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To determine the prevalence of vision impairment (VI) and blindness and their determinants in the elderly population of Tehran. In a cross-sectional study, multi-stage cluster sampling was used to select a sample of over 60 year population of Tehran. Optometric examinations included the measurement of uncorrected visual acuity, objective and subjective refraction, presenting and best corrected visual acuity. Vision impairment is reported according to the WHO definition. Visual acuity worse than 20/60 and 20/400 in the better eye was regarded as low vision and blindness, respectively. According to presenting visual acuity, VI was found in 14.8% (95%CI: 13.1–16.5) of the participants, including low vision in 13.8% (95%CI: 12.2–15.4) and blindness in 1.1% (95%CI: 0.5–1.6). The prevalence of VI ranged between 7.8% (95%CI: 6.0–9.5) in subjects aged 60–64 years and 40.0% (95%CI: 33.0–47.0) in participants over 80 years (p <.001). Multivariable logistic regression analysis showed that older age (OR = 1.07(per year)), lower education level (illiterate versus college: OR = 3.55), and lower economic status (middle versus rich: OR = 1.30 and poor versus rich; OR = 1.72) had a significant relationship with an increase in the prevalence of VI, and older age (OR = 1.14(Per year increase)) and diabetes (OR = 2.62) had a significant relationship with blindness. Refractive errors (63.1%) was the leading cause of VI followed by cataract (22.5%). However, cataract (48.3%) was the leading cause of blindness. Many older adults suffer from VI. Correction of refractive errors and cataract reduces a large percentage of VI. Age, education level, and economic status are other determinants of VI. [ABSTRACT FROM AUTHOR]

Background: Given the detrimental impacts of visual and cognitive impairment separately, in older adults, understanding their coexistence could inform strategies against age-related cognitive changes.Methods: Participants from Washington County (White) and Jackson (Black) sites of the Atherosclerosis Risk in Communities Study were recruited who differed on racial, regional, urbanicity, and community-based factors. Presenting distance visual acuity (DVA; representing vision loss due to disease or lack of eye-care), corrected DVA (representing optimal correction for refractive loss of vision), and contrast sensitivity were measured. Factor scores for global cognition, memory, executive function, and language domains were calculated for 3 visits. We quantified the associations of vision measures with change in cognitive scores, stratified by community/race, using generalized estimating equations.Results: In 982 participants, mean (standard deviation [SD]) baseline age was 74 (4) years, with 37% males and 45% Jackson/Black participants. As hypothesized, after accounting for potential confounders, in the better-eye, worse presenting DVA was associated with greater 10-year decline rate in global cognition, memory, and executive function in Washington County/White participants (eg, global cognition: -0.08 SD [95% confidence interval: -0.12, -0.04]). Worse corrected DVA was associated with greater 10-year decline rate in executive function in Washington County/White participants (-0.10 SD [-0.15, -0.04]). Better contrast sensitivity was associated with lower 10-year decline rate in global cognition and executive function in Washington County/White participants (eg, global cognition: 0.10 SD [0.06,0.14]). None of these associations were confirmed in Jackson/Black participants.Conclusions: Our study supports a functional link between some vision measures and cognition in older adults, but in only 1 of the 2 communities studied. [ABSTRACT FROM AUTHOR]

This multicenter, open-label study aimed to determine the safety and functional outcome of a high-addition segmented refractive bifocal intraocular lens (IOL) in late inactive age-related macular degeneration (AMD). Twenty eyes of 20 patients were enrolled and followed until 12 months after the intervention. Patients underwent cataract surgery with implantation of a LS-313 MF80 segmented refractive bifocal intraocular lens with a near addition of +8.0 D (Teleon Surgical Vertriebs GmbH, Berlin, Germany). The main outcome measures were distance corrected near visual acuity (DCNVA) and safety as determined by intra- and post-operative complications. Secondary outcomes included distance corrected visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), the need for magnification to read newspaper, preferred reading distance, speed and performance (logRAD), as well as patient satisfaction. Mean DCNVA improved from 0.95 (±0.19) to 0.74 (±0.35) logMAR, until 6 months after surgery, P<0.05. CDVA improved from 0.70 (±0.23) to 0.59 (±0.30) logMAR, UDVA from 0.94 (±0.25) to 0.69 (±0.34) logMAR, UNVA from 1.08 (±0.19) to 0.87 (±0.43) logMAR. The mean need for magnification decreased from 2.9- to 2.3-fold, preferred reading distance from 23 to 20 cm. No intraoperative complications occurred during any of the surgeries. One patient lost > 2 lines of CDVA between 6 and 12 months, in another case, the study IOL was exchanged for a monofocal one due to dysphotopsia and decreased CDVA. Implantation of a segmented refractive bifocal IOL with +8.0 D addition improves near and distance vision in patients with late AMD and has a satisfactory safety profile. [ABSTRACT FROM AUTHOR]

Purpose: Recent innovations in mobile technology for the measurement of vision present a valuable opportunity to measure visual function in non-clinical settings, such as in the home and in field-based surveys. This study evaluated agreement between a tablet-based measurement of distance and near acuity and contrast sensitivity as compared to gold-standard clinical tests. Methods: Participants aged ≥55 years recruited from a tertiary eye clinic underwent testing with three tablet-based and corresponding gold-standard clinical measures (ETDRS distance acuity, Pelli-Robson contrast sensitivity, and MNRead near acuity). Correlation and agreement between tablet-based and clinical tests were assessed. Results: A total of 82 participants with a mean age of 69.1 (SD = 7.6) years, and majority female (67.1%) and white (64.6%), were enrolled in this study. The mean (SD) difference between the tests (gold-standard – tablet) was −0.04 (0.08) logMAR for distance acuity, −0.11 (0.13) log units for contrast sensitivity, and −0.09 (0.12) logMAR for near acuity. 95% limits of agreement for distance acuity (-0.21, 0.12 logMAR), near acuity (-0.34, 0.14 logMAR), and contrast sensitivity (-0.36, 0.14 logCS) were also determined. The correlation between tablet-based and gold-standard tests was strongest for distance acuity (r = 0.78), followed by contrast sensitivity (r = 0.75), and near acuity (r = 0.67). The agreement between the standard and tablet-based methods did not appear to be dependent on the level of vision. Conclusions: This study demonstrates the agreement of tablet-based and gold-standard tests of visual function in older adults. These findings have important implications for future population vision health surveillance and research. [ABSTRACT FROM AUTHOR]

Background We examined the associations between dual impairments in visual and hearing acuity and aging-related cognitive decline. Methods This was a longitudinal study of adults who had visual and hearing acuity and cognitive function assessed in 1992–1996 and were followed for up to 24 years (mean = 7.3 years), with up to five additional cognitive assessments. Visual impairment was defined as vision worse than 20/40, hearing impairment as pure-tone average thresholds >25 dB. Associations were tested using linear mixed-effects regressions. Results Of 1,383 participants, 293 had visual impairment, 990 had a hearing impairment and 251 had both deficits. In fully adjusted models, low visual acuity was associated with poorer Mini-Mental State Examination (MMSE; β = −0.29) and Trail-Making Test Part B (Trails B; β = 13.22) performance, and with faster declines in MMSE (β = −0.12) and Trails B (β = 1.84). The combination of low visual and low hearing acuity was associated with poorer MMSE (β = −0.44) and Trails B (β = 11.20) scores, and with faster declines in MMSE (β = −0.19), Trails B (β = 3.50), and Verbal Fluency Test (VFT; β = −0.14) performance. Associations were similar in men and women. Conclusion Impairments in both vision and hearing are associated with a more rapid decline in cognitive function with aging. [ABSTRACT FROM AUTHOR]

Background The relationship between self-reported visual disability and cognitive impairment in older individuals is unclear. Objective To determine the relationship of vision-specific functioning (VSF), vision-specific mobility (VSM) and visual acuity (VA) with clinically assessed cognitive impairment in the Epidemiology of Dementia in Singapore study. Design Cross-sectional. Setting Population-based. Subjects Eight hundred and seventy-four adults aged ≥60 years at higher risk of possible cognitive impairment by the Abbreviated Mental Test and progressive forgetfulness question. Methods VSF and VSM were measured using Rasch-transformed continuous scores of two Impact of Vision Impairment questionnaire domains. Cognitive impairment was objectively determined using detailed neuropsychological testing and defined as no cognitive impairment (NCI), mild cognitive impairment-no dementia (CIND), moderate CIND only and moderate CIND or dementia. Associations were assessed using multinomial logistic regression models. Results Of the 874 participants (49.0% males, mean age (SD) 65.5 (7.0) years), 277, 281 and 316 had NCI, mild CIND and moderate CIND or dementia, respectively. Compared to NCI, the odds of moderate CIND, and moderate CIND or dementia increased for every SD worsening in VSF (OR: 1.44, 95% CI 1.14–1.82, and OR: 1.52, 95%CI 1.19–1.94, respectively) and VSM (OR: 1.42, 95%CI 1.11–1.81, and OR: 1.50, 95%CI 1.15–1.95). Similarly, the odds of mild CIND (OR: 1.62, 95%CI 1.19–2.22), moderate CIND (OR: 1.93, 95%CI 1.45–2.58), and moderate CIND or dementia (OR: 2.25, 95%CI 1.62–3.11) increased significantly with every SD worsening of VA. Conclusions Our results emphasise the importance of interventions to prevent vision loss and improve quality of life to reduce likelihood of age-related cognitive decline. [ABSTRACT FROM AUTHOR]

Background: An association between visual impairment and cognitive outcomes has been documented, but there is limited research examining this relationship using multiple measures of vision.Methods: Participants included non-demented individuals in Year 3 of the Visual impairment was assessed using visual acuity, contrast sensitivity, and stereo acuity. Cognitive function was defined using the digit symbol test and the Modified Mini-Mental State Examination (3MS). Incident cognitive impairment was defined as a 3MS score <80 or a decline >5 points following Year 3. Linear mixed effects models examined longitudinal associations adjusting for year, age, sex, race, education, smoking, depression, diabetes, study site, as well as interaction terms between the vision parameters and years in study, between baseline age and years in study, and quadratic terms of baseline age and years in study. Discrete Cox regression models examined the risk of incident cognitive impairment.Results: Analyses included 2,444 participants (mean age = 74). Visual acuity, contrast sensitivity, and stereo acuity impairments were not associated with statistically significant changes in annual digit symbol test scores over 7 years of follow-up, as compared to those without these impairments. However, visual acuity, contrast sensitivity, and stereo acuity impairments were associated with greater declines in annual 3MS scores over 9 years. Participants with impaired visual acuity, contrast sensitivity, and stereo acuity had a greater risk of incident cognitive impairment.Conclusions: Our results suggest that visual acuity, contrast sensitivity, and stereo acuity impairments may be risk factors for cognitive decline. [ABSTRACT FROM AUTHOR]

Rationale/Objective: To develop a screening and referral algorithm tool to help identify which older institutionalized individuals with dementia need an eye examination. Methods: The visual acuity (VA) screening test was developed on an iPad retina display. Three optotypes were used (letters, numbers, and tumbling E’s) to determine whether one works best with dementia. The screening VA results and algorithm decision were validated against those obtained by an optometrist performing a complete eye examination. Results: Of the 150 participants, 14.7% did not respond to any optotype, while 85.3% responded to letters, 84.0% to numbers, and 66.0% to tumbling E’s. The VA achieved was superior for letters. The concordance for the screening versus eye examination was >80% for VA and 90% for the algorithm. Conclusion: The results indicate that the tool was successful at identifying older individuals with dementia needing an eye examination. [ABSTRACT FROM AUTHOR]

The presence of visual impairment (VI) and hearing loss (HL) with may be a marker for subsequent cognitive decline over time in older people. A prospective, longitudinal population-based study of the 3654 participants of the Blue Mountains Eye Study were assessed for the associations between VI and HL and a decline in mini-mental state examination (MMSE) scores over a duration of 10 years from the 5-year (baseline of this report) to the 15-year follow-up visits. MMSE was assessed at the 5-, 10- and 15-year follow-up visits. A decline ≥3 scores from 5-year to 10- or 15-year visits indicated possible cognitive decline. VI was defined as best-corrected visual acuity <6/12 in the worse-eye, HL was defined as pure-tone average >40 decibels in the worse-ear and dual sensory impairment (DSI) was defined by the co-presence of VI and HL, detected at 5-year follow-up (baseline of this report). Participants with no VI and HL over the same 5- or 10-year corresponding period were controls. Associations of VI, HL and DSI with possible cognitive decline were assessed using logistic regression models adjusting for age and sex after excluding subjects with a stroke history. The presence of VI, HL or DSI was not associated with possible cognitive decline over 5 years (odds ratio (OR) 0.84, 95% confidence-intervals (CI) 0.40–1.79, OR 1.02, 95% CI 0.61–1.70 and 1.41, 95% CI 0.54–3.72, respectively) or 10 years (OR 1.09, 95% CI 0.52–2.30, OR 1.09, 95% CI 0.65–1.82 and 1.15, 95% CI 0.28–4.73, respectively). There were no changes to these findings after adjustment for other potential confounders. Age was significantly associated with possible cognitive decline (OR 1.07, 95% CI 1.04–1.10 for both periods). Neither visual impairment, hearing loss nor dual sensory impairment was independently associated with subsequent decline in cognition. [ABSTRACT FROM AUTHOR]

Purpose To examine whether older adults with vision impairment differentially benefit from cognitive speed of processing training ( SPT) relative to healthy older adults. Methods Secondary data analyses were conducted from a randomised trial on the effects of SPT among older adults. The effects of vision impairment as indicated by (1) near visual acuity, (2) contrast sensitivity, (3) self-reported cataracts and (4) self-reported other eye conditions (e.g., glaucoma, macular degeneration, diabetic retinopathy, optic neuritis, and retinopathy) among participants randomised to either SPT or a social- and computer-contact control group was assessed. The primary outcome was Useful Field of View Test ( UFOV) performance. Results Mixed repeated-measures ancovas demonstrated that those randomized to SPT experienced greater baseline to post-test improvements in UFOV performance relative to controls ( p's < 0.001), regardless of impairments in near visual acuity, contrast sensitivity or presence of cataracts. Those with other eye conditions significantly benefitted from training ( p = 0.044), but to a lesser degree than those without such conditions. Covariates included age and baseline measures of balance and depressive symptoms, which were significantly correlated with baseline UFOV performance. Conclusions Among a community-based sample of older adults with and without visual impairment and eye disease, the SPT intervention was effective in enhancing participants' UFOV performance. The analyses presented here indicate the potential for SPT to enhance UFOV performance among a community-based sample of older adults with visual impairment and potentially for some with self-reported eye disease; further research to explore this area is warranted, particularly to determine the effects of eye diseases on SPT benefits. [ABSTRACT FROM AUTHOR]

Background: visual and cognitive impairments are common in later life. Yet there are very few cognitive screening tests for the visually impaired.Objective: to screen for cognitive impairment in the visually impaired.Methods: case–control study including 150 elderly participants with visual impairment (n = 74) and a control group without visual impairment (n = 76) using vision-independent cognitive tests and cognitive screening tests (MMSE and clock drawing tests (CDT)) which are in part vision dependent.Results: the scoring of the two groups did not differ in the vision-independent cognitive tests. Visually impaired patients performed poorer than controls in the vision-dependent items of the MMSE (T = 7.3; df: 148; P < 0.001) and in CDT (T = 3.1; df: 145; P = 0.003). No group difference was found when vision-independent items were added to MMSE and CDT. The test score gain by the use of vision-independent items correlated with the severity of visual impairment (P < 0.002).Conclusion: visually impaired patients benefit from cognitive tests, which do not rely on vision. The more visually impaired the greater the benefit. [ABSTRACT FROM PUBLISHER]

Purpose: To determine visual function (VF) status in older people, to establish its degree of correlation with visual acuity (VA), and to assess its association with other physical and mental functional limitations. Participants: A sample of 1,160 persons aged 65 years or over were selected by simple randomization. Methods: The participants' VF (The Visual Function Index-VF-14), VA, self-reported vision, mental and physical function (Katz Index, Pfeiffer's test, and Geriatric Depression Scale), and socio-demographic data were determined. Multiple linear regression was used to assess the association between VF and its conditioning factors. Statistical adjustment was made for the possible confounding variables. Results: Of the studied subjects, 6.3% (95% confidence interval (CI) = 4.93-7.82) had VA of less than 6/18 in the better eye and 20.9% (95% CI = 18.6-23.3) had VA of less than 6/12. The best corrected VA of each participant demonstrated moderate correlation with his or her VF-14 score (r = 0.416; p < 0.001). Using multiple regression analysis, the variables associated with VF status were: visual impairment, self-reported poor vision, dependence in daily activities, cognitive impairment, depressive symptoms, female gender and older age. These independent variables explain 34.4% (r2 = 0.344) of the variation in the data. Conclusions: VF impairment is common in older persons and when associated with other limitations, it may be considered a major health problem with important consequences. As a complement to the preventive care guidelines on VA in older persons, assessment of VF impairment in clinical practice, using appropriate visual screening tools, is advisable. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity. DESIGN: Prospective cohort. SETTING: North Carolina. PARTICIPANTS: Three thousand eight hundred seventy-eight participants in the North Carolina Established Populations for the Epidemiologic Studies of the Elderly with nonmissing visual status, cognitive status, and disability status data at baseline MEASUREMENTS: Short Portable Mental Status Questionnaire (cognitive impairment defined as≥4 errors), self reported visual acuity (visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print), demographic and health-related variables, disability status (activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility), death, and time to nursing home placement. RESULTS: Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability (odds ratio (OR)=6.50, 95% confidence interval (CI)=4.34–9.75), mobility disability (OR=4.04, 95% CI=2.49–6.54), ADL disability (OR=2.84, 95% CI=1.87–4.32), and incident ADL disability (OR=3.66, 95%, CI=2.36–5.65). In each case, the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone, a pattern that was not observed for other adverse outcomes assessed. No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status. CONCLUSION: Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability, with each condition contributing additively to disability risk. Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity. When visual or cognitive impairment is present, efforts to maximize the other function may be beneficial. [ABSTRACT FROM AUTHOR]