Factors Influencing Vision Health and Eye Care among Older Adults in Northeast Tennessee.

OBJECTIVES: The purpose of this study was to examine the factors associated with vision impairment (VI), age-related eye disease (ARED), and frequency of eye examinations among older adults. METHODS: A cross-sectional study (N = 166) was designed to identify barriers in vision and eye care services among adults 50 years and older in four counties in Appalachian Tennessee. Surveys were administered in March 2023. Simple and multiple logistic regression analyses were used to determine the risk factors of VI and ARED and the frequency of eye examinations. RESULTS: In two out of the three regression models, predictors such as traveling >10 mi to an eye care provider, barriers to eye care, and a lack of exposure to eye health information emerged as significant factors. Individuals who traveled >10 mi to an eye care provider were more than twice as likely than individuals who traveled shorter distances to have VI and not maintain routine eye care (adjusted odds ratio [AOR] 2.69, 95% confidence interval [CI] 1.08-6.75; AOR 2.82, 95% CI 1.05-7.55, respectively). Reporting barriers to eye care doubled the odds of ARED (AOR 2.33, 95% CI 1.02-5.34) and substantially increased the odds of reporting a 3-year or longer interval since the last eye examination (AOR 7.45, 95% CI 1.85-29.96) compared with having no barriers to eye care. Moreover, limited exposure to eye health information tripled the odds of VI (AOR 3.26, 95% CI 1.15-9.24) and not maintaining routine eye care (AOR 3.07, 95% CI 0.97-9.70) compared with more exposure to eye health information. Other predictors also were uncovered in the analysis. CONCLUSIONS: This study contributes to the scarce literature on risk factors associated with vision health among older adults in Appalachia.

Computer vision syndrome and ergonomic risk factors among workers of the Commercial Bank of Ethiopia in Addis Ababa, Ethiopia: an institutional-based cross-sectional study.

Background: Computer vision syndrome (CVS) is the most pressing public health concern that affects vision and reduces quality of life and productivity, particularly in developing countries. Most of the previous studies conducted in Ethiopia focus on the knowledge and personal risk factors of bank workers. Moreover, ergonomic workstation design was not objectively assessed, which could hinder the implementation of effective intervention strategies. Therefore, this study aimed to determine CVS and ergonomic factors among commercial bank workers in Addis Ababa, Ethiopia. Methods: An institutional-based cross-sectional study was carried out among 466 study participants from May 26 to July 24, 2022. A multistage sampling technique was applied to select the study participants. Data were collected via a standardized tool of CVS (CVS-Q). Besides, workstation ergonomics were pertinently assessed. The collected data was entered into EpiData version 3.1 and exported to SPSS version 26 for data analysis and cleaning. Multivariable logistics regression analysis was performed to identify factors associated with CVS. The variables with a p-value < 0.05 were considered statistically significant factors. Results: Prevalence of CVS was 75.3% (95% CI: 71.2-79.2%). Blurred vision, eye redness, and headache, 59.8%, 53.7%, and 50.7%, respectively, were frequently reported symptoms. Glare (AOR = 4.45: 95% CI: 2.45-8.08), 20-20-20 principle (AOR = 1.98, 95% CI: 1.06-3.67), wearing non-prescription eyeglasses (AOR = 4.17; 95% CI: 1.92-9.06), and poor workstation (AOR = 7.39; 95% CI: 4.05-13.49) was significantly associated with CVS. Conclusion: The prevalence of CVS was found to be high. Glare at work, ignoring the 20-20-20 principle, wearing non-prescription eyeglasses, and poor workstation ergonomic design were independent predictors of CVS. Therefore, comprehensive interventional activities like adhering to the 20-20-20 principle, avoiding the use of non-prescription glasses, minimizing glare, and improving workstation ergonomic setup are essential to prevent CVS.

Praziquantel-related visual disorders among recipients in mass drug administration campaigns in schistosomiasis endemic settings: Systematic review and meta-analysis protocol.

BACKGROUND: Hundreds of millions of doses of Praziquantel (PZQ) have been administered to persons with and without schistosomiasis living in schistosomiasis endemic settings, through the mass drug administration (MDA) strategy which started in the early 2000s. A recent publication suggested high risk of PZQ-related visual disorders, raising public health concerns. We aim to systematically synthesize evidence on the magnitude of PZQ-related visual disorders. METHODS: We will search PubMed, Google Scholar, CINAHL, SCOPUS, CENTRAL and LILACS from 1977 (when the first human clinical trials on PZQ started) to 31st May 2024, with no language restrictions. The key search terms will include "Praziquantel", "PZQ", "visual disorder", "adverse events", "side effects", "blurry vision" and "visual impairment" together with alternative terms and synonyms. All the countries endemic for schistosomiasis will be included as search terms. We will also search HINARI, Africa Journals Online, Thesis Databases and Preprint Repositories. Where necessary, we will contact expert researchers working in the field of schistosomiasis, UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), pharmaceutical industries, country-specific Food and Drug Authorities (FDAs) and the European Medicines Agency databases. We will search Conference Proceedings and reference lists of relevant studies for additional studies. At least two authors will independently select studies, extract data and assess risk of bias in the included studies. Any disagreements or discrepancies will be resolved through discussion between the reviewers. Heterogeneity will be explored graphically, and statistically using the I2-statistic. We will conduct random-effects meta-analysis when heterogeneity is appreciable, and express dichotomous outcomes (visual adverse events including excessive lacrimation, blurry vision and visual impairments) as risk ratio (RR) or Odds Ratio (OR) with their 95% confidence interval (CI). We will perform subgroup analysis to assess the impact of heterogeneity, and sensitivity analyses to test the robustness of the effect estimates. The overall level of evidence will be assessed using GRADE. EXPECTED OUTCOMES: The present review expects to identify and categorize visual disorders occurring after administration of PZQ, alone or in combination with other drugs. By synthesizing the data from multiple studies, the review aims to present a quantitative assessment of the risk or odds of experiencing a visual disorder in different populations after ingesting PZQ. The review will also generate insights into whether PZQ in combination with other drugs are associated with increased odds of visual disorders and whether the occurrence of visual disorders correlates with dosage or treatment duration. Policymakers, public health experts and stakeholders could rely on the review findings to deliver context-sensitive preventive chemotherapy programs by adjusting drug combinations or dosing schedules to reduce risk of visual adverse effects in populations treated with PZQ. The review aims to identify gaps in the current evidence regarding visual disorders following PZQ administration in schistosomiasis endemic settings which can serve as the basis for future research on important but unanswered questions. DISSEMINATION AND PROTOCOL REGISTRATION: The findings of this study will be disseminated through stakeholder forums, conferences, and peer-review publications. The review protocol has been registered in the International Prospective Register for Systematic Reviews (PROSPERO)- CRD42023417963.

Cross-sectional study of prevalence and correlates of fear of falling in the older people in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES).

OBJECTIVE: To report the prevalence and risk factors for the fear of falling (FOF) among older individuals living in residential care facilities in India. DESIGN: Cross-sectional study. SETTING: Homes for the aged centres in Hyderabad, India. PARTICIPANTS: The study included individuals aged ≥60 years from homes for the aged centres. The participants underwent a comprehensive eye examination in make-shift clinics setup in homes. Trained investigators collected the personal and demographic information of the participants and administered the Patient Health Questionnaire-9 and Hearing Handicap Inventory for Elderly questionnaire in the vernacular language. FOF was assessed using the Short Falls Efficacy Scale. The presence of hearing and visual impairment in the same individual was considered dual sensory impairment (DSI). A multiple logistic regression analysis was done to assess the factors associated with FOF. PRIMARY OUTCOME MEASURE: FOF. RESULTS: In total, 867 participants were included from 41 homes for the aged centres in the analyses. The mean (±SD) age of the participants was 74.2 (±8.3) years (range 60-96 years). The prevalence of FOF was 56.1% (95% CI 52.7% to 59.4%; n=486). The multivariate analysis showed that those with DSI had eleven times higher odds of reporting FOF than those with no impairment (OR 11.14; 95% CI 3.15 to 41.4.) Similarly, those with moderate depression had seven times higher odds (OR 6.85; 95% CI 3.70 to 12.70), and those with severe depression had eight times higher odds (OR 8.13; 95% CI 3.50 to 18.90) of reporting FOF. A history of falls in the last year was also associated with increased odds for FOF (OR 1.52; 95% CI 1.03 to 2.26). CONCLUSION: FOF is common among older individuals in residential care in India. Depression, falling in the previous year and DSI were strongly associated with FOF. A cross-disciplinary approach may be required to address FOF among the older people in residential care in India.

Oral health in youth with visual impairment: A longitudinal survey.

This longitudinal survey aims to demonstrate improvement in oral hygiene among a group of youth with visual impairment (VI) achieved by repeated oral hygiene training, compare their progress with healthy peers (CG) and assess their oral health knowledge. In 100 VI (55♀, 45♂; ± 17.8 years) and 45 CG (23♀, 22♂; ± 17.2 years) oral hygiene training and a Quigley-Hein Plaque Index (QHI) rating were repeated six times at three-month intervals. The VI were divided into four subgroups according to the toothbrush hardness/type. A questionnaire was given to both groups. Appropriate statistical analyses were performed at 5% significance level. Both groups showed reduction in QHI, the VI had overall higher QHI values than CG. Use of an electric toothbrush in VI led to lower QHI in the last examination (p < 0.03). 69% of participants recommended dental specialists to improve communications by acquiring more illustrative aids. VI changed toothbrush less often (p < 0.02). A higher incidence of dental plaque was confirmed in VI compared to CG. After education and individual training, gradual plaque reduction has occurred in both groups. Using an electric toothbrush in VI resulted in better QHI outcomes. Repetitive preventive intervention in youth with VI helped them to adopt healthier oral hygiene habits.

Predictors and consequences of visual trajectories in Chinese older population: A growth mixture model.

Background: Given the relatively high prevalence of vision impairment and the heterogeneity of visual changes among the elderly population, we aimed to identify the visual trajectories and to examine the predictors and consequences associated with each trajectory class. Methods: We analysed data from 2235 participants involved in the 5th, 6th, 7th, and 8th waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), where vision impairment was evaluated using an adapted Landolt-C chart during each wave. We employed a growth mixture model (GMM) to identify distinct visual trajectories and logistic regression analysis to examine the predictors associated with each trajectory class. Furthermore, we investigated the effect of visual trajectories on distal consequences, including cognitive function, activities of daily living (ADL), instrumental activities of daily living (IADL), depression, anxiety, and fall risk. Within the CLHLS study, cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (CMMSE), ADL via the Katz index, and IADL through a modified version of Lawton's scale. Lastly, depression was assessed using the 10-item version of the Centre for Epidemiologic Studies (CES-D-10), while anxiety was measured using the Generalized Anxiety Disorder scale (GAD-7). Fall risk was determined by asking the question: 'Have you experienced any falls within the past year?' Results: We identified two distinct visual trajectories in our analysis. Most older adults (n = 1830, 81.9%) initially had a good vision level that diminished ('high-baseline decline' group). Conversely, the remaining participants (n = 405, 18.1%) initially had a lower vision level that improved over time ('low-baseline improvement' group). The 'high-baseline decline' group was more likely to include older adults with relatively higher body mass index (BMI) (odds ratio (OR) = 1.086; 95% confidence interval (CI) = 1.046, 1.127), individuals with higher formal educational qualifications (OR = 1.411; 95% CI = 1.068, 1.864), those current engaging in exercise (OR = 1.376; 95% CI = 1.046, 1.811), and individuals reporting more frequent consumption of fruit (OR = 1.357; 95% CI = 1.053, 1.749). Conversely, the 'low-baseline improvement' group had a higher likelihood of including older individuals (OR = 0.947; 95% CI = 0.934, 0.961), residents of nursing homes (OR = 0.340; 95% CI = 0.116, 0.993) and those self-reporting cataracts (OR = 0.268; 95% CI = 0.183, 0.391) and glaucoma (OR = 0.157; 95% CI = 0.079, 0.315). Furthermore, the 'high-baseline decline' group showed a positive impact on distal consequences, adjusting for sex, birthplace, residence, main occupation, education, economic status, and marital status. This impact included cognitive function (correlation coefficient (ß) = 2.092; 95% CI = 1.272, 2.912), ADL (ß = -0.362; 95% CI = -0.615, -0.108), IADL (ß = -1.712; 95% CI = -2.304, -1.121), and reported lower levels of depression (ß = 0.649; 95% CI = 0.013, 1.285). We observed no significant influence on fall risk and anxiety within the identified visual trajectories in the adjusted model. Conclusions: Vision in older adults with ocular disease could potentially be improved. Having formal education, maintaining an appropriate BMI, engaging in exercise, and consuming fruit more frequently appear to be beneficial for the visual health of the elderly. Considering the negative impact of visual impairment experience on distal cognition, self-care ability, and depression symptoms, stakeholder should prioritise long-term monitoring and management of vision impairment among older adults.

The Australian Eye and Ear Health Survey (AEEHS): Study protocol for a population-based cross-sectional study.

INTRODUCTION: Vision and hearing impairments are highly prevalent and have a significant impact on physical, psychological and social wellbeing. There is a need for accurate, contemporary national data on the prevalence, risk factors and impacts of vision and hearing loss in Australian adults. OBJECTIVES: The Australian Eye and Ear Health Survey (AEEHS) aims to determine the prevalence, risk factors and impacts of vision and hearing loss in both Aboriginal and Torres Strait Islander and non-Indigenous older adults. METHODS AND ANALYSIS: The AEEHS is a population-based cross-sectional survey which will include 5,000 participants (3250 non-Indigenous aged 50 years or older and 1750 Aboriginal and Torres Strait Islander people aged 40 years or older) from 30 sites covering urban and rural/regional geographic areas, selected using a multi-stage, random cluster sampling strategy. Questionnaires will be administered to collect data on socio-demographic, medical, ocular and ontological history. The testing battery includes assessment of blood pressure, blood sugar, anthropometry, visual acuity (presenting, unaided, pinhole and best-corrected), refraction, tonometry, slit lamp and dilated eye examination, ocular imaging including optical coherence tomography (OCT), OCT-angiography and retinal photography, and automated visual fields. Audiometry, tympanometry and video otoscopy will also be performed. The primary outcomes are age-standardised prevalence of cause-specific vision and hearing impairment. Secondary outcomes are prevalence of non-blinding eye diseases (including dry eye disease), patterns in health service utilisation, universal health coverage metrics, risk factors for vision and hearing impairment, and impact on quality of life.

Cross-sectional study of prevalence, causes and trends in visual impairment in Nirmal District, Telangana, India: Nirmal Eye Evaluation for Trends study.

OBJECTIVE: To determine the prevalence, causes and risk factors associated with visual impairment (VI) in the Nirmal district of Telangana, India, using extended Rapid Assessment of Visual Impairment (RAVI) methodology. DESIGN: Cross-sectional study. SETTING: Community setting. PARTICIPANTS: Participants aged ≥16 years were enumerated from 90 randomly selected clusters and 4629/5400 (85.7%) participants were examined. Presenting visual acuity (VA) was assessed using a Snellen chart with E optotypes at a 6 m distance. Near vision was assessed binocularly using an N notation chart with tumbling E optotypes at a 40 cm distance. An anterior segment examination done followed by distance direct ophthalmoscopy at 50 cm. Non-mydriatic fundus images were obtained. VI was defined as presenting VA worse than 6/12 in the better eye. The prevalence of VI in the current study was compared with a RAVI study conducted in 2014 to assess the trends in VI among those aged ≥40 years. PRIMARY OUTCOME: Prevalence, causes and risk factors for VI. RESULTS: Among those examined, 55% were women, 53% had at least school-level education, 2.3% self-reported diabetes and 8.7% self-reported hypertension. The prevalence of VI was 8.81% (95% CI 8.01% to 9.67%). Overall, uncorrected refractive errors (49.5%) were the leading cause of VI, followed by cataracts (40.2%) and posterior segment diseases (4.9%). Among those aged ≥40 years, the prevalence of VI declined by 19.3% compared with the 2014 baseline study (from 20.2% to 16.3%; p<0.01). CONCLUSION: The extended RAVI study conducted in the Nirmal district showed a considerable decline in the prevalence of VI. Targeted interventions are needed to provide adequate eye care for the high-risk groups in this district.

Causes of Vision Loss Associated with Dengue Fever in Bihar, India - A Case Series.

The incidence and geographic distribution of dengue has increased dramatically in recent years across various parts of the world. Previously, ocular findings in dengue fever were considered rare. We report a spectrum of ocular manifestations presenting with vision loss in the last dengue epidemic in an eastern state of India. This is a retrospective interventional case series of patients with vision loss who were diagnosed with dengue eye disease in the 2022 epidemic. Systemic and ophthalmic examinations were completed on all patients and were analyzed. Fifteen patients had presented with vision loss. The mean age was 41.7 ± 10.8 years, and patients were mostly males. Three patients presented with panophthalmitis and orbital cellulitis. Eight patients were diagnosed with optic neuropathy. Four patients had macular involvement: macular chorioretinitis, macular subhyaloid hemorrhage, and macular hemorrhages in two patients. All patients with optic neuropathy gave a history of mild fever and had remained undiagnosed. The rest had been diagnosed with the more severe dengue hemorrhagic fever. Vision recovered partially or fully in patients with optic neuropathy and macular disease. No eye could be salvaged in any panophthalmitis patients. Thrombocytopenia (platelet count <100 × 109 per liter of blood) was significantly associated with ocular hemorrhage and panophthalmitis, but thrombocytopenia was not significantly seen in optic neuropathy. We conclude that optic neuropathy may be an underreported cause of vision loss in dengue fever. An eye examination is advocated in all patients with dengue eye disease.

Visual impairment among diabetes patients in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been conducted to determine the prevalence of visual impairment and its associated factors among diabetes patients in Ethiopia, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of visual impairment and identify associated factors among diabetes patients. METHODS: An extensive search of literature was done on PubMed, Google Scholar, and Web of Sciences databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to calculate the pooled prevalence of visual impairment. RESULTS: A total of 34 eligible primary studies with a sample size of 11,884 participants were included in the final meta-analysis. The pooled prevalence of visual impairment was 21.73% (95% CI: 18.15, 25.30; I2 = 96.47%; P<0.001). Diabetes mellitus with a duration of diagnosis ≥10 years [AOR = 3.18, 95% CI: 1.85, 5.49], presence of co-morbid hypertension [AOR = 3.26, 95% CI: 1.93, 5.50], poor glycemic control [AOR = 4.30, 95% CI: 3.04, 6.06], age ≥56 years [AOR = 4.13, 95% CI: 2.27, 7.52], family history of diabetes mellitus [AOR = 4.18 (95% CI: 2.61, 6.69], obesity [AOR = 4.77, 95% CI: 3.00, 7.59], poor physical activity [AOR = 2.46, 95% CI: 1.75, 3.46], presence of visual symptoms [AOR = 4.28, 95% CI: 2.73, 6.69] and no history of eye exam [AOR = 2.30, 95% CI: 1.47, 3.57] were significantly associated with visual impairment. CONCLUSIONS: The pooled prevalence of visual impairment was high in Ethiopia. Diabetes mellitus with a duration of diagnosis ≥10 years, presence of co-morbid hypertension, poor glycemic control, age ≥56 years, and family history of diabetes mellitus, obesity, poor physical activity, presence of visual symptoms, and no history of eye exam were independent predictors. Therefore, diabetic patients with these identified risks should be screened, and managed early to reduce the occurrence of visual impairment related to diabetes. Moreover, public health policy with educational programs and regular promotion of sight screening for all diabetes patients are needed.

Development and validation of a questionnaire for assessing visual and auditory spatial localization abilities in dual sensory impairment.

Spatial localization is important for social interaction and safe mobility, and relies heavily on vision and hearing. While people with vision or hearing impairment compensate with their intact sense, people with dual sensory impairment (DSI) may require rehabilitation strategies that take both impairments into account. There is currently no tool for assessing the joint effect of vision and hearing impairment on spatial localization in this large and increasing population. To this end, we developed a novel Dual Sensory Spatial Localization Questionnaire (DS-SLQ) that consists of 35 everyday spatial localization tasks. The DS-SLQ asks participants about their difficulty completing different tasks using only vision or hearing, as well as the primary sense they rely on for each task. We administered the DS-SLQ to 104 participants with heterogenous vision and hearing status. Rasch analysis confirmed the psychometric validity of the DS-SLQ and the feasibility of comparing vision and hearing spatial abilities in a unified framework. Vision and hearing impairment were associated with decreased visual and auditory spatial abilities. Differences between vision and hearing abilities predicted overall sensory reliance patterns. In DSI rehabilitation, DS-SLQ may be useful for measuring vision and hearing spatial localization abilities and predicting the better sense for completing different spatial localization tasks.

Effect of visual impairment on subjective cognitive decline in older adults: a cross-sectional study in China.

OBJECTIVE: People with visual impairment have more functional limitations associated with subjective cognitive decline (SCD), and those with SCD are extremely susceptible to transitioning to irreversible cognitive impairment. This study aimed to explore if visual impairment is a significant predictor of SCD compared with other socioeconomic and health factors associated with SCD. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: The investigation aimed to assess the factors influencing SCD among 428 participants aged 60 and above in Zhaoyuan, China. PRIMARY OUTCOME MEASURES: The primary outcome variable was SCD, measured by the Chinese version of SCD questionnaire. Multiple logistic regression and propensity score matching (PSM) were used to analyse the influence of visual impairment on the subjective cognition of the elderly.32.2% of the elderly were experiencing SCD. Older adults with SCD showed a higher prevalence of visual impairment (72.5%) than the elderly without SCD (58.6%) (P=0.006). Multivariate logistic regression analysis showed that bad self-reported health status, lack of physical exercise and visual impairment were the risk factors for SCD in older adults, while more than 9 years of education was a protective factor. In addition, PSM model showed that after eliminating the dominant biases caused by the individual observable heterogeneity of older adults with and without visual impairment, the risk of SCD in the elderly with visual impairment was increased by 13.6%-14.5% and the difference was statistically significant (P<0.05). CONCLUSIONS: It was found that older adults experiencing visual impairments are at an elevated risk of developing SCD compared with their counterparts without such impairments. Additionally, visual impairment remains a significant risk factor for SCD in the elderly, even adjusting for potential biases arising from individual observable heterogeneity.

Relationship between self-reported hearing and vision problems, cognitive decline, depressive symptoms, and life satisfaction in older adults: a retrospective observational study.

BACKGROUND: Sensory impairment in older adults is associated with cognitive decline, elevated depressive symptoms, and low levels of life satisfaction. However, these relationships are usually investigated separately and in pairs. This study examined these relationships comprehensively, for the first time. METHODS: The analysis included 5,658 community-dwelling older adults from the China Health and Retirement Longitudinal Study (aged 50 to 108 years, 52.1% male) who completed the Jorm Informant Questionnaire Cognitive Decline in the Elderly and the Center for Epidemiological Studies-Depression-short form. A questionnaire was used to collect information on hearing, visual status, and life satisfaction. Structural equation modelling was used to examine the direct and indirect relationships between these variables. RESULTS: Self-reported hearing and vision problems are directly associated with cognitive decline and elevated depressive symptoms. In addition, hearing and vision problems are indirectly related to cognitive decline through elevated depressive symptoms. Although hearing and vision problems had no direct effect on life satisfaction, they were indirectly associated with life satisfaction through cognitive decline and depressive symptoms. CONCLUSIONS: This study provides the first epidemiological evidence of the comprehensive relationships between hearing and vision problems, cognitive decline, depressive symptoms, and life satisfaction. When older adults report hearing and/or vision problems, clinicians and caregivers should be aware of the concurrence of declined cognition, elevated depressive symptoms, and compensated life satisfaction. Future studies should examine the causal relationships and potential mechanisms of these relationships.

Hidden dangers: Does multisensory impairments accompanying visual impairment increase dementia risk.

BACKGROUND: Growing evidence suggests that sensory impairment, particularly in the form of visual impairment, may contribute to the development of dementia. However, it remains unclear whether experiencing concurrent visual impairment in combination with other types of multisensory impairments may further increase this risk. METHODS: The study used data from the UK Biobank cohort study, which recruited 500,000 adults. With meticulous screening procedures in place, individuals with visual impairment, hearing impairment, and oral health issues were identified for further follow-up evaluations. A multivariable regression analysis was conducted to investigate the relationship between multisensory impairments concurrent with visual impairment and cognitive function. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals to evaluate the association between multisensory impairments concurrent with visual impairment and dementia risk. RESULTS: Subjects experiencing multisensory impairments concurrent with visual impairment demonstrated a negative association with cognitive function. Notably, individuals who have both vision and hearing impairments had a significantly higher risk of developing dementia (HR 1.28, 95% CI [1.01-1.63]). Additionally, individuals who experience vision impairment and oral health issues simultaneously were also at higher risk for dementia (HR 1.61, 95% CI [1.32-1.97]). Furthermore, the risk of dementia among individuals with vision impairment, hearing impairment, and oral health issues further escalated to an even higher level (HR 1.63, 95% CI [1.19-2.24]). CONCLUSIONS: The correlation between the presence of multisensory impairments concurrent with visual impairment and cognitive decline is highly significant. Those with multisensory impairments concurrent with visual impairment are at a significantly increased risk of developing dementia.

Visual Impairment and Suicide Risk: A Systematic Review and Meta-Analysis.

Importance: Suicide is a substantial public health concern that involves various recognized contributing factors. Sensory impairments, specifically visual impairment, are deemed potential risk factors. Nonetheless, comprehensive information about associated risk levels and underlying determinants remains limited. Objective: To investigate the association between visual impairment and different aspects of suicide, including the assessment of risk levels and exploration of potential contributing factors. Data Sources: An electronic search was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases from their inception to February 8, 2024. Study Selection: All published studies were considered without restrictions on study design, publication date, or language. Data Extraction and Synthesis: Two independent reviewers extracted the published data using a standardized procedure in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Random-effects meta-analyses were used to estimate pooled effect sizes. Multiple meta-regression analyses were conducted to identify potential factors contributing to the association between visual impairment and the risk of suicide. Main Outcomes and Measures: The primary outcome measure was the odds ratio (OR) of suicidal behavior (including suicide attempt and suicide death) for individuals with visual impairment compared with those without. The secondary outcome measures were the pooled ORs of suicidal ideation and suicide death, respectively. Results: A total of 31 population-based studies with 5 692 769 unique individuals (mean [SD] age, 48.4 [8.5] years; 2 965 933 females [52%]) were included. For 17 studies (5 602 285 individuals) that evaluated suicidal behavior, the pooled OR was 2.49 (95% CI, 1.71-3.63). For 21 studies (611 899 individuals) that assessed suicidal ideation, the pooled OR was 2.01 (95% CI, 1.62-2.50). For 8 studies (5 067 113 individuals) investigating the association between visual impairment and suicide death, the pooled OR was 1.89 (95% CI, 1.32-2.71). The multiple meta-regression model identified age group as a predictive factor associated with suicidal behavior, with the studies included suggesting that adolescents were at the highest risk. While this analysis showed moderate heterogeneity for suicide death, high heterogeneity was observed for suicidal behavior and suicidal ideation. Conclusions and Relevance: The findings of this systematic review and meta-analysis support the association between visual impairment and increased risk of suicidal tendencies. The risk differed by age group, with a pronounced risk observed among adolescents.

Experts' perspectives on the impact of visual impairment and comorbid mental disorders on functioning in essential life domains.

BACKGROUND: Visual impairment (VI) with comorbid mental disorders (MDs) are expected to have a major impact on people's daily functioning, for which tailored support is needed. However, this has been barely investigated. Therefore, this study aimed to (1) determine the impact of VI and comorbid MDs on functioning in essential life domains, (2) gain insight into best-practices that are currently used to support this target group, and (3) determine strategies to optimize care in the future. METHODS: A four-step qualitative Delphi method was used to obtain input from 31 Dutch professionals who work with this target group (84% female, mean age 46 years, on average 11 years of experience in working with the target group). The Self-Sufficiency Matrices were used to determine the impact on various aspects of daily living, for people with VI and (1) autism spectrum disorder, (2) psychotic disorders, (3) obsessive-compulsive disorder, (4) antisocial personality disorder, (5) borderline personality disorder, (6) dependent personality disorder. RESULTS: Experts describe a frail and vulnerable population, in which the VI and MD often have a cumulative negative impact on people's physical and mental health. People frequently experience anxiety, depression, fatigue and sleep disturbances. Also, many tend to neglect self-care and substance abuse is common. They often experience difficulty in trusting others while at the same time being dependent on them. Social interaction and relationships are complicated because of communication restrictions (e.g. no facial recognition) and social incompetence or withdrawal. Experts advise taking transdiagnostic factors into account, using evidence-based psychological treatment options based on an intermittent approach, and offering multidisciplinary care. They stress the importance of building trust, showing patience and empathy, stimulating empowerment, involving the informal network and building on positive experiences. CONCLUSION: VI and comorbid MD have a major impact on people's daily functioning on a mental, physical, social and environmental level. This study provides insight into best-practices to support this target group. According to experts, more research is needed which could be aimed at investigating tailored diagnostic approaches and treatment options and include clients' perspectives.

Social engagement and cognitive impairment among nursing home residents: The role of sensory impairment.

BACKGROUND AND OBJECTIVES: Using US national nursing home data, this cross-sectional study sought to evaluate 1) the association between lack of social engagement and level of cognitive impairment; and 2) the extent to which this association differs by hearing and visual impairment. RESEARCH DESIGN AND METHODS: Our sample included 793,846 nursing home residents aged ≥ 50 years. The Index of Social Engagement was categorized as none/lower (0, 1, 2) or higher levels (3 through 6). Cognitive Performance Scale was grouped as intact/mild (0, 1, 2), moderate (3, 4), or severe (5, 6). Multinomial models provided adjusted odds ratio (aOR) and 95 % confidence intervals (CI) between none/lower social engagement and cognitive impairment. We estimated relative excess risk due to interaction (RERI) to quantify the joint effects of social engagement and sensory impairment types. RESULTS: Overall, 12.6 % had lower social engagement, 30.3 % had hearing impairment, and 40.3 % had visual impairment. Compared to residents with high social engagement, those with lower social engagement were more likely to have moderate/severe cognitive impairment (aORmoderate = 2.21, 95 % CI 2.17-2.26; aORsevere = 6.49, 95 % CI 6.24-6.74). The impact of low social engagement on cognitive impairment was more profound among residents with hearing impairment and/or visual impairment (RERIhearing = 3.89, 95 % CI 3.62-4.17; RERIvisual = 25.2, 95 % CI 23.9-26.6)). DISCUSSION AND IMPLICATIONS: Residents with lower social engagement had higher levels of cognitive impairment. Residents with sensory impairments are potentially more susceptible to the negative impact of lower levels of social engagement on level of cognitive impairment.

Association between vision impairment and increased prevalence of falls in older US adults.

BACKGROUND: Vision impairment (VI) is associated with falls in older adults. However, past studies have relied on geographically constrained samples with limited generalizability or self-reports of visual difficulty. To date, there have not been nationally representative studies on the association of objective measures of visual function and falls outcomes. METHODS: We used cross-sectional data from Round 11 of National Health and Aging Trends Study (NHATS), a nationally representative panel study of age-eligible Medicare beneficiaries (N = 2951). We performed Poisson regression to calculate the prevalence and prevalence ratio (PR) of >1 fall in the past year, any fall in the past month, fear of falling (FoF), and activity limitation due to FoF as a function of distance visual acuity, near visual acuity, and contrast sensitivity. Models were adjusted for demographic and health covariates and were weighted to make nationally representative parameter estimates. RESULTS: The weighted proportion of participants with VI was 27.6% (95% CI, 25.4%-29.9%). Individuals with any VI had a higher prevalence of falls compared with those without VI (18.5% vs. 14.1%, PR = 1.25, 95% CI 1.02-1.53). Specifically, contrast sensitivity impairment was associated with a higher prevalence of recurrent falls (20.8% vs. 14.7%; PR = 1.30, 95% CI 1.01-1.67) and recent falls (17.1% vs. 9.9%; PR = 1.40, 95% CI 1.01-1.94). This relationship existed even independent of near and distance visual acuity. Distance and near visual acuity were not significantly associated with falls. Having any VI was also associated with a higher prevalence of FoF (38.4% vs. 30.5%, PR = 1.17, 95% CI 1.02-1.34). CONCLUSION: The prevalence of falls is associated with poor contrast sensitivity but not with near or distance visual acuity. Findings suggest greater collaboration between geriatricians and eye care providers may be warranted to assess and address fall risk in older adults with VI.

Visual impairment burden in retinopathy of prematurity: trends, inequalities, and improvement gaps.

Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment, and the increase in number and survival of premature infants may inflate its burden globally. We aimed to comprehensively assess the trends and inequalities in the burden of ROP-related visual impairment and to identify improvement gaps to facilitate appropriate actions in neonatal care systems. We obtained ROP data from the Global Burden of Disease 2019 study. We employed joinpoint regression analysis to assess the trends of the burden of ROP-related visual impairment, measured by age-standardised prevalence rates, health equity analysis methods to evaluate cross-country burden inequalities, and data envelopment and stochastic frontier analyses to identify improvement gaps based on the development status, i.e., sociodemographic index (SDI). Between 1990 and 2019, the age-standardised prevalence rates of ROP-related visual impairment significantly increased worldwide (average annual percentage change: 0.23 [95% confidence interval, 0.21-0.26] among males and 0.26 [0.25-0.27] among females), primarily in developed regions. Although significant SDI-related cross-country inequalities were identified, these reduced over time (slope index of inequality: -57.74 [-66.22 to -49.25] in 1990 to -29.68 [-38.39 to -20.97] in 2019; health concentration index: -0.11 [-0.13 to -0.09] in 1990 to -0.07 [-0.09 to -0.06] in 2019). Notably, some less-developed countries exhibited superior performance despite limited resources, whereas others with a higher SDI delivered lagging performance.  Conclusion: The global burden of ROP-related visual impairment has steadily increased between 1990 and 2019, with disproportionate burden concentration among less-developed countries, requiring appropriate preventive and intervention measures. What is Known: • Retinopathy of prematurity (ROP) is an important cause of avoidable childhood visual impairment. • The prevalence of ROP is anticipated to increase due to the growing number of extremely premature infants. What is New: • The prevalence of ROP-related visual impairment has increased worldwide, primarily in developed regions, with declining but persisting cross-country inequalities. • The increasing burden of ROP-related visual impairment should be considered as part of global and national health agendas, requiring interventions with proven efficacy.