ABSTRACT
This study examined the association between varying levels of visual acuity (VA) and physical performance (Short Physical Performance Battery) in older adults. A cross-sectional analysis of participants aged ≥50 years with a clinical diagnosis of vision loss across two studies was undertaken. Of 434 (96%) participants with available VA data, 74% (320/434) had nil, 7% (32/434) had mild, 8% (33/434) had moderate, and 11% (49/434) had severe visual impairment. Poorer VA of both better and worse eye was found to be significantly associated with poorer standing balance (p = .006 and p = .004, respectively); worse VA of the better eye was significantly associated with increased number of steps per meter (p = .005). Mean total Short Physical Performance Battery score of this study population was lower than published normative data for this age group. Physical activity programs for older people with reduced VA should be targeted at improving balance and gait skills to reduce falls risk.
ABSTRACT
BACKGROUND: The patient pathway to cataract surgery in Australia generally begins with optometric services; however, little is known about the cataract surgery referral criteria used by optometrists in Australia. METHODS: Members of Optometrists Association Australia were invited to complete an online survey in April 2013. The survey elicited information on practice demographics, professional characteristics of optometrists and cataract surgery referral considerations. RESULTS: We received responses from 533 of 4272 (13 per cent) practising optometrists. Over three-quarters (407 of 528, 77 per cent) indicated a visual acuity (VA) cataract referral benchmark of 6/9 to 6/12. Almost all respondents (499 out of 532, 94 per cent) stated they included glare sensitivity as part of their referral criteria, whereas a considerably lower proportion (40 of 528, eight per cent) used contrast sensitivity testing. Patient-centred factors such as hobbies (94 per cent) and driving (73 per cent) featured in the decision to refer patients sooner, while a patient not wanting surgery (79 per cent) was the most frequent reason cited for delaying referral. Respondents practising in more advantaged socioeconomic areas were 2.4 times more likely to refer privately (95% CI 1.6-3.6) and less likely to consider surgical costs as an important consideration (p < 0.001). Almost all respondents (97 per cent) who referred publicly discussed public hospital waiting times with their patients (median minimum wait estimate of 12 to 18 months), compared to the smaller proportion (64 per cent) of respondents discussing private waiting times (median minimum wait estimate of one to two months). CONCLUSION: While modest reductions in VA were sufficient to prompt referral for cataract surgery by Australian optometrists, patient-reported visual disability guided the optometrist's overall referral decision. Socioeconomic status of practice location influenced the choice to refer publicly versus privately and surgical costs were also considered.
