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Objective: To assess recall bias by evaluating how well female cancer survivors remember details regarding their cancer diagnosis, treatment, and fertility preservation (FP) counseling.Oncofertility literature cites recall bias as a pitfall of retrospective surveys, but limited data exist to quantify this bias. Design: Retrospective secondary analysis of cross-sectional survey data. Setting: Single academic medical center. Patient(s): Female oncology patients of reproductive age, 18–44 years old, at least 6 months past their last chemotherapy treatment. Intervention(s): Not applicable. Main Outcome Measure(s): Recall of details surrounding cancer diagnosis and chemotherapy regimens, recall of FP counseling and ovarian reserve testing, and rates of chart-documented FP counseling. Result(s): In total, 117 patients completed the survey, with 112 verified via chart review. When asked to report the chemotherapy regimen, 57% (64 of the 112) marked “I don’t know/prefer not to say.” Regarding FP, 80% (90 of the 112) denied being offered counseling. Of the 37 (33%) who had documented FP conversations, 13 (35%) did not recall mention of fertility. Only 2 of 8 patients with ovarian reserve testing recalled this being performed at their initial visit. Multivariable logistic regression revealed older age was significantly associated with not being offered FP (odds ratio [OR] 0.87). Conclusion(s): Our results confirm that the accuracy of oncology patients’ reporting is limited by a poor recall, particularly regarding their specific chemotherapy regimen. More than 1 in 3 patients documented to have been offered FP counseling do not recall this discussion. Importantly, only one-third of cancer survivors had chart-documented FP counseling. Increased efforts are needed to ensure adequate follow-up beyond the initial visit.

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.

Purpose: To identify instrumental activities of daily living (IADL) tasks whose completion time is related to visual function in older adults., Methods: Visual function (acuity, contrast sensitivity, and useful field of view) and the time to complete 17 visual tasks of everyday life were measured in a sample of 342 older adults (mean age 71 years, range 56 to 86) recruited from eye clinics. The timed IADL (TIADL) tasks included a variety of visual activities such as reading ingredients on cans of food and instructions on medicine bottles, finding a phone number in a directory, locating items on a crowded shelf and in a drawer, and using a screwdriver., Results: Multiple regression analysis indicated that poorer scores for acuity, contrast sensitivity, and useful field of view were independently associated with longer times to complete visual TIADL tasks, even after adjusting for age, educational level, depression, and general health. Cognitive status also had a significant, independent association with timed task performance., Conclusions: Older adults' timed performance in everyday tasks is related to various aspects of visual function independent of the influences of other functional and health problems and advanced age. This suggests that TIADL tasks may eventually be useful as performance outcomes in intervention evaluations targeted at reversing vision impairment or minimizing its impact. To understand the relationship between vision impairment and TIADL task performance in older adults, cognitive impairment needs to be taken into account because it has a relatively strong and independent relationship with visual TIADL task performance.

This study investigated the link between the perception and production of the English vowel /i/ by adult native speakers of English. Participants first produced the vowel /i/ using normal (citation) and careful (hyperarticulated) speech, then completed a method of adjustment task in which they selected their ideal exemplar of /i/. In this perceptual task, 24 of 35 participants had a prototype; the remaining 11 did not, but were retained for comparison. In keeping with the hyperspace effect (K. Johnson, E. Flemming, & R. Wright, 1993), all participants selected perceptual stimuli with F1 and F2 values that were more extreme (i.e., higher and further forward in the vowel space) than those of their normal, citation productions. An analysis of front-back and high-low qualities for the perceptual and production data in Euclidian space revealed that hyperarticulated speech was closer to the perceptual data than citation speech was, but only for participants with relatively clear-cut prototypes. The basis for such individual variation in perception-production links is discussed.

Background: Cataract is a leading cause of vision impairment in older adults, affecting almost half of those over age 75 years. Driving is a highly visual task and, as with other age groups, older adults rely on the personal automobile for travel. The purpose of this study was to examine the role of cataract in driving., Methods: Older adults (aged 55-85 years) with cataract (n = 279) and those without cataract (n = 105) who were legally licensed to drive were recruited from eye clinics to participate in a driving habits interview to assess driving status, exposure, difficulty, and "space" (the distance of driving excursions from home base). Crash data over the prior 5 years were procured from state records. Visual functional tests documented the severity of vision impairment., Results: Compared to those without cataract, older drivers with cataract were approximately two times more likely to report reductions in days driven and number of destinations per week, driving slower than the general traffic flow, and preferring someone else to drive. Those with cataract were five times more likely to have received advice about limiting their driving. Those with cataract were four times more likely to report difficulty with challenging driving situations, and those reporting driving difficulty were two times more likely to reduce their driving exposure. Drivers with cataract were 2.5 times more likely to have a history of at-fault crash involvement in the prior 5 years (adjusted for miles driven/week and days driven/week). These associations remained even after adjustments for the confounding effects of advanced age, impaired general health, mental status deficit, or depression., Conclusions: Older drivers with cataract experience a restriction in their driving mobility and a decrease in their safety on the road. These findings serve as a baseline for our ongoing study evaluating whether improvements in vision following cataract surgery expand driving mobility and improve driver safety.

Two experiments were conducted to evaluate the perceptual magnet effect. In Experiment 1, American English speakers representing diverse dialects were presented with a fine-grained set of stimuli (varying in just noticeable differences for F1 and F2) and indicated whether they heard "/i/" or "not/i/," thus delimiting the /i/ portion of the vowel space for individual subjects. Then these same subjects selected their own /i/ prototype with a method-of-adjustment procedure. The data from this experiment were used to synthesize customized prototype and nonprototype stimulus sets for Experiment 2. In Experiment 2, 24 of our original 37 subjects completed a discrimination task for each of three conditions, in which vector stimuli varied from the subject's prototype, the nonprototype, or a foreign vowel (/y/) in 15-mel steps. Subjects displayed higher discrimination, as indexed by d', for the nonprototype condition than they did for both the prototype and the foreign conditions. In addition, discrimination was better for variants further away from the referent in each condition. However, discrimination was not especially poor for stimuli close to subjects' individual prototypes--a result that would have yielded the strongest support for the operation of a magnet effect. This negative finding, together with other aspects of our results, raises problems for any theory of vowel perception that relies solely on "one-size-fits-all" prototype representations.

The purpose of this study was to examine the association between visual and cognitive impairment in older drivers and their avoidance of potentially challenging, driving situation. A group of 257 older drivers participated in assessments of visual sensory function, eye health and cognitive function including the useful field of view test, and completed a structured questionnaire on driving exposure and how frequently they avoided challenging driving situations. Results replicated earlier studies showing that many older drivers limit their exposure to driving situations which are generally believed to be more difficult (e.g. rain, night, heavy traffic, rush hour). Furthermore, older drivers with objectively determined visual and/or attentional impairments reported more avoidance than those free of impairments; those with the most impairment reported avoiding more types of situations than other less impaired or non-impaired drivers. Older drivers with a history of at-fault crashes in the prior five years reported more avoidance than those who had crash-free records. Future research should evaluate the potentially beneficial role of self-regulation in enhancing older driver safety, particularly in those older drivers with visual and attentional processing impairments who have elevated crash risk.

Context: Motor vehicle crash risk in older drivers has been associated with visual acuity loss, but only weakly so, suggesting other factors contribute. The useful field of view is a measure that reflects decline in visual sensory function, slowed visual processing speed, and impaired visual attention skills., Objective: To identify whether measures of visual processing ability, including the useful field of view test, are associated with crash involvement by older drivers., Design: Prospective cohort study with 3 years of follow-up, 1990-1993., Setting: Ophthalmology clinic assessment of community-based sample., Patients: A total of 294 drivers aged 55 to 87 years at enrollment., Main Outcome Measure: Motor vehicle crash occurrence., Results: Older drivers with a 40% or greater impairment in the useful field of view were 2.2 times (95% confidence interval, 1.2-4.1) more likely to incur a crash during 3 years of follow-up, after adjusting for age, sex, race, chronic medical conditions, mental status, and days driven per week. This association was primarily mediated by difficulty in dividing attention under brief target durations., Conclusion: Reduction in the useful field of view increases crash risk in older drivers. Given the relatively high prevalence of visual processing impairment among the elderly, visual dysfunction and eye disease deserve further examination as causes of motor vehicle crashes and injury.

Purpose: To identify visual factors that are significantly associated with increased vehicle crashes in older drivers., Methods: Several aspects of vision and visual information processing were assessed in 294 drivers aged 55 to 90 years. The sample was stratified with respect to age and crash frequency during the 5-year period before the test date. Variables assessed included eye health status, visual sensory function, the size of the useful field of view, and cognitive status. Crash data were obtained from state records., Results: The size of the useful field of view, a test of visual attention, had high sensitivity (89%) and specificity (81%) in predicting which older drivers had a history of crash problems. This level of predictability is unprecedented in research on crash risk in older drivers. Older adults with substantial shrinkage in the useful field of view were six times more likely to have incurred one or more crashes in the previous 5-year period. Eye health status, visual sensory function, cognitive status, and chronological age were significantly correlated with crashes, but were relatively poor at discriminating between crash-involved versus crash-free drivers., Conclusions: This study suggests that policies that restrict driving privileges based solely on age or on common stereotypes of age-related declines in vision and cognition are scientifically unfounded. With the identification of a visual attention measure highly predictive of crash problems in the elderly, this study points to a way in which the suitability of licensure in the older adult population could be based on objective, performance-based criteria.

This study investigated the extent to which older adults' loss in spatial contrast sensitivity at a photopic level is attributable to neural changes in the aged visual system. Laser interferometry was used to generate interference fringes which bypass the optics of the eye in presenting a grating target on the retina. Older adults in good eye health exhibited on average a small but statistically significant loss (0.1-0.2 log unit) in contrast sensitivity across the spatial frequency range tested, although there was considerable overlap between young and old adults. This loss in contrast sensitivity for interference fringes accounted for less than half of the photopic contrast sensitivity loss at higher frequencies reported for older adults in studies using conventional direct-viewing techniques in which the optics of the aged eye are not bypassed. We conclude that neural changes in the aged visual system have a rather minor contribution to older adults' loss in spatial contrast sensitivity at a photopic level.

Older drivers have more accidents per miles driven than any other age group and tend to have significant impairments in their visual function, which could interfere with driving. Previous research has largely failed to document a link between vision and driving in the elderly. We have taken a comprehensive approach by examining how accident frequency in older drivers relates to the visual/cognitive system at a number of levels: ophthalmological disease, visual function, visual attention, and cognitive function. The best predictor of accident frequency as recorded by the state was a model incorporating measures of early visual attention and mental status, which together accounted for 20% of the variance, a much stronger model than in earlier studies. Those older drivers with a visual attentional disorder or with poor scores on a mental status test had 3-4 times more accidents (of any type) and 15 times more intersection accidents than those without these problems.

The Rescorla-Wagner theory (Rescorla & Wagner, 1972) of associative learning offers specific predictions about the associative strength of CS-US pairs when two or more CSs are conditioned to the same US separately and subsequently paired in a compound with the same US. The magnitude of orientation-contingent color aftereffects (AEs) was used as an index of associative strength in this study. The results of experiments using an "overprediction" (Rescorla, 1970) and a "blocking" (Kamin, 1969) paradigm conformed to the predictions of the Rescorla-Wagner theory. In Experiment 1, AEs were established simultaneously for horizontal-vertical and diagonal patterns. When observers subsequently viewed compound induction patterns, AE magnitude was found to be significantly decreased, relative to a condition in which observers did not view such an induction pattern. In Experiment 2, AE magnitude for a given test pattern following inspection of compound induction stimuli was significantly reduced by inspection of the other component prior to viewing the compound induction stimuli. The applicability of associative learning and feature-adaptation models of the McCollough effect is discussed.

A repetitive pattern of a triangular luminance profile may be perceived as a triangular-wave grating or as a square-wave grating. This illusion may reflect the operation of cortical phase-selective mechanisms that are biased toward particular phase relations and favor abrupt luminance gradients.

The purpose of this study was to determine how aging affects spatial contrast sensitivity at low light levels and to examine whether senile miosis, which reduces retinal illuminance in the aged eye, underlies any observed sensitivity loss. Contrast thresholds for targets having a range of spatial frequencies were measured in young (n = 13, M age = 24) and older (n = 11, M age = 73) adults who were free from identifiable ocular pathology. Measurements were carried out at three luminance levels spanning a three log unit range. Results indicated that older adults' loss in contrast sensitivity not only increased with increasing spatial frequency, but also became more pronounced with decreases in luminance level. Additional threshold measurements where pupil diameter was varied indicated that senile miosis was not responsible for older adults' loss in spatial vision at any level tested. Rather, older adults' miotic pupil tended to have a positive effect on their spatial vision in that it slightly improved their contrast sensitivity.

Contrast sensitivity as a function of target luminance for four spatial frequencies (0.5, 2, 4, and 8 cycles/deg) was measured in younger (n = 12; age range, 19-35 years) and older (n = 11; age range, 68-79 years) adults in order to examine the feasibility of optical and neural explanations for the impairment of contrast sensitivity in older adults. All subjects were free from identifiable ocular disease and had good acuity. Sensitivity for each spatial frequency was measured at eight luminance levels spanning 3.5 log units in the photopic-mesopic range. When gratings were flickered at 0.5 Hz, functions for older adults were displaced downward on the sensitivity axis across all luminance levels, and the slopes of these functions were steeper than those for younger adults, suggesting that optical mechanisms alone cannot account for the vision loss in older adults. Further measurements, in which spatial targets were flickered at 7.5 Hz, indicated that this faster temporal modulation affected sensitivity as a function of luminance differentially in younger and older adults. These data imply that the neural mechanisms subserving human spatial vision undergo significant changes during adulthood.

A major assumption underlying the use of contrast sensitivity testing is that it predicts whether a patient has difficulty seeing objects encountered in everyday life. However, there has been no large-scale attempt to examine whether this putative relationship actually exists. We have examined this assumption using a clinic based sample of adults aged 20-77 years. Contrast thresholds were measured for both: (1) gratings of 0.5-22.8 cycles/degree; and (2) real-world targets (faces, road signs, objects). Multiple regression techniques indicated that the best predictors of thresholds for real-world targets were age and middle to low spatial frequencies. Models incorporating these variables accounted for 25-40% of the variance. Although acuity significantly correlated with thresholds for real-world targets, the inclusion of acuity as a predictor variable did not improve the model. These data provide direct evidence that spatial contrast sensitivity can effectively predict how well patients see targets typical of everyday life.