Quality of Life and Psychological Aspects in Patients with Visual Impairment Secondary to Uveitis: A Clinical Study in a Tertiary Care Hospital in Brazil

Purpose: To evaluate the quality of life in individuals with bilateral visual impairment secondary to uveitis and its association with sociodemographic, clinical and psychosocial aspects.

Methods: Data were collected through a structured interviews, using four forms; the SF-12v2, HADS, NEI-VFQ-25 and a specific form developed to collect clinical and sociodemographic data.

Results: 80 patients were included with a mean age of 42.8 years; 63.8% female; 57.5% with permanent reduction of familiar income. The average number of medical visits was 15.2 ±10.7/year. In terms of health-related quality of life (HRQol), the mean of VFQ-25 score was 36.6 ± 15.1 and the mean of SF-12 physical and mental components scores were 43.3 ± 9.9 and 44.9 ± 12.2. Anxiety and depression symptoms were found in 65.1% and 32.5% of patients, respectively.

Conclusions: Visual impairment has impact on several scales of HRQoL leading to productivity loss and consumption of health resources.     

Quality of Life and Participation of Children With Visual Impairment: Comparison With Population Reference Scores

PurposeThe purpose of this study was to investigate quality of life and participation in children aged 3 to 17 years with visual impairment (VI) compared to reference groups and between subgroups with increasing severity levels of VI.MethodsParents of children aged 3 to 17 years (n = 500) and children aged 13 to 17 years (n = 75) completed the Child and Adolescent Scale of Participation (CASP). Children aged 7 to 17 years (n = 263) and their parents (n = 255) completed the KIDSCREEN-27 questionnaire to assess quality of life. Scores were compared to age and/or gender-appropriate population-based samples. For the CASP, a comparison was also made with children with chronic conditions or disabilities. The association between severity of VI and quality of life or participation was analyzed with linear regression models.ResultsChildren reported significantly worse on Physical Wellbeing and Social Support & Peers, but better on the School Environment KIDSCREEN-27 subscales compared to reference groups. Parents additionally reported worse on Autonomy & Parent Relation. Children''s participation was significantly worse compared to a population-based sample, but significantly better compared to children with chronic conditions and disabilities. Having moderate or severe VI/blindness was significantly associated with worse participation, as reported by parents relative to those with no VI.ConclusionsQuality of life of children with VI is affected especially regarding Physical Wellbeing and Social Support & Peers compared to a reference population, and their participation is considerably worse. Participation was more affected in children with more severe VI. These results contribute to the understanding of the impact of VI. Interventions targeting physical health, social skills, and participation are warranted.     

Development of the Scale of Quality of Life for Diseases with Visual Impairment

Purpose :To describe the development of the of scale quality of life which can measure the quality of life of Chinese patients with visual impairment. Methods: Based on a thorough literature search and consultation with ophthalmologists and public health professionals, 20 items were selected to create a scale. Fifty-seven cataract patients with vision impairment and 60 glaucoma patients with vision impairment and visual field loss were measured by the scale to evaluate the validity, reliability and responsiveness of the scale.Results: The scale covered four domains of the quality of life(QOL). The criterion related validity of the scale: r = 0. 6865 (P=0. 001). The test-retest reliability of the scale: r = 0. 8959(P = 0. 001). Coronback's alpha was 0. 9359. The variance ratio (VR) of intra-individual variance to inter- individual variance was 0. 0551 for overall scores. The correlation coefficient of split-half method was 0. 9553. The responsiveness; T-test, T = 5. 95 (P = 0. 001), effect size statistic     

New Systematic Review Methodology for Visual Impairment and Blindness for the 2010 Global Burden of Disease Study

Abstract

Purpose: To describe a systematic review of population-based prevalence studies of visual impairment (VI) and blindness worldwide over the past 32 years that informs the Global Burden of Diseases, Injuries and Risk Factors Study.

Methods: A systematic review (Stage 1) of medical literature from 1 January 1980 to 31 January 2012 identified indexed articles containing data on incidence, prevalence and causes of blindness and VI. Only cross-sectional population-based representative studies were selected from which to extract data for a database of age- and sex-specific data of prevalence of four distance and one near vision loss categories (presenting and best-corrected). Unpublished data and data from studies using rapid assessment methodology were later added (Stage 2).

Results: Stage 1 identified 14,908 references, of which 204 articles met the inclusion criteria. Stage 2 added unpublished data from 44 rapid assessment studies and four other surveys. This resulted in a final dataset of 252 articles of 243 studies, of which 238 (98%) reported distance vision loss categories. A total of 37 studies of the final dataset reported prevalence of mild VI and four reported near VI.

Conclusion: We report a comprehensive systematic review of over 30 years of VI/blindness studies. While there has been an increase in population-based studies conducted in the 2000s compared to previous decades, there is limited information from certain regions (eg, Central Africa and Central and Eastern Europe, and the Caribbean and Latin America), and younger age groups, and minimal data regarding prevalence of near vision and mild distance VI.     

Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review

The aim of this study was to report on the health inequalities facing stroke survivors with visual impairments as described in the current literature. A systemic review of the literature was conducted to investigate the potential health inequalities facing stroke survivors with subsequent visual impairments. A quality-of-evidence and risk-of-bias assessment was conducted for each of the included articles using the appropriate tool dependent on the type of article. Only four articles discussed health inequalities affecting stroke survivors with visual impairment specifically. A further 23 articles identified health inequalities after stroke, and 38 reported on health inequalities within the visually impaired UK or Irish population. Stroke survivors with visual impairment face inconsistency in eye care provision nationally, along with variability in the assessment and management of visual disorders. The subgroups identified as most at risk were females; black ethnicity; lower socioeconomic status; older age; and those with lower education attainment. The issue of inconsistent service provision for this population must be addressed in future research. Further research must be conducted in order to firmly establish whether or not stroke survivors are at risk of the aforementioned sociodemographic and economic inequalities.     

Visual Impairment and Mortality in a Rural Adult Population (The Southern Harbin Eye Study)

Purpose: To evaluate the association between visual acuity (VA) and 4-year mortality in an older population-based cohort.

Methods: Five thousand and fifty-seven persons aged 50 to 96 years (91.0% of the eligible population) residents of the Southern Harbin, Heilongjiang Provence, China participated in the study. At baseline (2006), the main ocular diseases were diagnosed from a basic ocular examination including presenting and best-corrected VA. Of the 5,057 participants in the baseline survey, those who died after the study were identified and the death certificate was checked. The physicians in charge of the health of the village population were asked for the presumed cause of death. The rate of death was determined in the follow-up survey in 2010. We evaluated the association of visual impairment (VI) and mortality using multiple logistic regression.

Results: Between the baseline examination and the censoring cutpoint study, a total of 214 subjects (4.2%) were dead. Females with VI were less likely to have died relative to male gender with VI (P?<?0.05). Compared with participants who reported better presenting VA (VA ≥ 20/60), the risk of mortality was significantly higher for those reporting moderate VI (20/400 ≤ VA < 20/60) (Odds Ratio [OR], 2.1; 95% confidence interval [CI],1–4.1) and those reporting severe VI (VA < 20/400) (OR,3.6; 95% CI, 2.0–6.6). Similar associations were obtained for best-corrected VA in the better eye (OR, 3.1; 95% CI: 1.5–6.4 and 3.9; 95%CI: 2.1–7.2, respectively).

Conclusion: In this Chinese population-based cohort we found that visual impairment predicted a significantly elevated mortality.     

Impact of Visual Impairment on Quality of Life: A Comparison With Quality of Life in the General Population and With Other Chronic Conditions

Purpose: Subjective evaluation of health-related quality of life (HRQoL) and health status is recognized as an important tool in the assessment and treatment of visually impaired patients. The aims of this study are to describe the generic HRQoL and health status of visually impaired patients and to compare the HRQoL of visually impaired patients with that of both the general population of the Netherlands and patients with other chronic conditions. Methods: 128 persons attending a rehabilitation centre for visually impaired adults completed the EuroQol questionnaire (EQ-5D). These patients' EQ-5D scores were compared with EQ-5D norms of the Dutch population and of patients with other chronic conditions; both sets of data were taken from the literature. Results: The average EQ-5D_index score of the total study population was 0.73 (SD 0.22). Visually impaired patients reported more problems on every dimension of the EQ-5D than the general Dutch population. Only stroke patients and patients with chronic fatigue syndrome and reported more problems on every dimension of the EQ-5D than visually impaired patients. Conclusions: Visual impairment has a substantial impact on the quality of life; compared with other chronic conditions, it seems to affect the HRQoL, spoiling the quality of life more than diabetes type II, coronary syndrome, and hearing impairments, but less than stroke, multiple sclerosis, chronic fatigue syndrome, major depressive disorder, and severe mental illness.     

The Impact of Visual Impairment on Completion of Cognitive Screening Assessments: A Post-Hoc Analysis from the IVIS Study

Aim:The aim of this study was to evaluate completed cognitive screens in stroke survivors with and without visual impairment to explore whether the presence of visual impairment impacts on completion of cognitive screening.Materials and methods:Cognitive screening assessment was undertaken using the Oxford Cognitive Screen (OCS). Data from visual function assessments (inclusive of visual acuity, visual fields, eye movements and visual perception evaluation) were analysed to determine whether presence and/or type of visual impairment impacted on cognitive screening scores achieved. Covariates, including glasses use, gender, age at stroke onset and stroke type, were used to assess confounding impacts on scores attained during cognitive screening.Results:1500 stroke admissions were recruited. One hundred ninety-seven who completed the OCS, were identified from the IVIS study database. Those who reported visual symptoms performed worse statistically on all cognitive tasks except the recall recognition (p = 0.232) and executive tasks (p = 0.967). Visual symptoms did not prevent participants from completing every section of the OCS (p = 0.095). In certain tasks, those not wearing their required glasses performed worse, including the executive function (p = 0.012), broken hearts and sentence reading tasks.Conclusions:Many tasks within cognitive screening assessment are impacted by presence of visual deficits, and adjustments, where possible (e.g. good lighting, large print) should be used to facilitate completion of cognitive screening. It is important to ensure required reading correction is worn during screening.     

The Impact of Visual Impairment on Health-related Quality of Life in Rural Africa

Purpose: To assess the impact of visual impairment (VI) on utility values in Sub-Saharan Africa and compare findings with other studies from low- and high-income countries.

Methods: Patients with normal vision and various levels of VI were recruited from a secondary eye clinic in rural Kenya and interviewed using time trade-off (TTO). VI was classified using the World Health Organization definition of (normal vision, visual acuity ≥20/60, VI 20/80–20/200, severe VI 20/240–20/400, and blindness <20/400).

Results: Mean age of the total sample (N?=?303) was 50.3 years (standard deviation, SD, ±18.17 years), and 51.5% of patients were male. Most were small-scale farmers and illiteracy was high at 40%. Mean TTO scores per group were: normal vision 0.93 (SD?±?0.10), VI 0.88 (SD?±?0.14), severe VI 0.86 (SD?±?0.13), blindness 0.73 (SD?±?0.17; p?≤?0.001). Lower TTO scores were independently associated with worse visual acuity (p?≤?0.001), longer duration of disease (p?≤?0.001) and illiteracy (p?=?0.011), but not with cause of VI, age, sex, marital status, socioeconomic status, or systemic comorbidities in multivariate analyses. Overall, TTO scores were considerably higher than those reported from high-income countries at similar levels of VI.

Conclusion: In this rural African population, duration and extent of vision loss, rather than cause, socioeconomic factors and comorbidities affected vision-related quality of life. Our findings underline the importance of providing sight-restoring treatment as timely as possible and the necessity of enhancing rehabilitation efforts for those with non-curable eye diseases.     

白内障患者视力改变与生存质量的关系

目的:了解白内障病人视力损害及康复与生存质量的关系,探讨影响白内障患者生存质量的因素。方法:应用视功能损害眼病生存质量量表测量142例不同视力损害的白内障患者生存质量及33例白内障摘除 人工晶体植入术前后的生存质量情况。结果:白内障患者视力改变与生存质量的总得分及各方面的得分有相关关系。白内障患者术前后生存质量得分差异有显著性,影响白内障患者生存质量的主要因素为视力损害、年龄和职业。结论:白内障的视力损害将降低患者的生存质量,适当时机进行白内障手术将有助于患者生存质量的提高,生存质量的测量为我们对白内障视力损害的评价提供了新的指标。眼科学报1997;13:85～89。     

Prevalence of Visual Impairment in the Adult Japanese Population by Cause and Severity and Future Projections

Purpose: To present a comprehensive estimate of the total number of people with visual impairment in the adult Japanese population by age, gender, severity and cause, and to estimate future prevalence based on population projections and expected demographic changes.

Methods: Definitions of visual impairment used in this study were based on the United States criteria. Total visual impairment was calculated as the sum of low vision and blindness. The prevalence estimates were based on input from a number of Japanese epidemiological surveys, census material and official population projections.

Results: There were an estimated 1.64 million people with visual impairment in 2007 in Japan. Of these, 187,800 were estimated to be blind. The prevalence of visual impairment in Japan increased with age and half of the people with visual impairment were aged 70 years or older. The leading causes of visual impairment in Japan were glaucoma (24.3%), diabetic retinopathy (20.6%), degenerative myopia (12.2%), age-related macular degeneration (10.9%), and cataract (7.2%). These five major causes comprised three-quarters of all visual impairment. The prevalence of visual impairment was projected to increase from 1.3% of the population in 2007 to 2.0% by 2050.

Conclusions: This comprehensive study presents the prevalence of total visual impairment in the adult Japanese population. The projected increases in the prevalence of visual impairment over time reflect the demographic changes of a declining and aging Japanese population. These projections highlight that the burden of disease due to visual impairment and imposed on society is likely to increase.     

Causes of Blindness and Visual Impairment among Students in Integrated Schools for the Blind in Nepal

Purpose: To identify the causes of blindness and visual impairment among students in integrated schools for the blind in Nepal.

Methods: A total of 778 students from all 67 integrated schools for the blind in Nepal were examined using the World Health Organization/Prevention of Blindness Eye Examination Record for Children with Blindness and Low Vision during the study period of 3 years.

Results: Among 831 students enrolled in the schools, 778 (93.6%) participated in the study. Mean age of students examined was 13.7 years, and the male to female ratio was 1.4:1. Among the students examined, 85.9% were blind, 10% had severe visual impairment and 4.1% were visually impaired. The cornea (22.8%) was the most common anatomical site of visual impairment, its most frequent cause being vitamin A deficiency, followed by the retina (18.4%) and lens (17.6%). Hereditary and childhood factors were responsible for visual loss in 27.9% and 22.0% of students, respectively. Etiology could not be determined in 46% of cases. Overall, 40.9% of students had avoidable causes of visual loss. Vision could be improved to a level better than 6/60 in 3.6% of students refracted.

Conclusion: More than one third of students were visually impaired for potentially avoidable reasons, indicating lack of eye health awareness and eye care services in the community. The cause of visual impairment remained unknown in a large number of students, which indicates the need for introduction of modern diagnostic tools.     

Measuring the Personal Burden of Eye Disease and Vision Impairment

Purpose: To describe research methods for assessing the personal burden of eye disease and vision impairment on health and functional well-being. Methods: Three methods are described, which are largely complementary of each other. (1) Questionnaires are patient-centered in that they provide the person's own self-reported perspective on difficulty in engaging in everyday activities, psychological well-being, and/or health status. Examples are generic and vision-targeted health-related quality of life instruments, domain-specific questionnaires, and instruments that screen for psychological comorbidities. (2) Direct assessment of actual behavior provides information about the functional competences the patient has. Examples are mobility performance and reading speed. (3) Administrative records maintained by government, healthcare, and other agencies provide information relevant to the existence of adverse or detrimental circumstances that engender decreased health and well-being. Examples are healthcare utilization, employment history, and motor vehicle collision involvement. Discussion: Measures of eye disease severity should not be used in research as surrogates for the personal burden of eye disease and vision impairment. Individuals personally respond to and cope with the presence of eye disease and vision impairment in very wide ranging ways. There are several ways to measure the personal burden of eye disease and vision impairment that provide information about the person's own perspective on his/her health and well-being and functional competences.     

双眼先天性白内障儿童生活质量的初步评价

目的评价双眼先天性白内障儿童生活质量的现状以及影响因素。方法应用双眼先天性白内障儿童生活质量量表对8—15岁的81例双眼先天性白内障儿童以及28例正常视力儿童进行了调查。白内障儿童组平均年龄为（9．8±2．6）岁,女性37例（45．7％）。其中36例患儿参加了术前及术后的问卷调查;另外45例患儿仅参与了术后的问卷调查。调查并比较白内障儿童和正常视力儿童的生活质量得分,依据年龄、性别、学习成绩、视力、手术干预以及白内障的类型特点对白内障儿童生活质量进行相关分析,同时应用多元回归模型分析白内障儿童生活质量的影响因子。结果双眼先天性白内障儿童手术后的生活质量得分明显低于正常视力儿童（P=0．00）。非致密性白内障患儿手术后生活质量高于手术前（P=0．00）。白内障儿童的视力与生活质量显著相关（r=0．53,P=0．00）。致密性和非致密性白内障儿童的术后生活质量得分差异有统计学意义（P=0．00）。进入多重线性回归方程的变量为白内障类型（β=6．14,P=0．00）、手术干预（β=3．21,P=0．01）和视力（β=1．07,P=0．01）。结论双眼先天性白内障儿童生活质量明显低下,其主要影响因素为白内障类型、手术干预和视力,其中提高视力是改善患儿生活质量的关键所在。（中华眼科杂志,2007,43：996．999）     

Coverage of Hospital-based Cataract Surgery and Barriers to the Uptake of Surgery among Cataract Blind Persons in Nigeria: The Nigeria National Blindness and Visual Impairment Survey

Purpose: To determine cataract surgical coverage, and barriers to modern cataract surgery in Nigeria.

Methods: Multistage stratified cluster random sampling was used to identify a nationally representative sample of 15,027 persons aged 40+ years. All underwent visual acuity testing, frequency doubling technology visual field testing, autorefraction, and measurement of best corrected vision if <6/12 in one or both eyes. An ophthalmologist examined the anterior segment and fundus through an undilated pupil for all participants. Participants were examined by a second ophthalmologist using a slit lamp and dilated fundus examination using a 90 diopter condensing lens if vision was <6/12 in one or both eyes, there were optic disc changes suggestive of glaucoma, and 1 in 7 participants regardless of findings. All those who had undergone cataract surgery were asked where and when this had taken place. Individuals who were severely visually impaired or blind from unoperated cataract were asked to explain why they had not undergone surgery.

Results: A total of 13,591 participants were examined (response rate 89.9%). Prevalence of cataract surgery was 1.6% (95% confidence interval 1.4–1.8), significantly higher among those aged ≥70 years. Cataract surgical coverage (persons) in Nigeria was 38.3%. Coverage was 1.7 times higher among males than females. Coverage was only 9.1% among women in the South-South geopolitical zone. Over one third of those who were cataract blind said they could not afford surgery (36%).

Conclusions: Cataract surgical coverage in Nigeria was among the lowest in the world. Urgent initiatives are necessary to improve surgical output and access to surgery.     

Visual Function and Quality of Life in Patients Who Had Undergone Eye Removal Surgery: A Patient Survey

Abstract

Purpose: To measure aspects of self-reported vision-related health status and assess the impact of treatment in patients who have undergone eye removal surgery (evisceration or enucleation), using a patient administered questionnaire.

Methods: In this non-randomised, questionnaire-based cohort study, patients were identified from the Artificial Eye Service referral register from 2003 to 2010. A self-administered questionnaire based upon previously published scales was completed to measure aspects of visual function and the impact of treatment.

Results: Thirty-six completed questionnaires were obtained. Mean age at surgery was 54.1 years (range 13–90), with 83% male. Indication for eye-removal was trauma in 14(39%) cases. Ten (28%) had ocular co-morbidity in the fellow-eye. The main reported difficulties were with peripheral vision or distance judgements, in 64% patients. The majority of drivers (66%) had maintained the ability to drive. Self-consciousness was reported in 28(78%) patients, and 56% were able to continue work or activities with no perceived limitations. Overall comfort and aesthetic improvement were noted by the majority. Procedure-specific information leaflets for patients were appreciated.

Conclusions: This survey increases our knowledge of aspects of vision-related health status following ocular pathology or trauma that requires eye removal, and may enable improved pre-operative patient counselling. Effects on peripheral vision may be noted most significantly, but the majority can continue normal activities with little difficulty. Overall improvement in comfort and appearance occurs in most patients, although feelings of self-consciousness are common.     

Utility Weights for the Vision-related Assessment of Quality of Life (AQoL)-7D Instrument

Purpose: To obtain utility weights consistent with the needs of economic evaluation for the Assessment of Quality of Life (AQoL)-7D, a generic instrument created to increase the sensitivity of the measurement of quality of life amongst people with impaired vision.

Methods: Two extant instruments were combined, the Vision-related Quality of Life Index (VisQoL) and the AQoL-6D. Utilities were obtained from patients with visual impairment and from the general population using time trade-off (TTO) methodology. Dimensions were combined and an econometric adjustment used to eliminate the effects of instrument redundancy. Bias was tested by comparison of holistic TTO values with utility scores predicted from the AQoL-7D scoring formula.

Results: The AQoL-7D instrument consists of 26 items and 7 dimensions each with good psychometric properties. Their combination into a single instrument resulted in significant redundancy which was successfully eliminated. Utility formulae for both the public and patients produced bias-free estimates of the utility of holistic health states describing visual impairment. Results imply differing valuations of health states by the public and by people with impaired vision.

Conclusions: The AQoL-7D can detect changes in health states affecting people with impaired vision which are likely to be overlooked by other generic instruments due to content insensitivity. The utilities it produces are generated using a “mainstream” methodology, the TTO. Quality-adjusted life year values based on the AQoL-7D may therefore be used for economic evaluation of programs.     

Income and Education are Independently Associated with Visual Impairment: The Korean National Health and Nutrition Examination Survey 2010-2012

Purpose: To investigate the association of visual impairment (VI) with socioeconomic status, including the highest educational level and household income when other confounding variables were adjusted.

Methods: The Korean National Health and Nutrition Examination Survey 2010–2012 data were analyzed. The final analyses included a total of 16,905 subjects with their demographic, socioeconomic, and health data. The socioeconomic data included the household income and the highest educational level. Household income was categorized into quartiles. The educational attainment was categorized as ≤ elementary school, middle school, high school, and ≥ university. VI was defined when the distance-corrected VA was worse than 0.32 (20/63 Snellen) in the better-seeing eye according to the definition of the World Health Organization. Four multiple logistic regression models were used to determine the odds ratio (OR) and 95% confidence interval (CI) between VI and household income or between VI and the highest educational level, by adjusting for several confounding variables.

Results: The prevalence of VI was 5.0% (844 subjects). Multiple logistic regression analyses indicated that the adjusted OR was 1.729 (95% CI: 1.108–2.697) for developing VI in subjects with ≤ elementary school as their highest education level compared to those with ≥ university education. Also, the adjusted OR of subjects in the first quartile of household income was 1.502 (95% CI: 1.061–2.127) for developing VI compared to those in the fourth quartile of household income.

Conclusions: The present study showed that household income and education were independently associated with VI even after adjusting for significant confounding variables.