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Objectives: To describe characteristics of services, providers, and patients in low-vision rehabilitation entities serving adults in the United States., Methods: Entities (excluding Veterans Affairs clinics) were identified through professional associations, Web searches, and a telephone survey to retina practices. A census obtained information on entity types, provider types, rehabilitation services available, and clientele. Surveys were administered by telephone, fax, e-mail, or mail, whichever was preferred by the respondent., Results: A total of 1228 low-vision rehabilitation service entities were identified, with 608 surveyed (49.5% response rate). Almost half (42.7%) were private optometry practices. State agencies had the highest number of clients per week (45.0 clients per week) whereas private optometry practices had the lowest (4.1 clients per week). Most (> or =88.0%) established rehabilitation goals, fit optical aids with basic training, and conducted eye examinations. Scanning, eccentric viewing, orientation and mobility, and advanced device training were less commonly offered (25%-50% of entities). Central vision impairment was the most common deficit (74.1% of clients), with age-related macular degeneration being the most common cause (67.1%). Among the clients, 85.9% had problems reading and 67.7% had problems driving; 44.9% had adjustment disorders. Almost 1 in 3 clients was aged 80 years or older., Conclusion: This census for the first time characterizes usual-care low-vision rehabilitation services in the United States for nonveteran adults.

Objective: To evaluate the impact of the Florida visual acuity licensing standard for drivers 80 years and older on fatal motor vehicle collision (MVC) involvement., Methods: Motor vehicle collision fatality rates for all Florida residents and for drivers 80 years and older were compared before and after the visual acuity licensing standard was implemented in January 2004., Results: From 2001 to 2006, there was a nonsignificant (P = .06) increase in MVC fatality rates in Florida; in contrast, fatality rates among drivers 80 years and older demonstrated a significant downward linear trend (P = .01). When comparing prelaw (2001-2003) and postlaw (2004-2006) periods, the fatality rate among all-aged occupants increased by 6% (rate ratio, 1.06; 95% confidence interval, 0.99-1.14); conversely, fatalities among drivers 80 years and older decreased significantly by 17% (rate ratio, 0.83; 95% confidence interval, 0.72-0.98)., Conclusions: Despite little evidence for an association between visual acuity and MVC involvement, the results of this study suggest that a vision screening law targeting Floridians 80 years and older resulted in a reduction in the MVC fatality rate among such drivers. The exact mechanism responsible for this association is unclear and future research should attempt to identify what might explain this relationship.

Objective: To examine the effect of treating uncorrected refractive error through spectacle correction on vision-targeted health-related quality of life and depressive symptoms in nursing home residents., Methods: Persons aged 55 years or older residing in nursing homes in Birmingham, Alabama, having uncorrected refractive error were randomly assigned to either immediate spectacle correction of uncorrected refractive error or delayed correction (after the 2-month follow-up visit)., Main Outcome Measures: Vision-targeted health-related quality of life (measured with the Nursing Home Vision-Targeted Health-Related Quality-of-Life Questionnaire and the VF-14) and depressive symptoms (measured with the Geriatric Depression Scale), assessed at baseline and at 2 months., Results: At the 2-month follow-up, the immediate refractive error correction group as compared with the delayed correction group had higher scores on the Nursing Home Vision-Targeted Health-Related Quality-of-Life Questionnaire subscales of general vision, reading, psychological distress, activities and hobbies, and social interaction (all P < .04) and the VF-14 (P < .001) as well as fewer depressive symptoms on the Geriatric Depression Scale (P = .003), adjusting for mental status and baseline outcome variables., Conclusions: Dispensing spectacles to treat uncorrected refractive error in nursing home residents leads to improved quality of life and decreased symptoms of depression., Application to Clinical Practice: This study demonstrates that older adults residing in nursing homes can personally benefit from access to the most basic of eye care services., Trial Registration: clinicaltrials.gov Identifier: NCT00347620.

Objective: To investigate whether hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) prevent the development of diabetic retinopathy., Methods: We conducted a nested case-control study among patients at the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama. Within a study population of male diabetic patients (n=6441), we identified incident cases of diabetic retinopathy diagnosed between January 1, 1997, and December 31, 2001 (n=114). Control subjects were selected using incidence density sampling and were matched for diabetes duration. Information regarding filled statin prescriptions was obtained for cases and controls., Results: Cases and controls did not differ regarding overall statin use in crude analysis (odds ratio, 1.01; 95% confidence interval, 0.64-1.59) and in multivariate analyses adjusted for age, race, and coexisting medical conditions (odds ratio, 1.00; 95% confidence interval, 0.60-1.67)., Conclusion: The results of this study do not support an association between statins and diabetic retinopathy.

Objective: To examine vision-targeted health-related quality of life and psychosocial characteristics in patients with benign essential blepharospasm (BEB) compared with patients with hemifacial spasm (HFS)., Methods: Persons with BEB (n = 159) or HFS (n = 91) were identified based on International Classification of Diseases, Ninth Revision, Clinical Modifications codes with subsequent verification by record abstraction. Information regarding demographics, health characteristics, disease characteristics, and vision-targeted health-related quality of life was obtained through a telephone interview., Results: For patients with BEB and HFS, the composite scores and subscale scores on the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) were low. Compared with patients with HFS, patients with BEB reported more depressive symptoms (P = .03), met the criteria for generalized anxiety disorder (P = .007), had lower NEI-VFQ-25 composite scores (P<.001), and had lower NEI-VFQ-25 subscale scores regarding general vision (P = .03), ocular pain (P<.001), distance activities (P = .001), driving (P<.001), and all of the vision-specific subscales addressing psychosocial issues., Conclusions: Compared with patients with HFS, those with BEB experience a greater reduction in vision-targeted health-related quality of life and are more prone to symptoms of depression and anxiety. This underscores the inadequacy of current treatment options for BEB in light of the fact that these patients had been undergoing standard-of-care treatments for some time.

Objective: To evaluate both the use of cholesterol-lowering medications as a group and the use of statins specifically with regard to the risk of age-related macular degeneration (AMD)., Methods: A case-control study was conducted using data from the Cardiovascular Health Study, a population-based prospective study of adults enrolled from 4 communities in the United States in 1989 and 1990. Individuals with AMD (cases) and those without AMD (controls) were compared with regard to their use of cholesterol-lowering medications and statins., Results: Nearly equal proportions of cases and controls used cholesterol-lowering medications, both before adjustment (odds ratio, 0.92; 95% confidence interval, 0.70-1.21) and after adjustment for selected confounding variables (age, sex, and race) (odds ratio, 1.35; 95% confidence interval, 0.98-1.87). Statin use was also found to be similar among cases and controls (odds ratio, 0.98; 95% confidence interval, 0.73-1.30). After controlling for the aforementioned 3 confounders (odds ratio, 1.40; 95% confidence interval, 0.99-1.98), we noted a modest trend for statin users to have an increased risk of AMD., Conclusion: The results suggest that no association exists between having used cholesterol-lowering medications and AMD. However, there was a suggestion that statin use might increase the risk of AMD.

Objective: To provide a comprehensive estimate of the rate of eye injury in the United States., Methods: Data from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey for 2001 were combined and used to provide estimates of eye injuries treated in emergency departments, inpatient and outpatient facilities, and private physicians' offices, as well as their causes and characteristics [corrected], Results: In the United States in 2001, an estimated 1 990 872 (6.98 per 1000 population) individuals experienced an eye injury requiring treatment in an emergency department, inpatient or outpatient facility, or private physician's office. Most eye injuries are treated in emergency departments (50.7%), followed by private physicians' offices (38.7%), and outpatient (8.1%) and inpatient (2.5%) facilities. Eye injury rates were highest among individuals in their 20s, males, and whites. Injury rates were highest for superficial injuries, foreign bodies, contusions, and open wounds., Conclusions: This study provides a comprehensive estimate of the rate of eye injury in the United States. Private physicians represent an important source of care for eye injury in the United States.

Objective: To present the descriptive epidemiology of emergency department-treated eye injury in the United States., Methods: Data from the Consumer Product Safety Commission's National Electronic Injury Surveillance System All Injury Program was used to estimate the number of patients treated in US emergency departments for eye injuries. Eye injury rates were calculated according to age, sex, and race, and characteristics of the injury event were determined., Results: The rate of emergency department-treated eye injury in the United States is 3.15 per 1000 population (95% confidence interval, 2.66-3.63). Rates were highest among those in their 20s and 30s, among males, and among American Indians and African Americans. The majority of injuries occurred in the home, and contusions and abrasions were the most common types of injury., Conclusion: This study documents the burden of eye injury in the United States and identifies areas wherein future research activities should be directed.

Objective: To develop an instrument (the Eye Care Expectations Survey [ECES]) that can identify and quantify the expectations of patients visiting eye care providers., Methods: A total of 202 patients attending 4 ophthalmology practices affiliated with Duke University Eye Center enrolled in the study. All participants completed the pilot version of the ECES, which was developed through a review of the expectations literature and a multicondition focus group process. Factor analysis of patients' responses was used to identify the performance characteristics of the ECES., Results: Factor analysis yielded factors that describe 4 distinct types of expectations: patient involvement in eye care, interpersonal manner, information about diagnosis and prognosis, and communication and clinical competence. These 4 factors explained 89% of the total variance. The factor analysis identified a subset of 27 questions (of the original 37) to represent the 4 factors. Estimates of internal consistency and test-retest reproducibility indicate that the ECES is reliable. In addition, tests of association with clinical variables support the construct validity of the survey. The psychometric properties of the ECES were influenced by the severity of the underlying eye condition as well as other demographic and clinical variables, including the patient's rating of his or her own vision, best corrected visual acuity, sex, education, race, and household income., Conclusions: Based on this cross-sectional study, the 27-item ECES appears to be a useful tool for better understanding patients' expectations regarding eye care.

Objective: To evaluate the association between specific occupant, collision, and vehicle characteristics and the risk of motor vehicle collision (MVC)-related eye injury., Methods: The 1988-2001 National Automotive Sampling System Crashworthiness Data System files were used. The Crashworthiness Data System is a national probability sample of passenger vehicles involved in police-reported tow-away MVCs. The risk of eye injury was calculated according to specific occupant (eg, age, seat belt use) and collision (eg, DeltaV [estimated change in velocity], vehicular intrusion) characteristics. The association between eye injury and these characteristics was calculated using risk ratios and associated 95% confidence intervals., Results: The incidence of eye injuries in MVCs has progressively increased since 1998. Frontal air bag deployment was associated with a statistically significant, 2-fold (risk ratio, 2.13 [95% confidence interval, 1.56-2.91]) increased risk of eye injury, whereas seat belt use was associated with a 2-fold (risk ratio, 2.17 [95% confidence interval, 1.89-2.44]) reduced eye injury risk. In late-model vehicles, frontal air bags are the most common cause of MVC-related eye injury. Older age, female sex, seat position, vehicle weight, and collision severity were also associated with eye injury risk., Conclusions: Seat belt use is the most effective means of occupant protection against MVC-related eye injury. For front-seated occupants in frontal collisions, the adverse effect of frontal air bags on the risk of eye injury should be considered against their protective effect for fatal injury.

Objective: To explore whether oral statin and other antihyperlipidemic medications are associated with open-angle glaucoma., Methods: The administrative clinical databases maintained at the Veterans Affairs Medical Center, Birmingham, Ala, were used to conduct a matched case-control study. Cases were all male patients aged 50 years and older with a new diagnosis of glaucoma on an outpatient or inpatient visit during the period January 1, 1997, through December 31, 2001. Ten control subjects were matched to each case according to age (within 1 year). Prescription files were assessed for statin use as well as additional medications to lower cholesterol levels. Information on comorbid medical conditions was also obtained. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Longer duration of statin use was associated with a lower risk of open-angle glaucoma (P for trend =.04) primarily among subjects with 24 months or more of use (OR, 0.60; 95% CI, 0.39-0.92). When stratified by comorbid medical condition, among those with cardiovascular disease (OR, 0.63; 95% CI, 0.42-0.97), lipid metabolism disorders (OR, 0.63; 95% CI, 0.41-0.99), and the absence of cerebrovascular disease (OR, 0.76; 95% CI, 0.58-0.99), statins demonstrated a protective effect on open-angle glaucoma. Finally, a protective association was also observed among those who used nonstatin cholesterol-lowering agents (OR, 0.59; 95% CI, 0.37-0.97)., Conclusions: Initial examination of an administrative clinical database indicates the intriguing possibility that long-term use of oral statins may be associated with a reduced risk of open-angle glaucoma, particularly among those with cardiovascular and lipid diseases. Nonstatin cholesterol-lowering agents were also associated with a reduced risk of having open-angle glaucoma. Additional investigation is warranted as to whether these classes of agents may provide an additional therapeutic addition for glaucoma.

Objective: To test the hypothesis that retinochoroidal collateral veins (RCVs), or alternatively, retinociliary or optociliary shunts/collaterals/veins or opticociliary anastomoses, act protectively against the development of anterior segment neovascularization (ASN) following central retinal vein occlusion (CRVO)., Design: Case-control retrospective medical record review of patients with CRVO., Patients: We identified 107 patients with CRVO, of whom 34 had developed ASN, by reviewing their medical records. After applying exclusion criteria, a case group and an age-, sex-, and visual acuity-matched control group were selected. We analyzed these groups for the presence or absence of RCVs and noted the time course involved in their development., Main Outcome Measures: Anterior segment neovascularization (including neovascularization of the iris and/or anterior chamber angle), neovascular glaucoma, and RCV development., Results: Only 1 (5.4%) of 19 individuals who developed ASN did so in the presence of RCVs. In contrast, 11 (57.9%) of 19 individuals in the control group developed RCVs. Statistical analysis revealed that patients who developed ASN were roughly 25 times less likely to have had RCVs than individuals who never developed ASN (odds ratio = 24.74; P =.001)., Conclusion: Retinochoroidal collateral veins are negatively associated with ASN post-CRVO and may function in a protective manner against such an outcome.

Background: The Impact of Cataracts on Mobility project has previously demonstrated that older drivers with cataract have an elevated risk of motor vehicle collision., Objective: To examine what types of visual impairment serve as a basis of the increased crash risk of older drivers with cataract., Methods and Design: A cross-sectional analysis was performed on 274 older drivers with cataract and 103 older drivers free of cataract recruited through 12 eye care clinics for the purposes of the Impact of Cataracts on Mobility project, a prospective study on driving mobility in older adults with cataract. Tests measured visual acuity, contrast sensitivity, and disability glare for each eye separately using habitual distance correction. The dependent variable was involvement in at least 1 state-recorded, at-fault vehicle crash during the 5 years prior to study enrollment., Results: Logistic regression evaluated associations (odds ratios [ORs]) between visual function and crash involvement. Better and worse eye models defined on the basis of visual acuity were developed. Associations between each type of visual function and crash involvement were adjusted for age, sex, driving exposure, cognitive status, and other types of visual function. For both the better and worse eye models, contrast sensitivity was independently associated with crash involvement, whereas visual acuity and disability glare were not. Drivers with a history of crash involvement were 8 times more likely to have a serious contrast sensitivity deficit in the worse eye (defined as a Pelli-Robson score of 1.25 or less) than those who were crash-free (OR = 7.86; 95% confidence interval [CI], 1.55-39.79); this association was weaker for the better eye but still statistically significant (OR = 3.78; 95% CI, 1.15-12.48). Crash-involved drivers were 6 times more likely to have severe contrast sensitivity impairment in both eyes (OR = 5.78; 95% CI, 1.87-17.86) than crash-free drivers. A severe contrast sensitivity deficit in only 1 eye was still significantly associated with crash involvement (OR = 2.70; 95% CI, 1.16-6.51)., Conclusion: Severe contrast sensitivity impairment due to cataract elevates at-fault crash risk among older drivers, even when present in only 1 eye.