Diabetic Retinopathy during pregnancy in Hispanic women with latent Toxoplasma gondii infection.

BACKGROUND: Retinal photography was performed in pregnancy and postpartum in pregnant Hispanic women with latent Toxoplasma gondii (TG) infection in order to screen for characteristic retinal lesions or the particular scars found in people with active T. gondii infection. A comparison group of TG negative women was included in the study but they did not have retinal photography. OBJECTIVE: The goal of the parent study was to assess for adverse pregnancy events and evidence for parasite reactivation in TG positive (TG + ) women, through examination of the eyes for characteristic lesions. Retinal photography, usually at prenatal visits 2 (17 +/- 3.35 weeks) and 3 (26.3+/-1.75) weeks, was done on TG + women. Fifty-six of these women also (43 %) had retinal photography at the postpartum visit. Health and demographic data were obtained at the first prenatal visit for all women. STUDY DESIGN: From the 690 recruited at the first prenatal visit, 128 TG- women and 158 TG + women were enrolled in a prospective study through pregnancy and the postpartum. All TG- women (n = 532) provided data at the first prenatal visit and throughout their pregnancy and birth through the EHR. This allowed comparison of health and outcome data for the TG + compared to a larger number of TG- Hispanic pregnant women. RESULTS: While there was no evidence of ocular toxoplasmosis during pregnancy, there was a surprisingly large number (42 %) of TG + women with diabetic retinopathy (DR). We also observed that TG + women had a 20 % incidence of gestational diabetes mellitus (GDM) compared to 11.3 % in the TG- women (p = 0.01). At postpartum (mean 5.6 weeks), 23 of 30 women with pregnancy DR showed no DR in the postpartum. CONCLUSIONS: No characteristic T. gondii lesions were discovered. Retinal photography serendipitously revealed DR in these T. gondii positive women. It was also found that latent TG infection was associated with increased incidence of GDM. Hispanic pregnant women's increased risk for latent TG infection, GDM and DR are underappreciated. Retinal photography may need to be considered an innovative approach to screening.

Low rates of eye care utilization among visually impaired subsidized senior housing residents.

OBJECTIVE: To examine the rate of self-reported vision impairment, eye disease, and eye care utilization among residents of subsidized senior housing (SSH) communities. METHODS: In this cross-sectional, observational study, residents of 14 SSH communities in Jefferson County, AL, USA self-reported their vision status and eye care utilization as part of vision screening events held in their community. RESULTS: Two hundred and thirty-seven residents self-reported their vision status, presence of eye disease, and eye care utilization. A third of participants (33.3%) reported difficulty with distance vision while 38% reported difficulty with near vision. Rates of eye disease among this sample were as follows: 40.3% reported having cataracts, 13.6% reported having glaucoma, 4.2% reported having age-related macular degeneration, and 5.5% reported having diabetic retinopathy. The majority of participants (52.8%) had not been to see an eye care provider within the last year. Persons with vision impairment were less likely to report having seen an eye care provider within the last year than those without impairment (p = .03). CONCLUSION: This study illuminates the low utilization of eye care among socioeconomically disadvantaged older adults residing in SSH, especially among those with vision impairment and eye disease. Vision-related health care is important in maintaining both physical and mental health in older adults.

Features and usability assessment of a patient-centered mobile application (HeartMapp) for self-management of heart failure.

BACKGROUND: Mobile health technologies have emerged as a way to actively engage patients in their healthcare decision-making process. One who is well informed and motivated is thought to engage in self-management activities. Thus, the conceptual framework included "information, motivation, and behavioral change" model, with patient engagement as a mediator in the development and assessment of a mobile health application "HeartMapp" for chronic heart failure (CHF) self-management. PURPOSE: To describe the development and features of the HeartMapp and preliminary assessment of the usability of HeartMapp. METHOD: A descriptive survey design was employed. A total of 37 participants (25 patients with CHF and 12 health care workers) navigated the HeartMapp and completed self-confidence and usability questionnaires. RESULTS: More than half of the patients used mobile phones to obtain health information. Patients reported moderate self-confidence (mean 26.60±12.18) in using HeartMapp. One in five patients reported a lack of confidence in using the chest-worn Bluetooth device. The observational data indicated that all patients completed the task of navigating the HeartMapp with little or no help. The health care members (n=12) demonstrated high confidence in recommending HeartMapp to patients (mean 4.58±0.67) and in utilizing data from HeartMapp for clinical decision making (mean 4.50±0.67). The self-confidence and usability questionnaires showed good reliability in this sample. CONCLUSION: Having access to CHF symptom monitoring and education readily available in a mobile app may motivate individuals to engage in the prescribed self-management skills to ultimately attain desired outcomes, which warrants further exploration.

Patterns of Disruptive Feeding Behaviors in Infants With Neonatal Abstinence Syndrome.

BACKGROUND: Severe irritability in infants with neonatal abstinence syndrome often impacts their ability to feed successfully, which challenges a mother's ability to demonstrate this most basic parenting skill. There is little empiric evidence to guide recommendations for practice in this population. PURPOSE: Describe the infant behaviors that disrupt feeding in infants with neonatal abstinence syndrome. METHODS: A mixed-method approach was used to describe digitally recorded infant feeding behaviors. Qualitative methodology was first used to identify categories of behaviors during the feeding. The categories were used as a coding scheme to identify the temporal sequence, duration, and frequency of behaviors observed during a feeding. RESULTS: The behavior categories that disrupted feeding were identified as fussing, resting, crying, and sleeping/sedated. Infants spent almost twice as much time in fussing as in feeding. The majority of the infants were fussing between 1 and 11 minutes during the feeding, and fussing disrupted feeding in every subject at least once. Feeding behavior occurred only 24% of the time, while fussing and crying occurred 51%. Fussing was the primary transitional behavior from one category to another. Infants who did not complete their feeding had nearly twice the mean number of fussing episodes as those who completed their feeding. IMPLICATIONS FOR PRACTICE: Fussing is a transitional state and appears to provide an opportunity to test interventions that help the mothers re-engage their infants in feeding. The frequency of the behavioral transitions provides a measure of irritability that has not been previously described in this population. IMPLICATIONS FOR RESEARCH: Additional study is needed to evaluate the impact and contributions of maternal behaviors and external variables on infant behavioral transition.

Vision Impairment Among Older Adults Residing in Subsidized Housing Communities.

PURPOSE OF THE STUDY: To examine the rate of vision impairment and the relationship between vision impairment, cognitive impairment, and chronic comorbid conditions in residents of federally subsidized senior housing facilities. DESIGN: Cross-sectional, observational study. METHODS: Vision screening events were held at 14 subsidized senior housing facilities in Jefferson County, Alabama for residents aged 60 years and older. Visual function (distance vision, near vision, and contrast sensitivity) measured with habitual correction if worn, cognitive status, and chronic comorbid conditions (hypertension, heart problems, circulation problems, and diabetes) were assessed. RESULTS: A total of 238 residents participated in the vision screenings. Most residents (75%) were African American. Vision impairment was common, with 40% of participants failing the distance acuity screening and 58% failing the near acuity screening; failure was defined as vision worse than 20/40 in either eye. Additionally, 65% failed the contrast sensitivity screening. A total of 30.6% of seniors had cognitive impairment. Regarding comorbid chronic conditions, 31% had circulation problems, 39% had diabetes, 41% had heart problems, and 76% had hypertension (59% had 2 or more of these). Visual acuity differed significantly between cognitive status groups and with the presence of heart and circulation problems. IMPLICATIONS: This study is among the first to provide information about vision impairment in this socioeconomically disadvantaged group of older adults. Vision impairment was common. Cognitive impairment and comorbid chronic conditions accounted for a small to moderate percentage of the variance in distance vision, near vision, and contrast sensitivity. Future studies should focus on strategies to facilitate access to eye care in this vulnerable population.

Cognitive screening in persons with chronic diseases in primary care: challenges and recommendations for practice.

An integrative literature review was performed to identify the challenges in current cognitive screening. The aim of the review was to serve as an evaluative resource to guide clinicians in the selection of the best available cognitive screening measures for early assessment of mild cognitive impairment (MCI) in people with chronic diseases. The review classified the available cognitive screening measures according to purpose, time to administer, and cognitive domains assessed as: 1) simple/ brief cognitive screening measures, 2) disease specific screening measures, 3) domain specific screening measures, 4) self-administered screening measures, and 5) technology-based screening measures. There is no single optimal cognitive measure for all patient populations and settings. Although disease specific cognitive screening measures are optimal, there is a lack of validated screening measures for many chronic diseases. Technology-based screening measure is a promising avenue for increasing the accessibility of cognitive screening. Future work should focus on translating available screening measures to mobile technology format to enhance the utility in busy primary care settings. Early cognitive screening in persons with chronic disease should enhance appropriate referrals for detailed neurocognitive examination and cognitive interventions to preserve and or minimize cognitive decline.

Cognitive speed of processing training in older adults with visual impairments.

PURPOSE: To examine whether older adults with vision impairment differentially benefit from cognitive speed of processing training (SPT) relative to healthy older adults. METHODS: Secondary data analyses were conducted from a randomised trial on the effects of SPT among older adults. The effects of vision impairment as indicated by (1) near visual acuity, (2) contrast sensitivity, (3) self-reported cataracts and (4) self-reported other eye conditions (e.g., glaucoma, macular degeneration, diabetic retinopathy, optic neuritis, and retinopathy) among participants randomised to either SPT or a social- and computer-contact control group was assessed. The primary outcome was Useful Field of View Test (UFOV) performance. RESULTS: Mixed repeated-measures ancovas demonstrated that those randomized to SPT experienced greater baseline to post-test improvements in UFOV performance relative to controls (p's < 0.001), regardless of impairments in near visual acuity, contrast sensitivity or presence of cataracts. Those with other eye conditions significantly benefitted from training (p = 0.044), but to a lesser degree than those without such conditions. Covariates included age and baseline measures of balance and depressive symptoms, which were significantly correlated with baseline UFOV performance. CONCLUSIONS: Among a community-based sample of older adults with and without visual impairment and eye disease, the SPT intervention was effective in enhancing participants' UFOV performance. The analyses presented here indicate the potential for SPT to enhance UFOV performance among a community-based sample of older adults with visual impairment and potentially for some with self-reported eye disease; further research to explore this area is warranted, particularly to determine the effects of eye diseases on SPT benefits.

Vision impairment among older adults residing in assisted living.

OBJECTIVE: To examine rates of visual impairment of older adults in assisted living facilities (ALFs). METHODS: Vision screening events were held at 12 ALFs in Jefferson County, Alabama, for residents above 60 years of age. Visual acuity, cognitive status, and presence of eye conditions were assessed. RESULTS: A total of 144 residents were screened. Of these 67.8% failed distance screening, 70.9% failed near screening, and 89.3% failed contrast sensitivity screening. A total of 40.4% of residents had cognitive impairment and 89% had a least one diagnosed eye condition. Visual acuities did not differ significantly between cognitive status groups or with greater numbers of eye conditions. DISCUSSION: This study is the first to provide information about vision impairment in the assisted living population. Of those screened, 70% had visual acuity worse than 20/40 for distance or near vision, and 90% had impaired contrast sensitivity. Cognitive impairment accounted for a small percentage of the variance in near vision and contrast sensitivity.

The variability of vision loss assessment in federally sponsored surveys: seeking conceptual clarity and comparability.

PURPOSE: To review U.S. national population-based surveys to evaluate comparability and conceptual clarity of vision measures. DESIGN: Perspective. METHODS: The vision questions in 12 surveys were mapped to the World Health Organization's International Classification of Functioning, Disability and Health framework under the domains of condition, impairment, activity limitation, participation, and environment. Surveys examined include the National Health Interview Survey, the Behavioral Risk Factor Surveillance Survey, National Health and Nutrition Examination Survey, the Census, and the Visual Function Questionnaire. RESULTS: Nearly 100 vision measures were identified in 12 surveys. These surveys provided no consistent measure of vision or vision impairment. Survey questions asked about differing characteristics of vision-related disease, function, and social roles. A question related to ability to read newspaper print was the most commonly asked question in surveys. CONCLUSIONS: Limited comparability of data and lack of conceptual clarity in the population-based surveys resulted in an inability to consistently characterize the population of people experiencing vision impairment. Consequently, vision surveillance was limited.

Disparities in eye care utilization among the United States adults with visual impairment: findings from the behavioral risk factor surveillance system 2006-2009.

PURPOSE: To estimate the prevalence of annual eye care among visually impaired United States residents aged 40 years or older, by state, race/ethnicity, education, and annual income. DESIGN: Cross-sectional study. METHODS: In analyses of 2006-2009 Behavioral Risk Factor Surveillance System data from 21 states, we used multivariate regression to estimate the state-level prevalence of yearly eye doctor visit in the study population by race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and other), annual income (≥$35,000 and <$35,000), and education (< high school, high school, and > high school). RESULTS: The age-adjusted state-level prevalence of yearly eye doctor visits ranged from 48% (Missouri) to 69% (Maryland). In Alabama, Colorado, Indiana, Iowa, New Mexico, and North Carolina, the prevalence was significantly higher among respondents with more than a high school education than among those with a high school education or less (P < .05). The prevalence was positively associated with annual income levels in Alabama, Georgia, New Mexico, New York, Texas, and West Virginia and negatively associated with annual income levels in Massachusetts. After controlling for age, sex, race/ethnicity, education, and income, we also found significant disparities in the prevalence of yearly eye doctor visits among states. CONCLUSION: Among visually impaired US residents aged 40 or older, the prevalence of yearly eye examinations varied significantly by race/ethnicity, income, and education, both overall and within states. Continued and possibly enhanced collection of eye care utilization data, such as we analyzed here, may help states address disparities in vision health and identify population groups most in need of intervention programs.

Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States.

PURPOSE: To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. DESIGN: Perspective, comparing systems. METHODS: We describe 3 currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. RESULTS: Each of the 3 sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. CONCLUSIONS: Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented.

Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys.

PURPOSE: To assess vision health disparities in the United States by race/ethnicity, education, and economic status. DESIGN: Cross-sectional, nationally representative samples. METHODS: We used national survey data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). Main outcome measures included, from NHANES, age-related eye diseases (ie, age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], glaucoma) and from NHIS, eye care use (ie, eye doctor visits and cannot afford eyeglasses when needed) among those with self-reported visual impairment. The estimates were age- and sex-standardized to the 2000 US Census population. Linear trends in the estimates were assessed by weighted least squares regression. RESULTS: Non-Hispanic whites had a higher prevalence of AMD and cataract surgery than non-Hispanic blacks, but a lower prevalence of DR and glaucoma (all P < .001 in NHANES 2005-2008). From 1999 to 2008, individuals with less education (ie, high school) and lower income (poverty income ratio [PIR] <1.00 vs ≥ 4.00) were consistently less likely to have had an eye care visit in the past 12 months compared with their counterparts (all P < .05). During this period, inability to afford needed eyeglasses increased among non-Hispanic whites and Hispanics (trend P = .004 and P = .007; respectively), those with high school education (trend P = .036), and those with PIR 1.00-1.99 (trend P < .001). CONCLUSIONS: Observed vision health disparities suggest a need for educational and innovative interventions among socioeconomically disadvantaged groups.

Visual impairment and health-related quality of life among elderly adults with age-related eye diseases.

PURPOSE: To examine the association between age-related eye disease (ARED), visual impairment, and health-related quality of life (HRQOL). METHODS: We used data from the 2006 and 2008 Behavioral Risk Factor Surveillance System to examine self-reported visual impairment and two HRQOL domains-physical impairment (including poor general health, physical unhealthy days, activity-limitation days, and disability) and mental distress (including mental unhealthy days, life dissatisfaction, major depression, lifetime depression, and anxiety) for people aged 65 years or older, by ARED status. RESULTS: People with any ARED were more likely than those without to report visual impairment as well as physical impairment and mental distress. The prevalence of visual impairment (P trend <0.001) and physical impairment (P trend <0.001) increased with increasing number of eye diseases after controlling for all covariates. There was no significant linear trend, however, in mental distress among people with one or more eye diseases. CONCLUSION: ARED was found to be associated with visual impairment and poorer HRQOL. Increasing numbers of AREDs were associated with increased levels of visual impairment and physical impairment, but were not associated with levels of mental distress.

The personal burden of decreased vision-targeted health-related quality of life in nursing home residents.

OBJECTIVE: To present the bother subscales of the Nursing Home Vision-Targeted Health-Related Quality of Life Questionnaire (NHVQoL) and to examine their relationship to the original NHVQoL subscales and objective measures of visual function. METHOD: 395 nursing home residents completed the bother subscales. Associations between bother subscales and original subscales and objectively measured vision were evaluated. RESULTS: Mean bother scores ranged from 1.97 to 2.30, reflecting an average rating of "a little" bother. For 20 NHVQoL items, more than 50% of participants reported "a lot" of bother. All NHVQoL original subscale scores were moderately correlated with bother subscales (p < .0001). Bother subscales and visual acuity were not highly correlated. DISCUSSION: Nursing home residents are bothered by reductions in vision-targeted health-related quality of life. The NHVQoL bother subscales may probe the personal burden of visual problems in this population that is not captured by the original subscales or objectively measuring visual function.

Enhancing caregiver health: findings from the resources for enhancing Alzheimer's caregiver health II intervention.

OBJECTIVES: To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother. DESIGN: Randomized, multisite clinical trial. SETTING: CG and care recipient (CR) homes in five U.S. cities. PARTICIPANTS: Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls. INTERVENTION: CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief "check-in" telephone calls during this 6-month period. MEASUREMENTS: The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention. RESULTS: After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race. CONCLUSION: A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.

The nursing home minimum data set for vision and its association with visual acuity and contrast sensitivity.

OBJECTIVES: To evaluate the association between the Minimum Data Set's (MDS) Vision Patterns section and near and distance visual acuity and contrast sensitivity in nursing home residents. DESIGN: Cross-sectional study. SETTING: Seventeen nursing homes in the Birmingham, Alabama, area. PARTICIPANTS: Three hundred seventy-one nursing home residents aged 55 and older with Mini-Mental State Examination scores of 13 or greater. MEASUREMENTS: The MDS 2.0 assessment for vision from the date closest to acuity and contrast sensitivity assessment were obtained from the resident's medical record. Acuity and contrast sensitivity were measured using the ETDRS chart and Pelli-Robson chart, respectively. RESULTS: The MDS rating of visual status was associated with distance and near visual acuity and contrast sensitivity. The MDS performed poorly in distinguishing residents with mild visual impairment from those with moderate visual impairment. For residents who were rated on the MDS as having adequate vision, 45.9% had distance acuity worse than 20/40 in the better eye, 72.8% had near acuity worse than 20/40 in the better eye, and 85.8% had contrast sensitivity less than 1.50. CONCLUSION: The MDS 2.0 assessment for vision in nursing home residents is positively associated with visual acuity and contrast sensitivity but does not adequately distinguish between individuals with mild and moderate visual impairment and classifies many as having adequate vision who have visual impairment. The validity of the MDS 2.0 as a mechanism for triggering comprehensive eye care for nursing home residents is questionable.

Vision-enhancing interventions in nursing home residents and their short-term effect on physical and cognitive function.

OBJECTIVES: To evaluate the effect of vision-enhancing interventions (cataract surgery or refractive error correction) on physical function and cognitive status in nursing home residents. DESIGN: Longitudinal cohort study. SETTING: Seventeen nursing homes in Birmingham, Alabama. PARTICIPANTS: A total of 187 English-speaking adults aged 55 and older. INTERVENTION: Participants took part in one of two vision-enhancing interventions: cataract surgery or refractive error correction. Each group was compared against a control group (persons eligible for but who declined cataract surgery or who received delayed correction of refractive error). MEASUREMENTS: Physical function (ability to perform activities of daily living and mobility) was assessed using a series of self-report and certified nursing assistant ratings at baseline and at 2 months for the refractive error correction group and at 4 months for the cataract surgery group. The Mini Mental State Examination was also administered. RESULTS: No significant differences existed within or between groups from baseline to follow-up on any of the measures of physical function. Mental status scores significantly declined from baseline to follow-up for the immediate (P=.05) and delayed (P<.02) refractive error correction groups and for the cataract surgery control group (P=.05). CONCLUSION: Vision-enhancing interventions did not lead to short-term improvements in physical functioning or cognitive status in this sample of elderly nursing home residents.

Pain assessment in persons with dementia: relationship between self-report and behavioral observation.

OBJECTIVES: To investigate the relationship between self-report and behavioral indicators of pain in cognitively impaired and intact older adults. DESIGN: Quasi-experimental, correlational study of older adults. SETTING: Data were collected from residents of nursing homes, assisted living, and retirement apartments in north-central Florida. PARTICIPANTS: One hundred twenty-six adults, mean age 83; 64 cognitively intact, 62 cognitively impaired. MEASUREMENTS: Pain interviews (pain presence, intensity, locations, duration), pain behavior measure, Mini-Mental State Examination, analgesic medications, and demographic characteristics. Participants completed an activity-based protocol to induce pain. RESULTS: Eighty-six percent self-reported regular pain. Controlling for analgesics, cognitively impaired participants reported less pain than cognitively intact participants after movement but not at rest. Behavioral pain indicators did not differ between cognitively intact and impaired participants. Total number of pain behaviors was significantly related to self-reported pain intensity (beta=0.40, P=.000) in cognitively intact elderly people. CONCLUSION: Cognitively impaired elderly people self-report less pain than cognitively intact elderly people, independent of analgesics, but only when assessed after movement. Behavioral pain indicators do not differ between the groups. The relationship between self-report and pain behaviors supports the validity of behavioral assessments in this population. These findings support the use of multidimensional pain assessment in persons with dementia.

Association between the Nursing Home Minimum Data Set for Vision and Vision-Targeted Health-Related Quality of Life in Nursing Home Residents As Assessed by Certified Nursing Assistants.

PURPOSE: The purpose of this study was to evaluate the association between the federally mandated Minimum Data Set (MDS) Vision Patterns assessment for nursing home residents in the United States and an assessment of their vision-targeted quality of life as assessed by certified nursing assistants (CNAs). METHODS: Participants were 371 residents over the age of 55 from 17 nursing homes in the Birmingham, Alabama metropolitan area and the CNAs directly assigned to their care. CNAs assessed the vision-targeted quality of life of residents in their charge using the Nursing Home Vision-Targeted Health-Related Quality of Life (NHVQoL) questionnaire. MDS assessment categories assigned to each resident by the MDS nurse coordinator ("adequate", "impaired", "moderately impaired", "highly impaired", "severely impaired") were obtained from the medical record. Visual acuity was measured using logMAR charts by trained research staff. RESULTS: CNA rated NHVQoL subscale scores decreased as the MDS rating indicated more vision impairment (all P's for trend < 0.05). Almost all mean scores were in the 80s and 90s for those in the adequate, impaired, and moderately impaired categories. For those with MDS ratings of severely or highly impaired, NHVQoL subscale scores (except ocular symptoms) were dramatically lower (P ≤ 0.001) than those rated as moderately impaired. CONCLUSIONS: Ratings by CNAs on the vision-targeted quality of life of nursing home residents under their care is in general agreement with the MDS category assigned by the nurse coordinator. However, CNA ratings are largely homogeneous in the adequate vision to moderately impaired categories.