The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma

Joshua R Ehrlich, Nathan M RadcliffeDepartment of Ophthalmology, Weill Cornell Medical College, New York, NY, USAPurpose: To determine if clinical evaluation of parapapillary atrophy (PPA) significantly improves the ability to distinguish open-angle glaucoma (OAG) patients from glaucoma suspects.Methods: Patients in this study were under evaluation for glaucoma and had open angles, at least one reliable 24-2 SITA-standard automatic perimetry, and digital stereophotographs of the optic disc. PPA was identified clinically as a parapapillary region of absent (βPPA) or hyper/hypopigmented (αPPA) retinal pigment epithelium. A single masked observer evaluated photos for: vertical cup-to-disc ratio (CDR), clock hours of total and βPPA, βPPA as percentage width of the optic disc, presence or absence of βPPA at each disc quadrant, and ordinal rating of total PPA. Generalized linear models were used to determine odds of an abnormal or borderline glaucoma hemifield test (GHT) as a function of PPA variables and covariates; model fit was assessed using the log-likelihood ratio test.Results: Of 410 consecutive patients, 540 eyes (of 294 patients) met inclusion criteria. Mean age was greater among patients with abnormal compared with normal GHT (P < 0.001), but sex and race/ethnicity did not differ between groups (P ≥ 0.22). Age, central corneal thickness (CCT) and CDR (P ≤ 0.006), but not intraocular pressure (IOP) (P = 0.71), were significant univariable predictors of the odds of an abnormal GHT. All PPA parameters significantly ­predicted GHT (P ≤ 0.03), except presence of temporal βPPA (P = 0.25). Adjustment for age, CCT, IOP, and CDR reduced the association between PPA and GHT, and model fit was not greatly improved by addition of PPA variables.Conclusions: Addition of most PPA parameters to a model already containing commonly assessed variables including age, CCT, IOP, and CDR does not significantly improve the ability to distinguish OAG patients from glaucoma suspects.Keywords: glaucoma, visual fields, parapapillary atrophy, optic nerv

Prevalence of Falls and Fall‐Related Outcomes in Older Adults with Self‐Reported Vision Impairment

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147783/1/jgs15628_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147783/2/jgs15628.pd

Functioning and Vision-Related Quality of Life in Severe Peripheral Field Loss due to Retinitis Pigmentosa: A Qualitative Study

Vision impairment and blindness are associated with disability and decreased social participation and independence. While vision rehabilitation may improve patients’ functional abilities, there is scarce data regarding the effectiveness of rehabilitation for patients with severe peripheral field loss (PFL). In order to evaluate rehabilitation strategies for individuals with severe PFL, a valid and reliable instrument to measure vision-dependent functioning and vision-related quality of life is needed. Accordingly, this qualitative study was the first phase in developing a patient-reported outcome (PRO) measure tailored to this population. Individuals with retinitis pigmentosa (RP) were recruited from the Kellogg Eye Center and the Association for the Blind and Visually Impaired. The study sample included 17 participants (53% female, mean age 48); median presenting visual acuity and Pelli-Robson contrast sensitivity were 20/40 and 1.2 log contrast sensitivity, respectively. The maximum horizontal extent of the Goldmann visual field was 11° in the better-seeing eye. Study participants completed a semi-structured qualitative interview, and two quality of life questionnaires. Interviews were recorded, transcribed and coded by two independent coders. Thematic analysis of the interview codes identified six vision-related quality of life themes across all RP participants: activity limitations, driving, emotional well-being, reading, mobility and social function. These themes will serve in the development of a PRO specific to severe PFL, which will facilitate evaluation and eventual evolution of low vision rehabilitation for patients with severe PFL

Design of Smart Head-Mounted Display Technology: A convergent mixed methods study

The purpose of this study was to explore the factors impacting preference for head-mounted display (HMD) technology among individuals with visual impairment. HMD are commercially available assistive devices intended for those with low vision. Individuals with a range of visual impairment and diagnosis of either age-related macular degeneration, diabetic retinopathy, glaucoma or retinitis pigmentosa were recruited. Participants completed the Impact of Vision Impairment (IVI) questionnaire, were taught to use three different HMDs (eSight, Epson Moverio, and NuEyes) and were subsequently interviewed regarding their experience. Interviews were recorded, transcribed, and coded by two independent coders. Qualitative data was analyzed using a thematic approach and a joint display analysis was conducted. Twenty-one participants were interviewed (mean age 58.2 years, 57% male, median Snellen acuity 20/40 [range 20/20-hand movement]). An equal number of participants (n=9) expressed preference for eSight and NuEyes, while (n=3) preferred the Epson Moverio. Participants emphasized ease of use, especially of HMD controls and screen, as primary reasons for HMD preference. Participants with lower IVI Well-Being scores were more likely to express eSight preference due to clarity, ease of use, and vision improvement. Those with moderate IVI Well-Being scores were more likely to prefer the NuEyes due to appearance, wireless design, and magnification. Those with higher IVI Well-Being scores cited usability as the most important HMD feature. This study found that user preferences for HMD was associated with vision-related well-being, and that usability of devices was paramount in preference

Vision difficulty and dementia: economic hardships among older adults and their caregivers

IntroductionLimited research has examined the economic impact of vision difficulty (VD) and dementia on older adults and their caregivers. We aimed to determine whether older adults with VD and/or dementia, and their caregivers, face more economic hardships than their counterparts without VD or dementia.MethodsWe used cross-sectional data from the 2015 National Health and Aging Trends Study (NHATS), a population-based survey of Medicare beneficiaries, linked to their family/unpaid caregivers from the National Study of Caregiving (NSOC). Regression models characterized the association of VD (self-report), dementia (survey and cognitive assessments), and co-occurring VD and dementia with debt, receiving financial help from relatives, government-based Supplemental Nutrition Assistance Program (SNAP), other food assistance, utility assistance, and caregiver financial difficulty.ResultsThe NHATS sample included 6,879 community-dwelling older adults (5670 no VD/dementia, 494 VD-alone, 512 dementia-alone, 203 co-occurring VD and dementia). Adults with VD and dementia had higher odds of receiving SNAP benefits (OR = 2.6, 95%CI = 1.4–4.8) and other food assistance (OR = 4.1, 95%CI = 1.8–9.1) than adults without VD/dementia, while no differences were noted for debt, financial help, and utility assistance. Adults with VD-alone had higher odds of debt (OR = 2.1, 95%CI = 1.3–3.2), receiving financial help (OR = 1.7, 95%CI = 1.1–2.5) and other food assistance (OR = 2.7, 95%CI = 1.7–4.3); while adults with dementia-alone had higher odds of debt (OR = 2.8, 95%CI = 1.4–5.5). The NSOC sample included 1,759 caregivers (995 caring for adults without VD/dementia, 223 for VD-alone, 368 for dementia-alone, and 173 for co-occurring VD and dementia). Compared to caregivers of older adults without VD/dementia, caregivers of adults with VD and dementia had higher odds of financial difficulty (OR = 3.0, 95%CI = 1.7–5.3) while caregivers of adults with VD-alone or dementia-alone did not.DiscussionWhile older adults with VD- or dementia-alone experienced increased economic hardships, disparities in food assistance were amplified among older adults with co-occurring disease. Caregivers of adults with co-occurring disease experienced more financial difficulty than caregivers of adults with a single or no disease. This study highlights the need for interventions across clinical and social services to support the economic wellbeing of our aging population and their caregivers