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Data on the prevalence of reported visual impairment and on the utilization of rehabilitation services were collected on a sample consisting of 1777 community-residing people aged at least 65 years. A visual disability was considered to be present if the answer to at least one of the following two questions was positive: Do you have trouble reading ordinary newsprint with glasses (if normally worn)? Do you have trouble clearly seeing the face of someone 12 feet away with glasses (if normally worn)? Prevalence of a reported near disability was 7.6%, prevalence of a reported distance disability was 4.4%, and 3.5% of subjects reported both types of disability. In a subsample of the surveyed population, the positive predictive value was 21% and the negative predictive value was 100%, using moderate or worse visual impairment as the gold standard. Among those answering yes to both questions, 11.4% received services from a rehabilitation center and 10.0% from a nonprofit agency. The utilization rates (adjusted to apply only to those whose visual impairment was confirmed by visual examination) reached 20% for rehabilitation centers and 17.5% for nonprofit agencies. Low utilization of rehabilitation services raises questions concerning the role of general eye care practitioners, community-based health centers, and rehabilitation centers in the rehabilitative process of the visually impaired elderly.

Purpose: The present study describes the prevalence of visual impairment and blindness in a geographically defined population 8 years after the introduction of a screening programme in 1987 for early detection of sight-threatening diabetic retinopathy., Methods: Of 374 patients with diabetes, comprising 2.6% of the population in the study community, 72% were examined with fundus photography or biomicroscopy during 1994-95. These patients form the basis of this study. The screening programme was fulfilled by 93% of subjects, all of whom underwent ophthalmic examinations at least every other year. A total of 79 eyes in 52 patients received photocoagulation for macular oedema alone or in combination with severe non-proliferative or proliferative retinopathy., Results: Eight years after the implementation of the programme, only three patients, all with type 2 diabetes (diabetes diagnosed at or after 30 years of age), had visual acuity < or = 0.1. The total number of eyes with visual acuity < or = 0.5 was higher in insulin-treated type 2 diabetic patients (n = 20) than in those on oral treatment (n = 5) or diet treatment only (n = 1) (p = 0.006 in both cases). The only independent risk factor for visual impairment in eyes with sight-threatening retinopathy was age., Conclusion: A small number of older type 2 diabetic patients end up with visual impairment due to unsuccessful photocoagulation of macular oedema.

Objectives: To study the epidemiology of optic nerve hypoplasia., Design and Methods: Children with optic nerve hypoplasia and visual impairment were identified through the Swedish Register of Visually Impaired Children. Pre- and perinatal characteristics were obtained from the Medical Birth Registry and by scrutinizing pregnancy and delivery records. Clinical characteristics of children with optic nerve hypoplasia are described. The following risk factors were studied: maternal age, parity, maternal smoking, gestational duration, birth weight, delivery method, Apgar score, maternal disease during pregnancy, drugs used in early pregnancy., Results: Young maternal age, first parity, maternal smoking, preterm birth and factors associated with preterm birth were risk factors for optic nerve hypoplasia. There was an indicated association with the use of fertility drugs and antidepressant drugs., Conclusions: Optic nerve hypoplasia is apparently associated not only with other anomolies, notably of the central nervous system, but also with signs of general disturbance in fetal development.

Purpose: To determine the incidence of open-angle glaucoma (OAG) in Melbourne, Victoria, Australia., Design: Population-based cohort study., Participants: Total of 3271 participants aged 40 years and older from Melbourne, Victoria, Australia., Main Outcome Measures: Five-year incidence of OAG., Methods: Participants were recruited through a cluster random sampling from nine urban clusters. Baseline examination was conducted from 1992 through 1994, and the follow-up data were collected from 1997 through 1999. Each participant both at baseline and follow-up underwent a standardized ophthalmic examination including intraocular pressure measurement, visual field assessment, cup-to-disc ratio measurement, and paired stereo photographs of the optic disc. Glaucoma was assessed by a consensus group of six ophthalmologists that included two glaucoma specialists. Glaucoma was diagnosed as possible, probable, or definite., Results: The overall incidence of definite OAG was 0.5% (95% confidence limits [CL], 0.3, 0.7); probable and definite incidence of OAG was 1.1% (95% CL, 0.8,1.4); and possible, probable, and definite OAG incidence was 2.7% (95% CL, 1.8, 3.7). The incidence of possible, probable, and definite OAG increases significantly as age increases (P < 0.001). The incidence of definite OAG increases from 0% of participants aged 40 to 49 years to 4.1% of participants aged 80 years and older. The incidence of probable and definite OAG increases from 0.2% of participants aged 40 to 49 years to 5.4% of participants aged 80 years and older. The incidence of possible, probable, and definite OAG increases from 0.5% of participants aged 40 to 49 years to 11% of participants aged 80 years and older. A nonsignificant but higher incidence of definite OAG among men was observed in this study when compared with women (odds ratio, 2.2; 95% CL, 0.9, 5.9). Fifty percent of the definite OAG participants were undiagnosed., Conclusions: The incidence of OAG increases significantly with age. The undiagnosed cases suggest the need to develop novel community screening strategies for glaucoma.

This report aims to describe the outcome and socio-economic characteristics of older persons attending the Blue Mountains Eye Study (BMES) with persistent correct-able visual impairment (VI). The BMESI examined 3654 persons aged 49+ during 1992-1994 and re-examined 2335 survivors during 1997-1999 (BMES II). Visual acuity was measured before and after standardized refraction. Participants had correctable VI if their better eye was visually impaired <6/12 before refraction (with distance glasses if worn) and was unimpaired after refraction. In BMES I,274 persons (7.5%) had correctable VI, of whom 127 returned to BMES II. Of this group of 127, 34 had persistent correctable VI and 74 were no longer impaired. Fewer persons with correctable VI returned and more died prior to BMES II, compared to persons with no or non-correctable VI. This study showed that persistent correctable impairment was more frequent with increasing age, among women, in those living alone, using community support services,or with a history of heart disease.

Purpose: To investigate the frequency of amblyopia among visually handicapped patients., Methods: The study is a retrospective investigation of all living patients registered in four Visual Rehabilitation Centres in a region in southern Sweden. The area's total population numbered 865,612 persons of whom 11,365 were registered as visually handicapped (with visual acuity < or = 0.3 in the better eye)., Results: Amblyopia was the main cause of decreased visual acuity in one eye in 1.72% (195 of 11,365) of the patients. The average age of the patients with amblyopia was 69 years (9-95 years) and 28.2% of these patients were less than 65 years old (the age for retirement in Sweden). The median visual acuity in the amblyopic eye among these patients was 0.1. The median visual acuity in the nonamblyopic eye was 0.2. The most common cause of decreased vision in the nonamblyopic eye was macular degeneration (39.5%). Bilateral amblyopia was present in 13 (6.7%) of the amblyopic patients. By comparing this study with earlier studies, we can calculate that about 1.2% of the persons with amblyopia 0.3 or lower will eventually become visually handicapped., Conclusion: A small but considerable number of patients who attend the Visual Rehabilitation Centres have amblyopia as a cause of their visual impairment. Since amblyopia can be treated if detected in childhood, later visual rehabilitation of these patients can be avoided or delayed, thereby reducing rehabilitation costs for society.

In epidemiological field studies on the prevalence and incidence of dementia, the problem of cognitive testing of visually impaired individuals is rarely discussed. In the Leipzig Longitudinal Study of the Aged (LEILA 75+) a version of the SIDAM (SIDAM-Structured Interview for the Diagnosis of dementia of the Alzheimer type, Multi-infarct dementia and dementias of other etiology) for the visually impaired was employed from which all items requiring image processing had been omitted (SIDAM-blind). In order to be able to interpret the test results, the final scores for the full SIDAM were estimated by linear transformation of the scores in the blind-version. The method of linear transformation is based on certain theoretical assumptions which are examined in this paper. Linear transformation of scores has proved to be a valid procedure only for individuals with high cognitive performances. Thus, an evaluation of estimated scores based on the norms for the original SIDAM has limitations. Consequently, age-specific norms for the SIDAM-blind are presented. Sensitivities and specificities for different cut-off points used to discriminate between demented and non-demented vision-impaired individuals are given.

Population-based vision screening studies of the prevalence rate of low vision and blindness in the U.S. are reviewed to evaluate the sources of disagreement among studies. The major reasons that studies disagree on prevalence rate estimates are differences in best-corrected visual acuity criteria for low vision and differences in the age range of the oldest age category. When corrections are made for these differences, the results of all prevalence rate studies, except the Mud Creek Valley Study, fit the same prevalence rate vs. age function. The greater prevalence rate of low vision and blindness for each age category that was observed in the Mud Creek Valley Study can be attributed to the higher prevalence rate of cataract associated with a paucity of health care services in the Mud Creek Valley population. The time-derivative of the prevalence rate vs. age function fit to the data provided an estimate of the annual incidence rate of low vision and blindness vs. age. The estimated annual incidence agreed with estimates from unpublished 8-year incidence data of the Baltimore Eye Survey. The incidence rate of low vision and blindness for Americans aged 40 to 60 years is higher among blacks than among whites. For Americans greater than age 60 years, the incidence rate for whites exceeds that for blacks. This observation probably reflects the different natural histories of glaucoma, a leading cause of low vision and blindness among black Americans, and age-related macular degeneration, a leading cause of low vision and blindness among white Americans. Using the age-dependent models of prevalence rate of low vision and blindness for white and black populations, an estimated 1.5 million Americans over age 45 years have a best-corrected visual acuity in the better eye that is < or = 20/70. Based on the incidence rate estimates, approximately 240,000 new cases of low vision and blindness occur each year. With the aging of the U.S. population, that number is expected to double over the next 25 years.

Purpose: To assess visual impairment in adults with intellectual disability after de-institutionalisation., Patients: The county has a population of 385 483 persons of 18 years and older; 961 were moderately, severely or profoundly intellectually impaired (ID), 837 of them (87 %) participated in the investigation., Methods: Visual acuity, VA: Østerberg picture charts and reduced copies for near vision could be used in 71% of the patients. Teller preferential looking procedure was applied to people who were unable to cooperate with the picture charts. When examined with picture wall chart VA 0.3-> or =0.10) was found in 10.8%, severe low vision in 1.2% (VA <0.10-> or =0.05), and blindness (VA<0.05) in 3.8%. Poor near vision (<0.3) was present in 19%. Those assessed with Teller acuity cards had poorer vision than the others. It is possible that the low values of assessment with Teller cards represent a combination of gnostic and resolution deficiencies, which means that the results of grating VA and recognition VA are non-comparable. Ophthalmic disorders: The most widespread medical condition was cerebral visual impairment, the most frequent eye disorders were optic atrophy, high myopia, cataract, and keratoconus. Refraction: Refraction was assessed in 710 persons (85%), the most prevalent cause of visual impairment was uncorrected ametropia. Hypermetropia of >+1.50 was found in 151 of 710 subjects (21%), and spectacles were used by 106 (15%); myopia <-1.0 was present in 213 individuals (30%), 95 persons (13%) had lenses <-1.0., Conclusion: Resettled adult people with intellectual disability have a high prevalence of treatable visual impairment. A structured scheme of referral to optometric and ophthalmological care is essential if these people are to be given the care to which they are entitled.

Objective: The aim of the study was to assess the caries experience of disabled children and young adults in Kuwait, to set baseline data, and to determine their treatment need., Method: Dental caries was scored by surface in accordance with WHO criteria. The study population comprised 832 disabled children and young adults (3-29 years; mean age 12.1 years) who were visually impaired, hearing impaired, had physical handicaps or developmental disorders, attending special needs schools., Results: The proportion of caries free subjects in the primary dentition (3-12-year-old children) was 11.2%. The mean dmft was 5.4, and dmfs 15.2, being highest in the Down's syndrome and lowest in the blind. The proportion of caries-free subjects in permanent dentition, over 5 years of age was 24.2%. The smallest percentage of caries-free subjects was found in the hearing impaired (16.4%) and highest percentage in the blind (35.5%). The mean DMFT was 4.5 and the DMFS 8.7, being highest in the Down's syndrome and lowest in the blind. Prevalence of untreated decay was highest in hearing impaired (86%). The caries experience of first permanent molars represented the largest proportion of the DMFT score (53.6%). In the permanent dentition increasing age, impaired hearing, and poor oral hygiene were significantly associated with caries risk., Conclusions: Caries experience among this disabled population was clearly higher than among the respective age groups in a previous national population survey. The study confirmed the need for strengthening organised preventive and restorative care for this population in Kuwait.

Background: Several health databases contain information on blindness and visual impairment in Canada. Such databases may permit studies of the outcomes, predictors, economic costs and meta-analysis of ocular health problems and visual disability. In this paper we summarize the existing public health information on blindness and visual impairment in Canada., Methods: A systematic search was performed to find the information in three areas: health administrative databases, health surveys and registries. Both literature searching and Internet searching were performed. The institutions were notified by email or telephone that information pertaining to vision and blindness was desired. When necessary, we visited the institution to obtain the information., Results: Health administrative databases contain information on a wide cross-section of diagnoses but are usually limited in detail and seldom provide longitudinal information. Health surveys have a limited amount of systematic information on vision-related questions and rely exclusively on self-reporting. Registries exist on a wide range of visual topics. The Canadian National Institute for the Blind (CNIB) has the most comprehensive registry., Interpretation: This is the first attempt at summarizing all the public health information on blindness and visual impairment in Canada. The present population-based ocular information has numerous shortcomings. More comprehensive validation of large registries, such as that of the CNIB, is needed to provide the foundation for a longitudinal ocular surveillance system. Such a system could guide research on risk factors and the effect of treatment, economic analyses, and public policy for ocular research and service allocation.

Purpose: To study the cause-specific prevalence of eye diseases causing bilateral visual impairment in Australian adults., Design: Two-site, population-based cross-sectional study., Participants: Participants were aged 40 years and older and resident in their homes at the time of recruitment for the study. The study was conducted during 1992 through 1996., Methods: The study uses a cluster stratified random sample of 4744 participants from two cohorts, urban, and rural Victoria. Participants completed a standardized interview and eye examination, including presenting and best-corrected visual acuity, visual fields, and dilated ocular examination. The major cause of vision loss was identified for all participants found to be visually impaired. Population-based prevalence estimates are weighted to reflect the age and gender distribution of the two cohorts in Victoria., Main Outcome Measures: Visual impairment was defined by four levels of severity on the basis of best-corrected visual acuity or visual field: <6/18 > or =6/60 and/or <20 degrees > or =10 degrees radius field, moderate vision impairment; severe vision impairment, <6/60 > or =3/60 and/or <10 degrees > or =5 degrees radius field; and profound vision impairment <3/60 and/or <5 degrees radius field. In addition, less-than-legal driving vision, <6/12 > or =6/18, and/or homonymous hemianopia were defined as mild vision impairment. In Australia, legal blindness includes severe and profound vision impairment., Results: The population-weighted prevalence of diseases causing less-than-legal driving or worse impairment in the better eye was 42.48/1000 (95% confidence interval [CI], 30.11, 54.86). Uncorrected refractive error was the most frequent cause of bilateral vision impairment, 24.68/1000 (95% CI, 16.12, 33.25), followed by age-related macular degeneration (AMD), 3.86/1000 (95% CI, 2.17, 5.55); other retinal diseases, 2.91/1000 (95% CI, 0.74, 5.08); other disorders, 2.80/1000 (95% CI, 1.17, 4.43); cataract, 2.57/1000 (95% CI, 1.38, 3.76); glaucoma, 2.32/1000 (95% CI, 0.72, 3.92); neuro-ophthalmic disorders, 1.80/1000 (95% CI, 0, 4.11); and diabetic retinopathy, 1.53/1000 (95% CI, 0.71, 2.36). The prevalence of legal blindness was 5.30/1000 (95% CI, 3.24, 7.36). Although not significantly different, the causes of legal blindness were uncorrected refractive errors, AMD, glaucoma, other retinal conditions, and other diseases., Conclusions: Significant reduction of visual impairment may be attained with the application of current knowledge in refractive errors, diabetes mellitus, cataract, and glaucoma. Although easily preventable, uncorrected refractive error remains a major cause of vision impairment.

The present study was carried out to determine the prevalence of malocclusion and traumatic injuries in disabled children and adolescents attending the special-needs schools in Kuwait. Included in the study were 818 children (438 males and 380 females), in the age groups of 3-20 years, who have visual impairment, hearing impairment, physical handicaps, or developmental disorders. The mean age of participants was 11.9 years. The survey was carried out according to the methods of WHO. The prevalence of severe malocclusion was 23.6%, and that of slight malocclusion was 37.0%. Children with Down syndrome (OR = 2.3; 95% CI = 1.51-3.52), those of increasing age (OR = 1.1; 95% CI = 1.01-1.10), and males (OR = 1.5; 95% CI = 1.05-2.07) had higher risk for the occurrence of severe malocclusion. Less than one-fifth of the subjects (16.9%) had traumatized anterior teeth. Severe malocclusion (OR = 1.8; 95% CI = 1.17-2.77) and increasing age (OR = 1.2; 95% CI = 1.13-1.26) were significant risk factors for the occurrence of traumatic injuries. We concluded that malocclusion and traumatic injuries are more prevalent among these subjects with disabilities than among the healthy population in Kuwait.

A national study was conducted in children attending six schools for the blind in Malaysia to identify the anatomical site and underlying causes of blindness (BL) and severe visual impairment (SVI), with a view to determine the potentially preventable and treatable causes so that appropriate control measures can be implemented in the future. The standardized clinical examination of eyes was performed and the findings were recorded on the WHO Prevention of Blindness Programme eye examination record form for children with blindness and low vision. A total of 358 children aged between 7 and 17 years were examined, of whom 332 (92.7%) were blind or severely visually impaired. The results relate to these 332 children. Lens was the major anatomical site (22.3%) of visual loss followed by retina (20.8%), whole globe (17.2%), cornea (15.1%), optic nerve (8.7%) and uvea (5.1%). Glaucoma was responsible for BL/SVI in 7.2% and others in 3.6% of cases. Hereditary diseases were responsible for visual loss in 29.5%, intrauterine factors in 4.5%, perinatal factors in 9% and childhood factors in 7.8% of cases. However, the aetiology was unknown in 49.1% of cases which included congenital anomalies of the globe. Childhood cataract and corneal scarring are major treatable causes of BL/SVI that can benefit from future intervention strategies. Perinatal screening for intrauterine factors and hereditary eye diseases, and appropriate interventional therapy will help in reducing the prevalence of childhood blindness.

Aim: To investigate the prevalence and the causes of childhood blindness and visual impairment in Poland., Material and Methods: The records of 3000 visually impaired children from the archives of Polish Association of Blinds and from the centers and schools for visually handicapped children from the years 1979-1999 have been reviewed., Results: The number of the visually disabled children in Poland has increased by 70% in the recent 10 years. The main causes of blindness and serious visual loss in the years 1979-1999 are optic nerve atrophy (21.66%), retinopathy of prematurity (19.01%), cataracts (14.13%), high myopia (11.84%), congenital abnormalities (8.65%), retinal dystrophies (8.08%) and glaucoma (6.42%). Optic nerve atrophy occurred mainly in premature infants. There have been great changes in the epidemiology of blindness in the recent 20 years; the percentage of visually disabled children caused by ROP has increased from 8.1% to 54.5% and caused by optic nerve atrophy from 15.5% to 27.27%. The prevalence of other causes has decreased in the same time., Conclusion: The main activities required to control blindness in Poland are promotion of pregnancy and prematurity care and improvements in the early diagnosis and treatment of retinopathy of prematurity.

Purpose: This report examines the relationship between psychophysical measures of visual impairment and self-reported difficulty with everyday visual tasks in a population-based sample of individuals 65 years of age and older., Methods: Community-dwelling residents (n = 2520) of Salisbury, MD, between the ages of 65 and 84 were recruited for the study. Visual acuity under normal and low luminance, contrast and glare sensitivity, stereoacuity, and visual fields were measured. Subjective physical disability was assessed with the Activities of Daily Vision Scale (ADVS)., Results: In multiple regression analyses adjusted for demographic factors, cognitive status, depression, and number of comorbid medical conditions, each of the vision tests except low luminance acuity was independently associated with lower ADVS scores. The analyses indicate that a factor of 2 reduction in visual acuity or contrast sensitivity, comparable with that observed in mild to moderate lens opacity, was associated with a three- to fivefold odds of reporting difficulty with daily tasks. Although age alone was a significant risk factor for disability, it was not associated with overall ADVS score, once visual impairment and other chronic medical conditions were taken into account., Conclusions: Visual acuity, contrast and glare sensitivity, stereoacuity, and visual fields are significant independent risk factors for self-reported visual disability in an older population. Visual impairment defined by acuity alone is not the only dimension of the association with subjective disability. Additional vision measures are required to understand the impact of vision loss on everyday life.

Purpose: Assessment of the burden of mortality in a cohort of visually impaired children in a geographically defined area., Methods: A 19-year follow-up of medical records and death certificates., Results and Conclusions: Of the initial 128 patients, born 1962-76, 17 (13%) had died, giving a highly significant increase in mortality compared to the equivalent age-specific Swedish population (p-value <0.000001). All deceased had additional impairments. Respiratory causes of death were found in 12/17 cases. The primary ophthalmological diagnosis was cerebral visual impairment in 8 cases, optic atrophy in 6 cases, one each of congenital cataract, microphthalmus and chorioretinitis. A more pronounced level of visual impairment gave an increased risk of mortality. A significantly higher mortality rate among multiply impaired was seen in the combined group with 'childhood blindness' (visual acuity <0.05) and 'visual impairment, undetermined or unknown' opposed to the group with 'low vision' (visual acuity 0.05-<0.3) (p=0.047).

Purpose: To assess the ophthalmological outcome in a cohort of visually impaired children in a geographically defined area., Methods: A 19-year follow-up of medical records, interview and, if needed, re-examination of the initial 128 patients, born 1962-1976., Results and Conclusion: Follow-up was possible in 123 patients (96%); 76 (59%) were still visually impaired, 17 (13%) were deceased, while 30 (23%) had acquired a visual function > or = 0.3. The chances of gaining a visual function outside the WHO limits for visual impairment was significantly higher for patients without additional impairments (p=0.0023). The initial ophthalmologic diagnosis remained unchanged in 88%. The diagnoses with improved visual development included albinism and congenital nystagmus, while retinal diseases showed poorer results. An increase in visual function could be seen even in the initially older age-groups, indicating a maturation of visual function beyond what is usually considered the limit of plasticity of the visual system.

Purpose: To produce the background to a pilot-study of the visual and social outcome of visually impaired children. A study, originally including 219 individuals, done in 1980 in the county of Malmöhus in southern Sweden, was revisited., Methods: A revision according to current WHO classification led to a cohort of 128 individuals. This was compared to the corresponding group, comprising 2048 individuals, of the total Swedish registration of visually impaired children of today., Results and Conclusion: The two groups were mostly similar as regards male/ female distribution, additional impairments, etiological factors and diagnoses. The prevalence of visual impairment due to peri-/neonatal influence had increased (p=0.038; odds ratio (OR): 1.61, 95% confidence interval (CI): 1.04-2.61), while visual impairment due to prenatal infections had decreased (p = 0.0001; OR: 0.26, 95%CI: 0.15-0.49). Regarding diagnoses we saw a significant decrease in chorioretinitis, as well as in microphthalmus and Stargardt's disease, while hypoplasia of the optic nerve increased. In all these, except chorioretinitis, the changes are probably due to altered diagnostic classification.

Purpose: To report age-specific prevalence and causes of bilateral and unilateral visual impairment in a representative older Australian population., Methods: Participants in the Blue Mountains Eye Study (n = 3654) underwent a detailed eye examination. Any visual impairment was defined as best-corrected visual acuity (VA) of 6/12 or worse, moderate impairment as VA 6/24-6/60 and severe impairment as VA worse than 6/60 (the Australian definition for legal blindness). Bilateral visual impairment was defined from the better eye and unilateral impairment from the worse eye. Proportional causes for visual loss were determined by the examining ophthalmologist., Results: Prevalence of bilateral and unilateral visual impairment was strongly age related. Corresponding bilateral and unilateral visual impairment prevalence rates were, respectively, 0.6% and 3.6% for persons aged 49-59 years, 1.1% and 8.2% for ages 60-69, 5.4% and 20.1% for ages 70-79, and 26.3% and 52.2% for persons aged 80+ years. Overwhelmingly, age-related maculopathy (ARM) was the predominant cause of bilateral blindness (13/17) and of moderate to severe bilateral visual impairment in persons aged 70+ years. However, cataract was the most frequent cause of mild bilateral visual impairment among persons aged 60+ years. Amblyopia was the most frequent cause of mild or worse unilateral visual impairment in persons aged 49-59 years. Cataract was the most common cause of mild unilateral visual impairment in people aged 60+ years, while ARM and cataract were jointly the most frequent causes of moderate to severe unilateral visual impairment in people aged 70+ years., Conclusions: These findings indicate that around half of visually impaired persons aged 60 years or over had cataract, a cause amenable to treatment.

The distance telescope has a historical reputation for causing difficulties in prescribing and adaptation. Hence, we considered that a retrospective survey of patients at Nottingham Low Vision Clinic might elucidate specific attributes that influence an individual patient's success in using a distance telescope. From 142 patients prescribed distance telescopes since the Clinic's inception, 133 apparently remained users and were mailed a preliminary three-question enquiry about usage of their distance telescopes. The 87 respondents were followed up with questionnaire 2, requesting explicit information about usage, namely frequency, degree of ease or difficulty, and purpose. Older patients required higher magnification (p < 0.025). Seventeen of 74 respondents to questionnaire 2 had various adaptational problems, which are discussed; 57 of 74 patients found their distance telescopes easy to use, and 49 of 57 were frequent users. Thus, ease and frequency are linked (p < 0.05). People tended to use their distance telescopes outdoors and indoors with similar frequency (p > or = 0.29). Adaptation was found to be unrelated to visual acuity, binocularity/monocularity, ocular pathology, or restricted mobility; magnification seemed to be influential, although not significantly. Aging did not significantly impede adaptation. We infer that the universal criterion for selecting treatable patients seems to be personality type. We conclude that adaptation to a device is dependent upon active recognition of its benefits, paralleled with a tolerance of its constraints, which combine to make usage easy and regular on at least one common task.

Objectives: To describe the age-specific prevalence of common eye diseases causing bilateral visual impairment and estimate the total number of Australians with cause-specific visual impairment., Methods: Cluster-stratified random sample of 5147 residents aged 40 years and older from urban and rural areas and aged-care facilities. Participants completed a standardized interview and eye examination. Four levels of bilateral visual impairment were defined: less than 20/40 to 20/60 and/or homonymous hemianopia (mild), less than 20/60 to 20/200 or better and/or less than 20 degrees to 10 degrees radius field (moderate), less than 20/200 to 10/200 and/or less than 10 degrees to 5 degrees radius field (severe), and less than 1O/ 200 and/or less than 50 radius field (profound). The major cause of vision loss was identified for all participants found to be visually impaired., Results: Uncorrected refractive error was the most common cause of bilateral visual impairment across all decades of life, rising from 0.5% in 40- to 49-year-olds to 13% among those aged 80 years and older. Prevalence of visual impairment due to diabetic retinopathy was 0.7% in 50- to 59-year-olds and 0.8% in those older than 80 years. Visual impairment due to glaucoma had a prevalence of 0.7% among 60-year-olds and rose to 4% of those older than 90 years. The prevalence of visual impairment due to cataract (only present in those aged 70 years or older) rose from 0.6% to 11% in those older than 90 years, and the prevalence of visual impairment due to age-related macular degeneration rose from 0.8% to 16% in those older than 90 years., Conclusions: The predominant causes of visual impairment change with age. Recognition of these patterns is fundamental for early diagnosis and treatment of eye disease and, where appropriate, referral for rehabilitation.

Background: The increase of life expectancy causes a rising number of partially sighted. Therefore our Department of Ophthalmology has founded a laboratory for partially sighted 7 years ago. To optimize patient care, the results were now reinvestigated., Materials and Methods: For the present study, 125 patients were selected by geographical aspects (home nearby clinic) from the lab's pool. After a 3 month minimum period of using the low-vision aid (LVA) patients were visited at their homes. Near visual acuity, distance visual acuity, magnification, and contrast sensitivity were studied under domestic and optimized conditions of illumination. Patients were interviewed in detail to investigate their habits of LVA use., Results: An overall number of 94 patients (66 females and 28 males) could be evaluated. The most patients were between 80 and 84 years old. Vision impairment was attributable mostly to macular degeneration (55%) and diabetic retinopathy (21%). Visual acuity and contrast sensitivity decreased during the period of investigation. 79% of the patients had a unsatisfactory domestic illumination (< 1000 lx). Only 23% of the patients used their LVA at a fixed location. Main field of using LVA was reading (68%). The LVA were rarely used for writing and other fields of practice. 76% of LVA were used daily, more than 50% for a maximal duration of 1 h/d. Magnifiers were preferably used for short-time activities. Closed circuit television systems (CCTV) had a very good acceptance. Telescopes were characterized by a very high rate of rejection. The number of non-used LVA was approximately a fifth. Reasons were decreased visual acuity, impractical handling, missing introduction by delivering optician (54%) as well as unsatisfactory illumination., Conclusions: Improved patient care can be obtained by regular check-up visits (6 months), enhanced illumination, low-vision training, home visits, multi-disciplinary care and modified prescription of LVA.

Objective: To assess whether visual impairment contributes to average length of stay (ALOS) within inpatient care facilities., Methods: We used the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) data for 1993, containing 1 principal diagnosis code and up to 8 secondary diagnosis codes for approximately 2.6 million hospital discharges. We evaluated ALOS differences in patients with and without visual impairment and in patients with eye pathologic conditions, including eye surgery. Visual impairment is not a primary admitting diagnosis, but may be coded as a secondary diagnosis. Eye pathology comprises a large variety of conditions, including corneal ulcers, abscesses, corneal deposits, edema, cataracts, vitreous hemorrhages, and many other eye disorders (ICD-9-CM codes 360-368.9 and 370-379)., Results: The ALOS was 13.4 days for patients with visual impairment (N = 5764), 11.9 days for patients with either eye pathology or visual impairment (N = 60,085), and 8.2 days for patients with no visual impairment (N = 2,546,586). Using a series of multivariate models that controlled for the variables of age, sex, and payer source, as well as disease, disorders, and ophthalmology procedures, we found that the existence of visual impairment added 2.4 days to the ALOS (P<.001), while eye pathology combined with a secondary diagnosis of visual impairment added 1.8 days to the ALOS (P<.001)., Conclusions: Visual impairment contributes significantly to hospital length of stay. A better understanding of the functional care needs of patients with visual impairment in an acute care setting and at the time of discharge from the hospital may contribute to reducing excess ALOS and its related costs while improving the quality of patient care.

Background/aims: Out of an estimated 90,000 visually impaired people in Scotland, 509 make use of a guide dog. Initial research in Northern Ireland suggests that the ophthalmic profile of guide dog owners (GDOs) is highly specific. The aim of this study was to compare the ophthalmic and visual characteristics of Scottish GDOs with other groups of visually impaired people., Methods: A random sample of GDOs from central and northern Scotland (n = 82) underwent a detailed assessment of residual vision (distance and near acuity, visual fields, contrast, and glare sensitivity). Comparative data were obtained from two populations of visually impaired non-GDOs-one group attending hospital ophthalmic and low vision clinics (n = 50) the other social services rehabilitation clients (n = 35). All participants completed a questionnaire to elicit ophthalmic history, age, and registration details., Results: GDOs were found to be significantly younger and more profoundly visually impaired than non-GDOs. The main causes of visual impairment were retinitis pigmentosa (23%), optic atrophy (15%), and retinopathy of prematurity (7%). Ninety nine per cent of GDOs were registered blind and had been visually impaired for an average of 39 years. Only 31% were totally blind., Conclusion: GDOs represent a unique minority of the visually impaired population. Epidemiological registration trends would suggest that the numbers of young profoundly visually impaired people are unlikely to increase relative to their elderly counterparts. This has implications on the future demand for guide dog ownership.

Objective: To assess the prevalence and causes of moderate visual impairment in an urban population in southern India., Design: Population-based, cross-sectional study., Participants: A total of 2522 (85.4% of the eligible) persons of all ages, including 1399 persons 30 years of age or older, from 24 clusters representative of the population of Hyderabad city., Testing: The eligible subjects underwent a detailed ocular evaluation, including logarithm of the minimum angle of resolution (logMAR) visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, cataract grading, and stereoscopic dilated fundus evaluation. Automated threshold visual fields and slit-lamp and fundus photography were done when indicated by standardized criteria., Main Outcome Measure: Moderate visual impairment was defined as presenting distance visual acuity less than 20/40 to 20/200 or visual field loss by predefined standardized conservative criteria in the better eye., Results: In addition to the 1% prevalence of blindness in this sample reported earlier, moderate visual impairment was present in 303 subjects, an age-gender-adjusted prevalence of 7.2% (95% confidence interval [CI], 4.5%-9.9%; design effect, 2.7). The major cause of moderate visual impairment was refractive error (59.4%, 95% CI, 52.3%-66.5%) followed by cataract (25.3%, 95% CI, 19%-31.6%). Multivariate analysis showed that the prevalence of moderate visual impairment was significantly higher in those 40 years of age or older (odds ratio, 10.9; 95% CI, 8-15) and females (odds ratio, 1.89; 95% CI, 1.41-2.53) and lower in those belonging to the highest socioeconomic status (odds ratio, 0.27; 95% CI, 0.14-0.51). However, because of the pyramidal age distribution of the population, 38.1% of the total moderate visual impairment was present in those younger than 40 years of age. The proportion of moderate visual impairment caused by refractive error was higher in the younger than in the older age groups (P < 0.0001)., Conclusions: Projecting the results to the 26.5% urban population of India, there would be 18.4 million (95% CI, 11.5-25.2 million) persons with moderate visual impairment in urban India alone. Refractive error was the major cause of moderate visual impairment in the population studied. The absolute proportion of moderate visual impairment in those younger than 40 years of age was considerable. The eyecare policy of India, apart from dealing with blindness, should address the issue of the relatively easily treatable uncorrected refractive error as the cause of moderate visual impairment in an estimated 10.9 million persons in urban India.

Objective: To determine whether older drivers with poorer cognitive and/or visual function drive fewer miles or avoid driving in situations that pose higher crash risks, such as at nighttime, in rush hour traffic, or when weather conditions are bad., Design: A cross-sectional data analysis conducted as part of a larger prospective study., Subjects: A total of 3238 drivers aged 65 and older applying for renewal of their driver's license at one of eight participating North Carolina driver's license offices., Measurements: Subjects were administered a battery of brief tests of cognitive and visual function, which included the Trail Making Test Parts A and B, the Short Blessed Orientation-Memory-Concentration test, and measures of high and low contrast visual acuity, contrast sensitivity, and peripheral vision. Participants were also asked to complete a brief driving survey containing questions about the number of miles they drove and whether they avoided driving under certain conditions, such as after dark or on busy, multi-lane roadways. Driver age and gender were covariates in the analyses., Results: Results of multivariate logistic regression models show a clear pattern of reduced driving exposure--lower annual miles and greater avoidance of high-risk driving situations--associated with lower levels of cognitive and visual function. In general, the prevalence odds of reduced driving exposure were higher for the cognitive function variables than for the visual function variables, and higher for males than for females. Men who scored in the lowest quartile of performance on one of the cognitive tests were six to seven times more likely to report driving fewer than 3000 miles a year than were men scoring in the highest quartile, and women with low scores were one-and-one-half to two times more likely to report driving less than 3000 miles than women with higher scores., Conclusions: While the findings of this study are reassuring, they do not guarantee that all drivers with cognitive and visual impairments are limiting their driving exposure appropriately, and geriatricians and other health professionals should be encouraged to evaluate their patients' cognitive and visual fitness for driving and provide counsel where indicated.

Background: Assessment of the causes of childhood blindness is important to develop preventive and therapeutic strategies that can reduce the incidence of visual impairment., Methods: A retrospective survey of the clinical records of 395 consecutive children younger than 14 years of age who were attended by the Low Vision Service of State University of Campinas (UNICAMP) was conducted. Data on the age distribution, the causes of low vision, the types of low vision aids prescribed, the follow up of their use, and improvement in visual acuity were obtained., Results: Congenital bilateral toxoplasmic macular scars, optic atrophy, and congenital cataracts were the major causes of low vision in this population. The optical aid most frequently prescribed was a telescope. The improvement of visual acuity with the use of aids was highly significant.

Visual impairment (corrected visual acuity in the best eye < 0.3) was evaluated in a retrospective study of 296 children born between 1976 and 1985 and recruited from three French departments. For children younger than 9 years, the overall prevalence was 0.80 per 1000 and that of blindness was 0.28 per 1000. No decrease in prevalence was noted over this decade. The most common aetiologies were antenatal factors (48%), which were observed mainly in the cases of poor vision, and perinatal factors (27%), which were more common in the cases of blindness. Fifty-six per cent of the children had an additional severe handicap. The most common association was with motor impairment and mental retardation. The mean age of first medical care (3.1 years) did not change over the decade: 2.0 years for children with an associated handicap, 2.9 years for cases of isolated blindness and 5.1 years for cases of isolated poor vision. Among children with isolated visual impairment, there was a significantly higher percentage of scholastic underachievers in those presenting after the age of 5 years (39.3% vs. 14.6%).

Objective: This study aimed to provide a comparative analysis of American population-based prevalence of uncorrected binocular distance visual acuity in Hispanics and non-Hispanics., Design: The study design was a population-based survey., Participants: Data from the Hispanic Health and Nutrition Examination Survey between 1982 and 1984 and the National Health and Nutrition Examination Survey I from 1974 through 1975 were analyzed to investigate the epidemiology of uncorrected binocular distance visual acuity in adults 25 to 74 years of age in Cuban Americans (N = 391), Mexican Americans (N = 1350), Puerto Ricans (N = 504), African Americans (N = 245), and non-Hispanic white Americans (N = 2571)., Main Outcome Measure: Uncorrected binocular distance visual acuity in both eyes was assessed using Sloan letters or Landolt rings., Results: Prevalence rates of 20/50 or worse uncorrected binocular distance visual acuity were 22%, 24%, 19%, 18%, and 32% for African Americans, Cuban Americans, Mexican Americans, Puerto Ricans, and non-Hispanic whites, respectively. After adjustment for gender and age, the rates were significantly higher (P < 0.05) for non-Hispanic whites compared to each of the other ethnic groups. Significant increases in the prevalence of 20/50 or worse distance visual acuity were observed for increasing age groups (25-39, 40-59, and 60-74 years) within each gender-ethnic subgroup. Analysis of differences in prevalence by gender (controlling for age) indicated a slightly higher prevalence of 20/50 or worse distance visual acuity in women than in men (range of odds ratios, 1.1-2.1). Based on 1993 census population estimates in the United States, more than 42 million adults 25 to 74 years of age have an uncorrected binocular distance visual acuity of 20/50 or worse. Approximately 1.7 million of these adults are of Hispanic origin., Conclusion: The prevalence of impaired uncorrected binocular distance visual acuity generally is lower in Hispanics than in non-Hispanic whites.

Purpose: The purpose of this study was to gain information about the employment status of legally blind patients., Methods: Fifty-two patients with one of four juvenile-onset macular dystrophies or achromatopsia responded to questions about their employment histories and their psychological well-being. Results from the questionnaire were analyzed using z-tests for differences in proportions or t-tests for differences in means., Results: Forty-eight percent of the patients reported that they were employed and 52% that they were not employed. The subgroup that was not employed had a significantly higher proportion of women than men, whereas the employed group had approximately equivalent proportions of men and women. The employed subgroup reported that their success at work was due to social support. This subgroup had significantly higher household incomes, was significantly less likely to collect disability-income benefits, had significantly higher educational levels, had significantly higher positive affect, and had significantly lower negative affect than the subgroup that was not employed. A logistic regression analysis indicated that education was the primary predictor of employment., Conclusion: Analysis supports the conclusion that it is beneficial for legally blind individuals to obtain an optimal level of education and receive suitable social support to facilitate their successful employment.

Purpose: To gain an overview of the spectrum of diagnoses among Swedish visually impaired children., Methods: An epidemiological study of all known visually impaired children was made by review of medical records., Results and Conclusion: In all we found 2373 children, 0-19 years of age, with an age-specific prevalence of 10.9/10,000. The two largest diagnostic groups included neuro-ophthalmological and retinal diseases. The most frequent disorders were cerebral visual impairment, non-hereditary optic atrophy, retinal dystrophy (when regarded as a general entity), congenital hypoplasia of the optic nerve and congenital cataract. Nystagmus secondary to brain disorder, albinism, congenital nystagmus, retinopathy of prematurity and high myopia were also found in a considerable number of patients. The leading diagnoses in children with WHO-defined childhood blindness were non-hereditary optic atrophy, cerebral visual impairment and retinopathy of prematurity. A large proportion of the children, especially in the groups with neuro-ophthalmological disorders and malformations of the posterior segment had additional impairments, emphasizing the importance of a multi-disciplinary approach when assessing multi-handicapped children.

Purpose: To profile certain demographic features of the low-vision population in Ontario, Canada., Methods: Sixty-six optometrists or optometry centers, 8 ophthalmologists, and 23 Canadian National Institute for the Blind rehabilitation worker teams were recruited to the study. They were required to report on their low-vision examinations during a 3-year period., Results: Reports from 4744 low-vision examinations were received. Of the patients examined, 71% were over age 65 (subsequently called seniors or elderly), and 55% were over age 75. Ninety percent of all the patients lived in households and 10% lived in institutions. Seniors made up 71% of the patients living in households and 88% of the patients living in institutions. Most of the seniors were women (65%), and 57% had functional limitations in addition to low vision, most commonly limitations in mobility, hearing, or agility. Age-related maculopathy was the primary diagnosis in 75% of seniors, and the most common secondary diagnosis was cataract (46%). The main objective for most elderly low-vision patients was to gain improvement in personal reading (75%)., Conclusions: The vast majority of low-vision patients were elderly, the largest number being 75 to 84 years old. When older senior low-vision patients (> or = 85 years) were compared with younger seniors (65 to 74 years), the older seniors were more likely to be women, more likely to have additional functional limitations, more likely to live in an institution, and more likely to have age-related maculopathy and cataract. Whether some elderly low-vision patients may be helped by cataract surgery needs to be determined.