Depressive symptoms in people with vision impairment: a cross-sectional study to identify who is most at risk.

OBJECTIVE: To identify the risk factors for significant depressive symptoms in people with visual impairment in England and Wales to provide information on who is most at risk and to whom support services could be targeted in future. DESIGN: A cross-sectional study using baseline data from a pragmatic randomised controlled trial. SETTING AND PARTICIPANTS: 990 participants aged 18 or over attending 1 of 14 low-vision rehabilitation primary care optometry-based clinics in South Wales or two hospital clinics in London. OUTCOME MEASURE: A score of ≥6 on the Geriatric Depression Scale-15 was classed as clinically significant depressive symptoms. RESULTS: In a multivariable logistic regression model, significant depressive symptoms were associated with age (adjusted OR (AOR)=0.82, 95% CI: 0.66 to 0.90, p<0.001), ethnicity (AOR non-white compared with white=1.72, 95% CI: 1.05 to 2.81, p=0.031), total number of eye conditions (AOR for two vs one condition=0.98, 95% CI: 0.67 to 1.43; three or more vs one condition=0.34, 95% CI: 0.15 to 0.75, p=0.026), self-reported health (AOR for excellent vs poor=0.01, 95% CI: 0.00 to 0.12; very good vs poor=0.06, 95% CI: 0.03 to 0.13; good vs poor=0.14, 95% CI: 0.08 to 0.24; fair vs poor=0.28, 95% CI: 0.18 to 0.46, p<0.001) and self-reported visual functioning (AOR=1.45, 95% CI: 1.31 to 1.61, p<0.001). CONCLUSION: Younger age, a non-white ethnicity, fewer eye conditions and poorer self-reported health and visual function are risk factors for significant depressive symptoms in this population. TRIAL REGISTRATION NUMBER: ISRCTN46824140; Pre-results.

The impact of ocular manifestations of rheumatoid arthritis on the health-related quality of life and the functional ability of black Africans.

Objectives To determine the patterns, predictors and overall impact of ocular manifestations of rheumatoid arthritis (RA) on the health-related quality of life and disability index. METHODS: A total of 50 Nigerian patients with RA were studied. Full ocular evaluation was done to determine the presence of each defined ocular manifestation of RA. All patients completed the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires. RESULTS: The mean ± SD age of the patients was 47.2 ± 12.5 years. A total of 42 cases of ocular diseases were found in 23 (46%) patients. Keratoconjunctivitis sicca was found in 15 (30%) patients; cataract, 13 (26%); scleritis/episcleritis, 4 (8%); disk edema, 4 (8%); glaucoma, 3 (6%); ulcerative keratitis, 1 (2%); vitreitis, 1 (2%); and macula edema, 1 (2%) patient. There is an association of the presence of ocular manifestations with the physical component summary (PCS) [T = - 3.398, P = 0.001] and the mental component summary (MCS) [T = - 2.616, 0.012] of the SF-36 but not with the HAQ-DI (T = 1.685, 0.099). Following multiple regression analysis, the predictors of the presence of ocular manifestations were age greater than 45 years and positive anti-citrullinated protein antibody. Following linear regression analyses, Steinbrocker's functional class independently predicted the PCS while both Steinbrocker's functional class and female sex predicted the MCS. CONCLUSIONS: The development of ocular disorders associated with RA is associated with a significant negative impact on the quality of life of the patients.

Association of Vision Impairment and Major Eye Diseases With Mobility and Independence in a Chinese Population.

IMPORTANCE: Mobility limitations arising from vision impairment (VI) can result in loss of independence and reduced quality of life. However, few data are available on the association between VI and mobility limitations at a population-based level, particularly in Asian populations. OBJECTIVE: To assess the association of VI and major eye diseases with mobility and independence (M&I) in a Chinese population. DESIGN, SETTING, AND PARTICIPANTS: The Singapore Chinese Eye Study (February 9, 2009, to December 19, 2011) was a population-based, cross-sectional study of 3353 persons aged 40 to 80 years of Chinese ethnicity. Patients underwent visual acuity testing, and sociodemographic and medical data were collected from standardized questionnaires. Data analysis for this study was performed October 2015 to April 2016. EXPOSURES: Presenting bilateral visual acuity (categorized as none, moderate, or severe VI) and major eye diseases (cataract, uncorrected refractive error, glaucoma, age-related macular degeneration, and diabetic retinopathy). MAIN OUTCOMES AND MEASURES: Patients answered questions on the M&I scale of the Impact of Vision Impairment questionnaire, validated using Rasch analysis. The composite M&I score (score range, -4.47 to 7.48 logits; higher scores indicate better M&I) and 11 individual item scores were the main outcomes. The association between bilateral VI and eye conditions and the composite and individual M&I item scores was assessed using linear regression models. RESULTS: Of the 3353 patients, the mean (SD) age was 59.7 (9.9) years, and 1662 (49.6%) were male. The mean (SD) presenting visual acuity values in the better and worse eyes were 0.20 (0.21) and 0.39 (0.42) logMAR, respectively. A total of 1432 patients (42.7%) and 114 patients (3.4%) had moderate and severe bilateral VI, respectively. Mobility and independence systematically worsened as the severity of bilateral VI increased. There was a clinically meaningful reduction in M&I (20%; ß, -1.44; 95% CI, -1.75 to -1.13) and all 11 M&I tasks in patients with severe bilateral VI compared with no VI. Glaucoma (13%; ß, -0.94; 95% CI, -1.82 to -0.06) and cataract (6%; ß, -0.43; 95% CI, -0.65 to -0.22) were independently associated with worse M&I, with patients with glaucoma particularly concerned about avoiding falling or tripping. CONCLUSIONS AND RELEVANCE: Bilateral VI in this population was associated with substantial decrements in M&I, with glaucoma and cataract independently associated with worse M&I. Although these associations do not prove that preventing bilateral VI will improve M&I in this population, the results suggest that such interventions could be of tremendous value from this perspective.

Transplant related ocular surface disorders: Advanced techniques for ocular surface rehabilitation after ocular complications secondary to hematopoietic stem cell transplantation.

HSCT has been linked to the development of an assortment of ocular surface complications with the potential to lead to permanent visual impairment if left untreated or if not treated early in the course of disease. Strategies for therapy include maintenance of lubrication and tear preservation, prevention of evaporation, decreasing inflammation, and providing epithelial support. The ultimate aim of treatment is to prevent permanent ocular sequelae through prompt ophthalmology consultation and the use of advanced techniques for ocular surface rehabilitation. We describe several rehabilitation options of ocular surface complications occurring secondarily during the post-HSCT course.

Prevalence of visual hallucinations in a national low vision client population.

PURPOSE: To evaluate the prevalence of visual hallucinations (Charles Bonnet syndrome) in a national population undergoing vision rehabilitation. STUDY DESIGN: Cross-sectional survey. PARTICIPANTS: Participants were 2565 new clients older than 40 years attending a Canadian National Institute for the Blind (CNIB) vision rehabilitation clinic. METHODS: Participants were asked the following question: "Many people who come to CNIB tell us that they see things they know are not there. Some see patterns or shapes. Others see images of people or animals. Have you ever experienced this?" Responses were cross-tabulated on the basis of age, sex, eye disease, visual acuity, and whether the clients lived alone. Multivariable logistic regression was used to analyze the responses. RESULTS: Overall, 18.8% of people surveyed indicated that they had experienced hallucinations. In the multivariable model, females showed higher odds of hallucinations than males did (odds ratio [OR] 1.32, 95% CI 1.06-1.64, p = 0.02). Clients with greater vision loss had higher chances of experiencing hallucinations than those with the lowest level of vision loss (OR 1.49, 95% CI 1.19-1.88, p = 0.0005). There was no significant difference in the chances of experiencing hallucinations between people with age-related macular degeneration, diabetic retinopathy, and glaucoma, or in older versus younger respondents. People who did not live alone had higher chances of experiencing hallucinations than those who lived alone (OR 1.54, 95% CI 1.19-1.98, p = 0.0009). CONCLUSIONS: Visual hallucinations are experienced by approximately 1 in 5 patients with vision loss caused by any eye disease, warranting greater awareness of the phenomenon among all vision health professionals and their patients.

Keeping up appearances: the role of identity concealment in the workplace among adults with degenerative eye conditions and its relationship with wellbeing and career outcomes.

PURPOSE: This study aims to describe the interplay between the work trajectories and the passing patterns of individuals with degenerative eye conditions in different phases of their career, as well as the disease progression and the career and well-being outcomes associated with different works and passing trajectories. METHODS: Qualitative interviews on the topic of work trajectories were conducted with 36 working or retired individuals with degenerative eye conditions. The "bigger picture" method was used to explore passing and concealment behavioral patterns, and their associations with various work trajectories. RESULTS: Five patterns of passing and concealment behavior in the workplace were identified and were linked with various work trajectories among visually impaired study participants: (1) no career adjustments, concealed condition throughout career; (2) revealed condition after adjusting career plans; (3) increasingly open about their condition over the course of their career; (4) engaged in career planning, always open about their condition; and (5) engaged in limited career planning, always open about their condition. CONCLUSIONS: Patterns characterized by less planning and more identity concealment were associated with more stress and lower levels of self-acceptance, while patterns characterized by more planning for vision deterioration and less passing behavior were associated with higher levels self-acceptance and fewer obstacles over the course of an individual's career. The study's findings can serve as a guide for health professionals. IMPLICATIONS FOR REHABILITATION: Many individuals with degenerative eye conditions try to conceal their identity as visually impaired in the professional setting. Different aspects of career outcomes (e.g. age of retirement) and wellbeing outcomes (e.g. self-acceptance and stress) associate with identity concealment patterns of individuals throughout their careers. Identifying concealment patterns will allow health professionals to tackle particular adverse outcomes and challenges associated with these patterns.

Caso clínico: tortícolis muscular congénita secundaria a parálisis del iv par craneal unilateral / Case report: congenital muscular torticollis due to unilateral fourth nerve palsy

La tortícolis muscular es una deformidad que puede ser congénita o adquirida, caracterizada por una inclinación lateral de la cabeza al hombro, con torsión del cuello y desviación de la cara. La etiología es incierta, aunque se han desarrollado numerosas teorías. Si el diagnóstico es precoz, la tortícolis muscular congénita (TMC) se puede tratar conservadoramente, requiriendo cirugía en raras ocasiones. Presentamos el caso clínico de un paciente diagnosticado de TMC secundaria a parálisis del iv par craneal izquierdo, que fue diagnosticado después de 4 años tras varias exploraciones oftalmológicas sin hallazgos. Para llegar a un diagnóstico precoz es necesario hacer un buen diagnóstico diferencial (AU)

Muscular torticollis is a deformity that can be congenital or acquired and is characterised by lateral inclination of the head to the shoulder, with torsion of the neck and deviation of the face. The aetiology is uncertain, although many theories have been developed. If an early diagnosis is made, congenital muscular torticollis (CMT) can be treated conservatively and rarely requires surgery. We report the case of a 4-year-old boy diagnosed with CMT due to left fourth nerve palsy after several normal visual examinations. An appropriate differential diagnosis is essential to achieve an early diagnosis (AU)

The challenges of providing eye care for adults with intellectual disabilities.

This review is intended to raise awareness of the importance of providing high-quality eye care for people with intellectual disabilities and the increasing need for this eye care to be community-based. We describe the challenges to the provision of high-quality community-based eye care for people with intellectual disabilities and ideas, evidence and methods for overcoming them. The prevalence of visual impairment in people with intellectual disabilities has been reported to be at least 40 per cent, rising to as high as 100 per cent in those with profound and severe disabilities. A progressive move toward deinstitutionalisation has shifted the provision of care for people with intellectual disabilities. Individuals can have the freedom to access health-care services of their choice. This has posed challenges to the health-care system, including how to deliver high-quality community-based eye care, creating a current significant unmet need for eye-care services. Undiagnosed refractive error and under-prescription of spectacles are major reasons for avoidable visual impairment among people with disabilities. There is an apparent reluctance of optometrists to engage in this work due to the perceived difficulties of working with people with intellectual and multiple disabilities. There are challenges associated with diagnosis and management of ocular conditions in people with intellectual disabilities and the demand is clear. Small shifts in training, knowledge and awareness would place optometry well to meet the challenges of this specialised area of eye care.

[Suitable working conditions for elderly people with different degrees of compensation of dysfunctional blood circulation of eyes].

In dealing with complex problems in labor and social rehabilitation of elderly people with different degrees of compensation of dysfunctional blood circulation of eyes, a great role play methods of rational and qualitative analysis of appropriate employment. The analysis of 110 patients of 55-70 years of age (220 eyes) with dysfunctional blood circulation of eyes has been done. Professional abilities of elderly patients with dysfunctional blood circulation of eyes depend on the state of functioning vision and the level of blood circulation of the eye. In our study we show the clinical and prognostic data and based on that we could develop the absolutely prohibited working conditions depending on the level dysfunctional blood circulation of eyes of elderly people.

Prosthetic guidelines for ocular rehabilitation in patients with phthisis bulbi: a treatment-based classification system.

Prosthetic rehabilitation of phthisis bulbi defects is the only treatment option for cosmetic rehabilitation of patients with such defects. Currently, there is no treatment-based classification for prosthetic rehabilitation of patients with phthisis bulbi. Phthisical ocular defects and/or prosthetic rehabilitation were evaluated in an attempt to establish prosthetic guidelines that could be organized into a classification system. Fifty patients who received rehabilitation for phthisis bulbi were reviewed. Phthisis bulbi defects were divided into 4 classes. All the patients had rehabilitation, depending upon the class to which they were assigned. The aim of this treatment-oriented classification system was to organize and define the complex nature of the restorative decision-making process for patients with phthisis bulbi.

Ocular disorders among schoolchildren in Khartoum State, Sudan.

From December 2005 to June 2007, a total screening of all 1418 government primary schools in Khartoum State, Sudan, was performed to estimate ocular problems among children aged 6-15 years. We screened 671,119 children (56.7% males) for significant refractive error and other eye ailments. Ocular problems were found in 20,321 (3.03%) children. The 3 localities with highest ocular pathology were Karary (26.2%), Ummbada (21.0%) and Jabal Awlia (15.7%). The overall prevalence of refractive error was 2.19%. Myopia was found in 10,064 (1.50%) children while 4661 (0.70%) were hyperopic. Other ocular problems included vernal keratoconjunctivitis, vitamin A deficiency, microbial conjunctivitis, strabismus and corneal opacity. Only 288 (0.04%) children were diagnosed with active trachoma: 86.5% of these were from Ummbada locality, on the periphery ofthe State, where transportation facilities are poor and poverty is widespread. Overall, 99% of the eye ailments identified are either treatable or preventable. To reduce these and to achieve the goals of Vision 2020, an effective and efficient school health programme is needed.

Psychosocial impact on anophthalmic patients wearing ocular prosthesis.

The aim of this study was to assess the improvement in psychosocial awareness of anophthalmic patients wearing ocular prostheses and its relationship with demographic characteristics, factors of loss/treatment, social activity, and relationship between professional and patient. Surveys including a form for evaluation of psychosocial pattern were conducted with 40 anophthalmic patients rehabilitated with ocular prosthesis at the Center of Oral Oncology in the authors' dental school from January 1998 to November 2010. The improvement in psychosocial awareness was assessed by comparing the perception of some feelings reported in the period of eye loss and currently. Wilcoxon tests were applied for comparison of patients' perception between the periods. χ(2) tests were used to assess the relationship between the improvement in psychosocial awareness and the variables of the study. In addition, the logistic regression model measured this relationship with the measure of odds ratio. The feelings of shame, shyness, preoccupation with hiding it, sadness, insecurity and fear were significant for improvement in psychosocial awareness. It was concluded that the anophthalmic patients wearing an ocular prosthesis has significant improvement in psychosocial awareness after rehabilitation.

[Analysis of primary disability due to ophthalmic pathology in child population of the Amur region].

The state of health of child population is a constant care of ophthalmologists of the Amur region. Over the last few years the level of childhood disability due to ophthalmic pathology has decreased from 1.83 per ten thousand (1999) to 1.14 per ten thousand (2011) and, according to our prognosis, will continue to decrease down to 0.82 per ten thousand by 2014. The level of childhood disability in urban and rural areas was 1.17 per ten thousand and 1.06 per ten thousand correspondingly. Female to male proportion in primary disabled children in the Amur region in 2002-2004 was 43% to 57%. For many years the leading cause of childhood disability due to pathology of the organ of vision has been amblyopia (28%). Prevention and reduction of primary disability of children is one of the main activities of pediatric ophthalmologists in Russia.

Boston ocular surface prosthesis: an Indian experience.

CONTEXT: Boston ocular surface prosthesis (BOSP) is a scleral contact lens used in the management of patients who are rigid gas permeable (RGP) failures as with corneal ectasias such as keratoconus and in those patients who have ocular surface disease such as Stevens-Johnson syndrome (SJS). AIM: To report utilization of BOSP in a tertiary eye care center in India. MATERIALS AND METHODS: We retrospectively reviewed charts of 32 patients who received BOSP from July 2008 to May 2009. Indications for fitting these lenses, improvement in visual acuity (VA) before and after lens fitting and relief of symptoms of pain and photophobia were noted. Paired t-test was used for statistical analysis using SPSS version 16.0 for Windows. RESULTS: Thirty-two patients (43 eyes) received these lenses. These consisted of 23 eyes of 17 patients who failed RGP trials for irregular astigmatism and corneal ectasia such as keratoconus and post radial keratotomy and scar and 20 eyes of 15 patients with SJS. Mean age of RGP failures was 27.94 years. Pre- and post-BOSP wear mean LogMAR VA was 1.13 and 0.29, respectively, in RGP failures. The P value was statistically significant (P < 0.001). In patients with SJS, LogMAR VA was 0.84 ± 0.92 before and 0.56 ± 0.89 after lens wear. The P value was statistically significant (P < 0.001). VA improved by >2 lines in 7/20 eyes (35%) with SJS, with improvement in symptoms. CONCLUSION: BOSP improves VA in patients who have irregular astigmatism as in ectasias and RGP failures and improves vision and symptoms in patients with SJS.

Feasibility of the Dutch ICF Activity Inventory: a pilot study.

BACKGROUND: Demographic ageing will lead to increasing pressure on visual rehabilitation services, which need to be efficiently organised in the near future. The Dutch ICF Activity Inventory (D-AI) was developed to assess the rehabilitation needs of visually impaired persons. This pilot study tests the feasibility of the D-AI using a computer-assisted telephone interview. METHODS: In addition to the regular intake, the first version of the D-AI was assessed in 20 patients. Subsequently, patients and intake assessors were asked to fill in an evaluation form. Based on these evaluations, a new version of the D-AI was developed. RESULTS: Mean administration time of the D-AI was 88.8 (± 41.0) minutes. Overall, patients and assessors were positive about the D-AI assessment. However, professionals and 60% of the patients found the administration time to be too long. All included items were considered relevant and only minor adjustments were recommended. CONCLUSION: The systematic character of the revised D-AI will prevent topics from being overlooked and indicate which needs have the highest priority from a patient-centred perspective. Moreover, ongoing assessment of the D-AI will enhance evaluation of the rehabilitation process. To decrease administration time, in the revised D-AI only the top priority goals will be fully assessed. Using the D-AI, a rehabilitation plan based on individual needs can be developed for each patient. Moreover, it enables better evaluation of the effects of rehabilitation. A larger validation study is planned.