Environmental Features Contributing to Falls in Persons With Vision Impairment: The Role of Home Lighting and Home Hazards.

PURPOSE: To evaluate whether home hazards and lighting levels are associated with higher fall rates in adults with varying degrees of visual field (VF) damage from glaucoma. METHODS: Participants with diagnosed or suspected glaucoma provided three years of prospective falls data via monthly falls diaries. A post-fall telephone questionnaire determined fall locations. Seven home areas were evaluated for hazards and lighting via an in-home assessment. Multivariate models adjusting for relevant confounders, including age, sex, comorbidity, and severity of VF damage, evaluated the influence of hazards and lighting on fall rates in each home region. RESULTS: Mean baseline age for the 170 participants was 71.0 (7.6) years and 78 (46%) of participants were female. Fifty-nine participants experienced a total of 83 home falls, with the greatest number of falls occurring on the indoor stairs (n = 24, 29%) and bedroom (n = 17, 21%). Neither the number nor the percentage of hazardous items graded as hazardous was associated with the rate of falls (P > .26). Each 10-fold increase in room lighting was associated with 35% fewer falls in that home region (P = .02). The relation between lighting and the rate of falls did not differ with the degree of visual field damage (P > .3), and a lower fall rate was noted with better lighting even in participants with mild or no VF damage (rate ratio = 0.52/10-fold better lighting; P = 0.01). CONCLUSIONS: Fewer home falls were found with better lighting, but not with fewer home hazards. Lighting improvements at home may reduce fall rates in older adults. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Increased choroidal thickness in patients with Sturge-Weber syndrome.

IMPORTANCE: With the recent development of enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT), it is now possible to measure choroidal thickness in patients with Sturge-Weber syndrome and detect abnormalities that are not visible as part of the fundus examination. OBSERVATIONS: We were successful in imaging at least 1 eye in 12 individuals with Sturge-Weber syndrome using enhanced depth imaging SD-OCT. Eyes were defined as affected if they manifested at least one of the following: darkened choroid, glaucomatous optic nerve damage, or conjunctival hyperemia. None of the participants had a clinically visible choroidal hemangioma. The affected eyes had over twice the choroidal thickness of the unaffected eyes (mean [SD], 697 [337] µm vs 331 [94] µm; P = .004, determined by use of an unpaired t test). For the 6 unilaterally affected participants who had both eyes imaged, the choroidal thickness was greater in the affected eyes than in the unaffected eyes of 5 participants (mean [SD], 672 [311] µm vs 329 [88] µm; P = .01, determined by use of a paired t test). CONCLUSIONS AND RELEVANCE: The advent of enhanced depth imaging SD-OCT has allowed us to quantify choroidal thickness in the posterior pole, even in eyes with a markedly thickened choroid, such as those found in individuals with Sturge-Weber syndrome. Spectral-domain OCT has a much higher resolution (5-10 µm) than B-scan ultrasonography (150 µm) and can be used to distinguish between the retina and the choroid. Furthermore, enhanced depth imaging SD-OCT can detect choroidal thickness in eyes without clinically apparent choroidal abnormalities.

Preferences for eye drop characteristics among glaucoma specialists: a willingness-to-pay analysis.

PURPOSE: To determine the importance that US glaucoma specialists place on attributes of eye drops for lowering intraocular pressure. MATERIALS AND METHODS: We performed a cross-sectional survey by conducting a telephone interview with 113 members of the American Glaucoma Society. We administered a willingness-to-pay (WTP) instrument asking glaucoma specialists how much they would pay to obtain particular characteristics in an eye drop. Demographic data were correlated with the WTP responses. We compared the glaucoma specialists' responses to those previously obtained from patients. The main outcome measure was willingness-to-pay more (in US dollars). RESULTS: Almost all respondents were willing to pay extra to reduce the frequency of administration of eye drops from 3 times a day to once a day, and to avoid blurred vision, drowsiness, or inhibition of sexual performance. Only 54 (48%) were willing to pay more to avoid iris darkening. The mean amount that respondents were willing to pay (relative to US 50 dollars) differed significantly across eye drop characteristics (P < 0.001). The mean amount that the respondents were willing to pay was highest for avoidance of inhibition of sexual performance (US 105 dollars), blurred vision (US 92 dollars), and drowsiness (US 92 dollars). When compared with glaucoma and glaucoma suspect patients, more ophthalmologists were likely to pay extra for desirable eye drop attributes. However, the magnitude of the extra amount was similar between ophthalmologists and patients. CONCLUSIONS: Glaucoma specialists place differing value on various eye drop characteristics. Although the proportion of glaucoma specialists willing to pay more is generally greater than the proportion of patients, the preferences of glaucoma specialists and patients are alike.

Patient preferences for eye drop characteristics: a willingness-to-pay analysis.

OBJECTIVE: To determine the importance that patients place on the characteristics of topical therapy for lowering intraocular pressure. METHODS: We administered a willingness-to-pay instrument to 230 patients from 4 glaucoma subspecialty practices, asking them how much they would be willing to pay to obtain particular characteristics in an eye drop. Data about the subjects' demographics, economic status, attitudes toward eye drops and systemic medications, and symptoms from eye drops were correlated with their willingness to pay using 2-part models. RESULTS: Of our subjects, 169 (77%) were using eye drops to lower their intraocular pressure. Fatigue, blurred vision, and tearing were the most commonly reported symptoms. Eye drop medications most valued by the subjects did not produce blurring, drowsiness, or inhibition of sexual performance; 85% were willing to pay more for an eye drop that did not cause blurring, and on average they were willing to pay 40% more. Higher educational levels and income were generally associated with a willingness to pay more for eye drops with desirable attributes. MAIN OUTCOME MEASURE: Willingness to pay more (in dollars). CONCLUSIONS: Patient preferences for eye drop characteristics can be assessed using a willingness-to-pay instrument. Patients place differing value on various eye drop characteristics. A better understanding of patient preference could lead to better compliance.