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OBJECTIVE: To examine the performance of self-reported visual difficulty (VD) in predicting objective visual impairment (VI) in older adults and explore factors that influence discordance in these classifications. DESIGN: Cross-sectional analysis of the National Health and Aging Trends Study (2022). METHODS: Participants reporting blindness or difficulties with distance or near vision were characterized as having VD. Presenting binocular distance visual acuity (VA), near VA, and contrast sensitivity (CS) were assessed. Objective VI was defined as having VI in either distance VA (worse than 20/40), near VA (worse than 20/40), or CS (worse than 1.55 logCS). Receiver operating characteristic analysis was used to compare performance of VD in predicting objective VI. To investigate factors that influence discordance, we limited our sample to adults with objective VI and employed a multivariable logistic regression model to identify factors associated with not reporting VD. Similar analyses were performed to explore factors associated with reporting VD in adults without objective VI. RESULTS: 4,999 adults were included in the 2022 cohort. VD achieved an area under the curve (AUC) of 56.0 (95% CI: 55.2, 56.9) in predicting objective VI, with a sensitivity of 15.8 (95% CI: 14.2, 17.5) and specificity of 96.3 (95% CI: 95.5, 96.9). Characteristics associated with not reporting VD in adults with objective VI included: female gender (odds ratio [OR]: 0.64 [95% CI: 0.42, 0.99]), Hispanic ethnicity (OR: 0.49 [95% CI: 0.31, 0.78), higher income (≥75k, OR: 1.99 [95% CI: 1.14, 3.45]), having ≥4 comorbidities (OR: 0.46 [95% CI: 0.29, 0.72]), and having depressive symptoms (OR: 0.49 [95% CI: 0.25, 0.93]). Meanwhile, factors associated with self-reporting VD in the absence of objective VI included Hispanic ethnicity (OR: 2.11 [95% CI: 1.15, 3.86]), higher income (≥75k, OR: 0.27 [95% CI: 0.12, 0.63]), and having anxiety symptoms (OR: 3.05 [95% CI: 1.56, 5.97]). CONCLUSIONS: Self-reported visual difficulty is a distinct measure assessing disability and has limited ability in predicting objective VI. Caution is advised when utilizing self-reported visual difficulty as a surrogate measure for objective VI in epidemiological studies, though it may still be an effective way to capture risk of current or future disability.
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Background: There is a paucity of information on rate and time to return to play (RTP) in elite-level soccer players who have sustained foot fractures. Purpose: To (1) determine the rate and timing of RTP after foot fracture (eg, tarsal, metatarsal, or phalangeal), (2) investigate foot fracture reinjury incidence after RTP, and (3) evaluate performance after foot fracture as compared with matched, uninjured controls. Study Design: Descriptive epidemiology study. Methods: Athletes sustaining foot fractures were identified across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2000 and 2016. Injured athletes were matched to controls (1:1) using demographic characteristics and performance metrics from 1 season before injury. The authors recorded RTP rate, reinjury incidence, player characteristics associated with RTP within 2 seasons of injury, player availability, field time, and performance metrics during the 4 seasons after injury. Results: A total of 192 elite soccer players sustaining a foot fracture were identified; 40 players (20.8%) underwent operative treatment. Athletes missed an average of 69.41 ± 59.43 days and 5.15 ± 23.28 games. In the 4 seasons after injury, 80% of players returned to play, with 72% returning to play within 1 season of injury. Nine players (5%) sustained a subsequent foot fracture. Athletes with a foot fracture demonstrated significantly longer league retention compared with uninjured controls (P < .001). Elite soccer players older than 30 years of age were less likely to RTP (odds ratio, 0.67; P = .002), whereas career experience, field position, and baseline performance showed no significant association with RTP rates. Injured athletes demonstrated similar performance to controls during the 4 years after injury, and there were no position-dependent differences on subgroup analysis. The players who underwent operative treatment had more assists per 90 minutes and more team points per game during the first season after injury compared with athletes treated nonoperatively. Conclusion: Foot fractures in elite soccer players resulted in moderate loss of play time (69.41 days). RTP rates were high at 80%, although players older than 30 years of age were less likely to RTP. On RTP, athletes who sustained a foot fracture maintained performance similar to preinjury levels and to uninjured controls.
