sensitivity and stereo-acuity. The pinhole test has often been used in attempts to detect uncorrected refractive errors, but results from this test can be problematic and possible reasons for this are discussed. Appropriate venues for vision screening are contingent upon the format of the vision screening programme. There is still uncertainty over the battery of vision tests that are most appropriate. This, and optimum venues for screening, require further research before it can be fully determined whether vision screening of older people meets the Wilson criteria. If a vision screening programme using a battery of vision tests, perhaps computerised, can be established, then this should be tested to determine the sensitivity and specificity for detecting the target conditions. Ultimately, longitudinal studies are necessary to determine whether such a screening programme will lead to improved visual performance and quality of life in older people.

Vision in older people

Vision in older people

Correctable visual impairment in older people: a major unmet need.

This review seeks to determine the prevalence of correctable visual impairment (VI) in older people in the UK, to discover what proportion of these cases are undetected, to suggest reasons for the poor detection and to make recommendations for improving the detection. To establish the context of these issues, the review will also touch on the general prevalence and causes of VI in older people in developed countries and on the impact of VI in older people. Typically, studies suggest that VI affects about 10% of people aged 65-75, and 20% of those aged 75 or older. There is a strong relationship between impaired vision in older people and both reduced quality of life and increased risk of accidents, particularly falls. The literature suggests that those with low vision are about two times more likely to have falls than fully sighted people, and the annual UK cost of treating falls directly attributable to VI is pound 128 million. The literature on the prevalence of undetected reduced vision in older people reveals that between 20 and 50% of older people have undetected reduced vision. The majority of these people have correctable visual problems (refractive errors or cataract). It is particularly startling that, in 'developed countries', between 7 and 34% of older people have VI that could simply be cured by appropriate spectacles. The reasons why so many cases of treatable VI remain untreated are discussed, and suggestions are made for improving the detection of these cases. We conclude that there should be better publicity encouraging older people to attend for regular optometric eye examinations. A complementary approach is annual visual screening of the elderly, possibly as part of GPs annual health check on people aged 75 years and older. Recommendations are made for evaluating new approaches to screening and for improving the management of cases detected by screening.

Eyes on Epo

A wonder drug for the blood now shows promise in protecting vision. New work suggests that erythropoietin (Epo), a natural hormone used to treat anemia in cancer and AIDS patients and to illicitly boost performance of endurance athletes, helps prevent deterioration of rodent retinas. The work illuminates a molecular pathway that protects eye cells and offers promise for treating a disease that steals vision in older people. By age 65, one in four Americans suffers from macular degeneration (MD), an untreatable disease in which light-sensitive cells in the retina die. The affliction disrupts vision in the eye's center, making reading and detail work difficult or impossible. MD's triggers remain fuzzy, but epidemiological studies suggest that smoking, poor diet, and extended exposure to sunlight are likely culprits. Scientists posit that MD results when retinal photoreceptor cells commit suicide through a process known as apoptosis. Epo blocks apoptosis in blood cells, and recent work suggests that the drug rescues neurons as well. Building on that knowledge, cell biologist Christian Grimm of University Hospital in Zürich, Switzerland, and colleagues explored whether Epo can sustain retinal cells in rodents. Although long-term oxygen starvation fosters retinal cell degeneration, brief oxygen deprivation prevents intense light from damaging mouse photoreceptor cells. To investigate whether Epo contributes to this protective effect, Grimm and colleagues studied two groups of mice that had been exposed to either normal or low oxygen concentrations for 6 hours. The scientists then subjected the animals to intense light for 2 hours, dilating their pupils and using toys and food to encourage the rodents to keep their eyes open. After this treatment, the team measured the amount of Epo messenger RNA (mRNA) produced by photoreceptor cells. Animals that breathed low oxygen carried nearly 10 times more Epo mRNA in their retinas than did controls. Further experiments identified what cranks up Epo mRNA production: The low-oxygen treatment prevents cells from destroying a protein called HIF-1, which activates the Epo gene. With more HIF-1, Epo quantities rise. Additional studies bolster the connection between Epo and retinal cell maintenance. The team injected the hormone into the abdomens of mice raised under normal oxygen concentrations and exposed them to intense light. The treated rodents lost fewer photoreceptor cells than did untreated ones. Together, the data suggest that elevated amounts of Epo preserve photoreceptor cells, at least in mice. Epo's utility in human eye diseases awaits further proof, says lead author Grimm, and the hormone can thicken blood and hinder circulation. But companies are already seeking Epo derivatives that selectively target neurons and leave blood cells untouched, he says. Such compounds might slow MD's progression while minimizing side effects. That Epo protects mice from light damage is exciting, says retinal degeneration researcher Michael Danciger of Loyola Marymount University in Los Angeles, but the experiment might not mimic the degeneration that occurs in age-related MD. Follow-up experiments should probe whether Epo protects eyes in a mouse version of MD, he says. That line of inquiry could help bring Epo's vision-protecting potential into focus. --R. John Davenport; suggested by Amir Sadighi Akha C. Grimm, A. Wenzel, M. Groszer, H. Mayser, M. Seeliger, M. Samardzija, C. Bauer, M. Gassmann, C. E. Remé, HIF-1-induced erythropoietin in the hypoxic retina protects against light-induced retinal degeneration. Nat. Med . 8 , 718-724 (2002). [Abstract] [Full Text]

Binocular vision in older people with adventitious visual impairment: sometimes one eye is better than two.

To determine the effect of adventitious visual impairment (low vision) on monocular and binocular spatial contrast sensitivity of older people. A between-within repeated measures design. Fifty-nine older adults between the ages of 50 and 96; 49 of the observers had age-related macular degeneration (AMD). Visual acuity screening and spatial contrast sensitivity. In almost half of the population with AMD, the sensitivity to spatial information, as measured by spatial contrast sensitivity, is worse when both eyes are used than when the stimuli are viewed with only one eye. This "binocular inhibition" is not related to the contrast sensitivity of the better eye or to acuities. Furthermore, this inhibition process is reflected primarily in images with medium to low spatial frequency components (medium to large size bars). These results have important implications for understanding the functional impact of low vision in older people. They suggest that almost one-half of older people with AMD view the world best using only one of their eyes, whereas for the other half, there is an advantage to using binocular vision for certain visual tasks.

Hearing and Vision in Healthy Older Australians: Objective and Self-Report Measures

The full extent of hearing and vision impairments in older Australians and their effects on communication is not well known. The aims of the present study were to (1) determine the prevalence of hearing and vision impairments in a sample of older Australians, (2) investigate the nature of hearing and vision difficulties experienced in everyday life, and (3) compare the results obtained using objective and self-report assessments. The prevalence of hearing and vision impairments were 57% and 28%, respectively, while 19% of participants had a dual sensory loss. More participants reported vision difficulties (35%) than had a measured impairment, whereas the percentage of participants who reported hearing difficulties (55%) was similar to the prevalence of objectively measured hearing impairment. However, there was extensive 'mismatching' in that participants reporting difficulty were frequently not those who had objectively measured impairment. The finding that approximately one in five older Australians has a dual sensory loss highlights the need to assess both hearing and vision in older people in order to provide appropriate rehabilitation. The results also indicate that these sensory conditions should be evaluated both objectively and subjectively in order to obtain accurate and complete information about an individual's performance.