Self-reported quality of life in patients with retinitis pigmentosa and maculopathy of Bothnia type

Marie SI Burstedt, Eva MönestamDepartment of Clinical Sciences/Ophthalmology, University of Umeå, SwedenPurpose: To assess vision-related quality-of-life subscales with objective measurements of visual function in patients affected with retinitis pigmentosa of Bothnia type (BD).Methods: Forty-nine patients answered the NEI-VFQ-25 questionnaire. High- and low-contrast distance acuity (VA), near VA, and visual fields (VF) were measured. Weighted VA (WVA) and low-contrast (10%) VA (WLCVA), binocular VF areas, and central scotoma were calculated. Adjusted mean subscale scores were calculated and associations analyzed.Results: Subscale scores for general, far, and near vision, social functioning, and color vision were lowest while general health, ocular pain, and mental health were highest in the BD phenotype. The correlations were substantial and similar for WVA, WLCVA, and near vision. The degree of measured VF impairment had few associations with the different adjusted subscale scores.Conclusion: The NEI VFQ-25 subscales were well associated with clinical vision measures depending on VA. The progression of VF defects typical for the BD phenotype does not seem to affect the self-perceived quality of life, which might indicate adaptability to this type of progressive VF loss. The BD phenotype has a significant impact on multiple domains of daily life, but there are no signs of accelerating depression related to the increasing visual impairment.Keywords: visual function, low vision, maculopathy, RP, Bothnia dystrophy, visual cycle, RLBP

Associations between subjective and objective visual function in patients with unilateral macular holes

AbstractForty-six patients with uniocular macular holes and unaffected, fellow eyes were studied to evaluate inter- and intraocular associations between various objective tests of visual function and perceived visual ability. The affected eye had significant associations between visual acuity (VA) and the fovea threshold test, but for the fellow eye only VA and low-contrast VA 10% were associated. The reduction in visual acuity under low-contrast conditions relative to high-contrast did not differ between the affected eye and the healthy eye. Subjective visual ability seems to depend more on the visual acuity of the affected eye than the healthy eye

First and second eye cataract surgery and driver self-regulation among older drivers with bilateral cataract: A prospective cohort study

Background: Driving a car is the most common form of transport among the older population. Common medical conditions such as cataract, increase with age and impact on the ability to drive. To compensate for visual decline, some cataract patients may self-regulate their driving while waiting for cataract surgery. However, little is known about the self-regulation practices of older drivers throughout the cataract surgery process. The aim of this study is to assess the impact of first and second eye cataract surgery on driver self-regulation practices, and to determine which objective measures of vision are associated with driver self-regulation. Methods: Fifty-five older drivers with bilateral cataract aged 55+ years were assessed using the self-reported Driving Habits Questionnaire, the Mini-Mental State Examination and three objective visual measures in the month before cataract surgery, at least one to three months after first eye cataract surgery and at least one month after second eye cataract surgery. Participants' natural driving behaviour in four driving situations was also examined for one week using an in-vehicle monitoring device. Two separate Generalised Estimating Equation logistic models were undertaken to assess the impact of first and second eye cataract surgery on driver-self-regulation status and which changes in visual measures were associated with driver self-regulation status. Results: The odds of being a self-regulator in at least one driving situation significantly decreased by 70% after first eye cataract surgery (OR: 0.3, 95% CI: 0.1-0.7) and by 90% after second eye surgery (OR: 0.1, 95% CI: 0.1-0.4), compared to before first eye surgery. Improvement in contrast sensitivity after cataract surgery was significantly associated with decreased odds of self-regulation (OR: 0.02, 95% CI: 0.01-0.4). Conclusions: The findings provide a strong rationale for providing timely first and second eye cataract surgery for older drivers with bilateral cataract, in order to improve their mobility and independence

Visual and refractive outcomes and glistenings occurrence after implantation of 2 monofocal, aspheric, hydrophobic acrylic IOLs

PURPOSE: To compare the Clareon intraocular lens (IOL) with the Tecnis PCB00 IOL in terms of visual performance, refractive outcomes, glistenings occurrence, and quality-of-life outcomes. SETTING: Guy's and St Thomas' NHS Foundation Trust, London, England. DESIGN: Single-center, single-masked, prospective, randomized, controlled trial. METHODS: One hundred thirty-nine patients with bilateral cataracts were randomized to receive the Clareon (C IOL) or Tecnis (T IOL) IOL. Visual acuity, refraction, central corneal thickness (CCT), endothelial cell loss, contrast sensitivity, and mesopic gap acuity, evaluation of glistenings and rates of perioperative and postoperative complications were recorded. Quality-of-life outcomes were measured with the EuroQOL-5 Dimension questionnaire and the Patient-Reported Outcome Measures questionnaire. Optimised A-constants were available for the T IOL but not the C IOL. RESULTS: Seventy-one patients (140 eyes) received the C IOL and 68 patients (134 eyes) received the T IOLs. Data were analysed for the first implanted eye. At 12 months, mean uncorrected distance visual acuity (logarithm of the minimum angle of resolution) was 0.02+/-0.10 and 0.01+/-0.08 (mean+/- SD; P=0.49; 95% CI -0.02, 0.04) in the C IOL and T IOL groups, respectively. Corrected visual acuity was -0.02+/-0.09 and -0.03+/-0.06, respectively (P=0.45; 95% CI -0.02, 0.04). The increase in CCT was 14+/-19 and 16+/-28 μm, respectively (P=0.63;95% CI -10.16, 6.16). Mean absolute refraction spherical equivalent error from target refraction was 0.41+/-0.28 for the C IOL and 0.25+/-0.2 for the T IOL groups (P=0.002; 95% CI 0.08, 0.24). Glistenings were minimal (median grade 0), with no difference in grades between groups (P=0.2). PROMS improved postoperatively and were similar in both groups. CONCLUSIONS: There were no differences in visual outcomes between the Clareon IOL and Tecnis PCB00 IOLs. Glistenings were rarely observed in either IOL with no difference in grades. There was no difference in perioperative or postoperative complications. Surgeon optimization of the A-constant for the Clareon IOL is recommended

Oculo-visual changes and clinical considerations affecting older patients with dementia

Purpose: Dementia is associated with various alterations of the eye and visual function. Over 60% of cases are attributable to Alzheimer's disease, a significant proportion of the remainder to vascular dementia or dementia with Lewy bodies, while frontotemporal dementia, and Parkinson's disease dementia are less common. This review describes the oculo-visual problems of these five dementias and the pathological changes which may explain these symptoms. It further discusses clinical considerations to help the clinician care for older patients affected by dementia. Recent findings: Visual problems in dementia include loss of visual acuity, defects in colour vision and visual masking tests, changes in pupillary response to mydriatics, defects in fixation and smooth and saccadic eye movements, changes in contrast sensitivity function and visual evoked potentials, and disturbance of complex visual functions such as in reading ability, visuospatial function, and the naming and identification of objects. Pathological changes have also been reported affecting the crystalline lens, retina, optic nerve, and visual cortex. Clinically, issues such as cataract surgery, correcting the refractive error, quality of life, falls, visual impairment and eye care for dementia have been addressed. Summary: Many visual changes occur across dementias, are controversial, often based on limited patient numbers, and no single feature can be regarded as diagnostic of any specific dementia. Nevertheless, visual hallucinations may be more characteristic of dementia with Lewy bodies and Parkinson's disease dementia than Alzheimer's disease or frontotemporal dementia. Differences in saccadic eye movement dysfunction may also help to distinguish Alzheimer's disease from frontotemporal dementia and Parkinson's disease dementia from dementia with Lewy bodies. Eye care professionals need to keep informed of the growing literature in vision/dementia, be attentive to signs and symptoms suggestive of cognitive impairment, and be able to adapt their practice and clinical interventions to best serve patients with dementia

Twenty-year follow-up of cataract surgery in car-drivers : associations between subjective visual difficulties and objective visual function

Background/Aims: Driving especially at night is a visually demanding task. Long-time outcome of cataract surgery in drivers is important to study, as many patients live for decades after surgery. The purpose of this study is to longitudinally investigate visual function in active car drivers, 20 years after cataract surgery. Methods: From a population-based, prospective, cohort of cataract surgery patients, initiated in 1997–98, 114 of the 133 surviving patients were included. Preoperatively, postoperatively 5, 10, 15 and 20 years after surgery, the patients answered a visual function questionnaire including driving status and difficulty. Habitual visual acuity, best corrected visual acuity (BCVA), and low contrast acuity (LCVA) 10% and 2.5% were measured. Results: The driving difficulties in daylight were almost absent after surgery and did not change over 20 years. Nighttime driving was more difficult and declined longitudinally after surgery, p=0.013, but were at 20 years still less than before cataract surgery. Patients with better BCVA experienced less difficulties driving in darkness, p=0.005. Self-reported problems with glare were significantly associated with BCVA of the better-seeing eye, LCVA 10% and LCVA 2.5% (p=0.046, p=0.033, and 0.024 respectively). Self-reported difficulties with seeing in low-contrast conditions were also significantly associated with BCVA, p=0.004. Conclusion: Twenty years after cataract surgery, most active drivers have no or minor visual functional problems during driving in daytime. Difficulties in nighttime driving are more common and increase significantly over time. Twenty years after surgery, all current drivers had still better subjective ability to drive, compared with before surgery

Long-term results of cataract surgery in type 2 diabetics, a 20-year prospective longitudinal study

Purpose: To investigate the 20-year outcome, in best-corrected visual acuity (BCVA), and subjective visual function (VF-questionnaire, VF-14) after cataract surgery in type 2 diabetics, compared with non-diabetics. Methods: 109 type 2 diabetics and 698 non-diabetics, who had cataract surgery during 1 year at one institution, were included in this prospective, longitudinal, population-based cohort study. BCVA and VF-14 responses were recorded pre- and postoperatively, and every 5 years up to 20 years after surgery. Retinopathy was graded before surgery. Results: There was no significant difference between diabetics and non-diabetics, in change in BCVA from 10 years or more after surgery, p = 0.45, p = 0.44 and p = 0.83, at 10, 15 and 20 years, respectively, as well as in self-perceived visual function (VF-14) at any time after surgery, p = 0.72, p = 0.20 and p = 0.78, 10–20 years, respectively. At any follow-up, there was no significant difference in BCVA in relation to retinopathy level before surgery, p = 0.1 at 20 years. There was a trend from 10 years after surgery and onward that patients with no retinopathy at baseline lost fewer letters during the 20 years than diabetics with retinopathy. Patients with known type 2 diabetes at surgery had a significantly lower survival compared with the non-diabetics at each follow-up, p = 0.003. Conclusion: In surviving diabetics, BCVA and subjective visual function were retained in most cases up to 20 years after cataract surgery. Cataract extraction is effective in causing a sustainable improvement in visual function also in type 2 diabetics. Knowledge of these long-term outcomes is essential when counselling diabetics for cataract surgery

Evaluation of energy performance in single family houses

In order to improve people’s living situation and decrease the use of fossil energy in the world, researchers’ attention has been focused on the energy side of the building sector. Especially single family houses in the Nordic countries Norway, Sweden and Finland have been given attention in the Increasing Energy Efficiency in Buildings (IEEB) project, with the purpose of increasing energy efficiency in buildings. In the project presented in this report, this has been studied by simulating a low energy single family house at different locations in Scandinavia, and applying the various national building codes to the house to see how it would match the energy requirements. The simulated locations included the different climates in Helsinki, Oulu (Finland), Oslo, Narvik (Norway), Piteå, Umeå, Karlstad, Borlänge, Stockholm and Kalmar (Sweden). The house fulfilled almost all the national energy requirements with more or less margin because of its low energy use. A comparison with actual measurements of the house did not match as good, because of uncertainty in measurement methods and climate aspects. The national building codes and climate in the Nordic countries turned out to be similar enough for a coordination of the building codes to be possible in the future

Evaluation of energy performance in single family houses

In order to improve people’s living situation and decrease the use of fossil energy in the world, researchers’ attention has been focused on the energy side of the building sector. Especially single family houses in the Nordic countries Norway, Sweden and Finland have been given attention in the Increasing Energy Efficiency in Buildings (IEEB) project, with the purpose of increasing energy efficiency in buildings. In the project presented in this report, this has been studied by simulating a low energy single family house at different locations in Scandinavia, and applying the various national building codes to the house to see how it would match the energy requirements. The simulated locations included the different climates in Helsinki, Oulu (Finland), Oslo, Narvik (Norway), Piteå, Umeå, Karlstad, Borlänge, Stockholm and Kalmar (Sweden). The house fulfilled almost all the national energy requirements with more or less margin because of its low energy use. A comparison with actual measurements of the house did not match as good, because of uncertainty in measurement methods and climate aspects. The national building codes and climate in the Nordic countries turned out to be similar enough for a coordination of the building codes to be possible in the future