Previous studies have reported that reduced visual acuity is associated with functional dependenc... more Previous studies have reported that reduced visual acuity is associated with functional dependence in older persons. The purpose of this study was to determine whether components of vision impairment besides reduced acuity contribute to reduced functional independence. Community dwelling adults aged 65 years and older were administered a battery of vision tests including distance acuity, letter contrast sensitivity, disability glare, and stereoacuity. A physical function questionnaire assessed self-reported difficulty with activities of daily living (ADL's), Instrumental activities of daily living (IADL's), and mobility activities. A visual function questionnaire assessed self-reported difficulty with a wide variety of everyday visual activities. Multiple logistic regression analysis showed that reduced acuity and reduced contrast sensitivity were independently associated with an overall vision disability score. Acuity was associated with difficulty in tasks requiring good resolution and adaption to changing light conditions, whereas contrast sensitivity was associated with difficulty in tasks requiring distance judgments, night driving, and mobility. Glare and stereoacuity were not associated with self-reported disability. Reduced acuity and contrast sensitivity are significant risk factors for self-reported disability.
Exposure to UV-B radiation in sunlight has been shown to increase the risk of cataract formation ... more Exposure to UV-B radiation in sunlight has been shown to increase the risk of cataract formation in high-risk occupational groups, but risk to the population has not been quantified. To determine the ocular exposure to UV-B radiation in sunlight for a population of older persons and to determine the association between UV-B and lens opacities. The Salisbury Eye Evaluation project, a population-based cohort of older adults. Salisbury, Md. A total of 2520 community-dwelling 65-year-old to 84-year-old adults in Salisbury, Md, from 1993 to 1995, of whom 26.4% were African Americans. Association of photographically documented cortical opacity 3/16 or greater in at least 1 eye with ocular UV-B exposure, reported in Maryland sun-years of exposure. The odds of cortical opacity increased with increasing ocular exposure to UV-B (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.20). The relationship was similar for women (OR, 1.14; 95% CI, 1.00-1.30) and for African Americans (OR, 1.18; 95% CI, 1.04-1.33). Analyses of the ocular dose by each age group after the age of 30 years showed no vulnerable age group, suggesting damage is based on cumulative exposure. Although this population of older Americans has relatively low ocular exposure to UV-B in sunlight, there is still an association between ocular exposure and increasing odds of cortical opacity. Our study found an association among African Americans, which, to our knowledge, has not been reported previously. All sex and racial groups would benefit from simple methods to avoid ocular sun exposure.
Accomplishing a compression of morbidity will require prevention of disability, a significant com... more Accomplishing a compression of morbidity will require prevention of disability, a significant component of illness in older adults. To do this, better understanding is needed of the natural history of functional loss prior to disability. The authors hypothesize that there is an identifiable stage of ...
This report examines the relationship between psychophysical measures of visual impairment and se... more 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. 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). 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. 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.
We assessed vision before and after uncomplicated extracapsular cataract extraction and intraocul... more We assessed vision before and after uncomplicated extracapsular cataract extraction and intraocular lens implantation in 72 symptomatic patients with acuity equal to or better than 20/80 and no other ocular abnormality. Contrast sensitivity was measured with the Pelli-Robson Letter Chart (Metropia Ltd, Cambridge, England) and disability glare was measured under daytime conditions with the Brightness Acuity Tester (Mentor O&O Inc, Norwell, Mass) and under nighttime conditions with a computer-controlled video display. Prior to surgery there was significant disability glare that was not correlated with acuity. There was also a loss in contrast sensitivity that was moderately correlated with acuity (r = -.43; P < .001). Following surgery, most patients' scores returned to normal on all tests. Improvement in disability glare and contrast sensitivity was independent of improvement in acuity. Furthermore, patients with the poorest preoperative vision were as likely to regain normal function after surgery as those with the best preoperative vision.
Previous studies have reported that reduced visual acuity is associated with functional dependenc... more Previous studies have reported that reduced visual acuity is associated with functional dependence in older persons. The purpose of this study was to determine whether components of vision impairment besides reduced acuity contribute to reduced functional independence. Community dwelling adults aged 65 years and older were administered a battery of vision tests including distance acuity, letter contrast sensitivity, disability glare, and stereoacuity. A physical function questionnaire assessed self-reported difficulty with activities of daily living (ADL's), Instrumental activities of daily living (IADL's), and mobility activities. A visual function questionnaire assessed self-reported difficulty with a wide variety of everyday visual activities. Multiple logistic regression analysis showed that reduced acuity and reduced contrast sensitivity were independently associated with an overall vision disability score. Acuity was associated with difficulty in tasks requiring good resolution and adaption to changing light conditions, whereas contrast sensitivity was associated with difficulty in tasks requiring distance judgments, night driving, and mobility. Glare and stereoacuity were not associated with self-reported disability. Reduced acuity and contrast sensitivity are significant risk factors for self-reported disability.
Exposure to UV-B radiation in sunlight has been shown to increase the risk of cataract formation ... more Exposure to UV-B radiation in sunlight has been shown to increase the risk of cataract formation in high-risk occupational groups, but risk to the population has not been quantified. To determine the ocular exposure to UV-B radiation in sunlight for a population of older persons and to determine the association between UV-B and lens opacities. The Salisbury Eye Evaluation project, a population-based cohort of older adults. Salisbury, Md. A total of 2520 community-dwelling 65-year-old to 84-year-old adults in Salisbury, Md, from 1993 to 1995, of whom 26.4% were African Americans. Association of photographically documented cortical opacity 3/16 or greater in at least 1 eye with ocular UV-B exposure, reported in Maryland sun-years of exposure. The odds of cortical opacity increased with increasing ocular exposure to UV-B (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.20). The relationship was similar for women (OR, 1.14; 95% CI, 1.00-1.30) and for African Americans (OR, 1.18; 95% CI, 1.04-1.33). Analyses of the ocular dose by each age group after the age of 30 years showed no vulnerable age group, suggesting damage is based on cumulative exposure. Although this population of older Americans has relatively low ocular exposure to UV-B in sunlight, there is still an association between ocular exposure and increasing odds of cortical opacity. Our study found an association among African Americans, which, to our knowledge, has not been reported previously. All sex and racial groups would benefit from simple methods to avoid ocular sun exposure.
Accomplishing a compression of morbidity will require prevention of disability, a significant com... more Accomplishing a compression of morbidity will require prevention of disability, a significant component of illness in older adults. To do this, better understanding is needed of the natural history of functional loss prior to disability. The authors hypothesize that there is an identifiable stage of ...
This report examines the relationship between psychophysical measures of visual impairment and se... more 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. 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). 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. 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.
We assessed vision before and after uncomplicated extracapsular cataract extraction and intraocul... more We assessed vision before and after uncomplicated extracapsular cataract extraction and intraocular lens implantation in 72 symptomatic patients with acuity equal to or better than 20/80 and no other ocular abnormality. Contrast sensitivity was measured with the Pelli-Robson Letter Chart (Metropia Ltd, Cambridge, England) and disability glare was measured under daytime conditions with the Brightness Acuity Tester (Mentor O&O Inc, Norwell, Mass) and under nighttime conditions with a computer-controlled video display. Prior to surgery there was significant disability glare that was not correlated with acuity. There was also a loss in contrast sensitivity that was moderately correlated with acuity (r = -.43; P < .001). Following surgery, most patients' scores returned to normal on all tests. Improvement in disability glare and contrast sensitivity was independent of improvement in acuity. Furthermore, patients with the poorest preoperative vision were as likely to regain normal function after surgery as those with the best preoperative vision.
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