Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study

OBJECTIVE: To study the prevalence and causes of blindness and visual impairment in various age categories of a large population-based study. METHODS: For the study, 6775 subjects aged 55 years or older underwent an extensive ophthalmologic screening examination, including measurements of visual acuity and the visual field and fundus photography. The causes of blindness or visual impairment were determined using all screening information and medical records. RESULTS: The prevalence of blindness, according to World Health Organization criteria, ranged from 0.1% in subjects aged 55 to 64 years to 3.9% in subjects aged 85 years or older; the prevalence of visual impairment ranged from 0.1% to 11.8%. For persons younger than 75 years, myopic degeneration and optic neuropathy were the most important causes of impaired vision. For persons aged 75 years or older, age-related macular degeneration was the major cause of the increased prevalence of blindness, whereas age-related cataract predominantly caused the increased prevalence of visual impairment. CONCLUSIONS: The hierarchy of causes of blindness and visual impairment is highly determined by age. As yet, little can be done to reduce the exponential increase of blindness; however, adequate implementation of surgery to treat cataract could reduce visual impairment by one third. Underuse of ophthalmologic care is a prominent cause of the high frequency of untreated cataracts among the elderly.     

Everyday activity patterns and sensory functioning in old age.

In the present study the authors investigated the relationship between visual and auditory acuity and everyday activity functioning. Participants were 516 older adults (70–103 years; equal numbers of men and women) who were members of the age-stratified Berlin Aging Study. Two categories of everyday activity functioning, perceived competence with basic activities of daily living (BaCo; basic competence) and amount of participation in discretionary social and leisure tasks (ExCo; expanded competence), were examined. The results revealed that sensory acuity, particularly vision, was a significant predictor of both BaCo and ExCo (rs ranging from .32 to .47). Indeed, hearing and vision could explain most of the age-related variance in everyday activities. At the same time, in the context of a broader model, evidence for the differential prediction of BaCo and ExCo was found, although there was also evidence for strong general age-related predictive variance that was common to both measures. Discussion focuses on the role of sensory acuity constructs as mediators of age-related variance in psychological and behavioral outcomes and the potential causal implications of this mediation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a Tactile Wisconsin Card Sorting Test.

Objective: To evaluate the construct validity of a tactile adaptation of the Wisconsin Card Sorting Test (TWCST) for use with individuals with visual impairment. Study Design: Static-group comparison (1-factor design with 3 levels). Setting: A VA Healthcare System residential rehabilitation center for persons with visual impairment. Participants: Fourteen persons who were both neurologically and visually impaired (NVI), 14 persons who were visually impaired but neurologically healthy (VI), and 15 healthy controls (HC). Measures: TWCST and Wechsler Adult Intelligence Scale (3rd ed.) Verbal scale (Psychological Corporation, 1997). Results: The TWCST accurately discriminated the NVI group from both the VI and HC samples. Conclusions: Findings provide preliminary support for the construct validity of the TWCST for use with persons with visual impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

U-83836E prevents kainic acid-induced neuronal damage

Tsukuba College of Technology is the first national university established as an institute of higher education for the visually and hearing impaired. We have been systematically conducting a University Personality Inventory (UPI) survey on our students since 1989 to understand their mental health. In this study, we compared the UPI scores of the new students of Tsukuba College of Technology in 1993 and 1994 with unimpaired students from the University of Tsukuba (control group), but found no significant difference in the UPI scores of the visually impaired and the control group. However, we noticed a significant difference in the average UPI scores between the hearing impaired and the control group. The visually impaired group were divided into four subgroups, UPI scores descended in order from degree 1 (total blindness), to degrees 2 and 3 (amblyopia), to degree 4 (visual acuity > or = 0.3). The UPI scores of the degree 4 subgroup were significantly lower than those of the control group. An investigation of the items for which the check rate was at least 50% showed that the visually impaired students had a variety of psychological problems, most of which seemed to concern depression or anxiety as did the normal control group. The number of affirmative responses increased with low visual acuity. The only one belonging to the 'lie' scale item was observed in the group of hearing impaired students. Thus, comparing these three groups from the viewpoint of mental health, we noticed the hearing impaired group was slightly different from the other two groups, but the visually impaired group was similar to the normal control group.     

Pain and cognitive status in the institutionalized elderly: perceptions & interventions

The purposes of this study were to examine the relationship between: (1) nurses' ratings of pain and corresponding administration of pain medication to elderly long-term care residents, and (2) cognitive status of the elderly and pain medication orders/administration. Participants were 83 residents, 60 years of age and older, in two groups: cognitively impaired (n = 64), and cognitively intact (n = 19). For comparison purposes, 19 of the cognitively impaired subjects were matched on age and diagnosis to provide control for potentially painful conditions. A retrospective medication review of the resident's charts was conducted to compare medication orders and administration on analgesics that were scheduled and p.r.n. (given as needed). The pain ratings of 25 RNs using a visual analogue scale were correlated with pain medications given to the resident on the day of the rating. Results indicated that RNs' ratings of resident pain and the administration of pain medications were not significantly correlated. In addition, cognitively impaired residents were prescribed significantly less scheduled medication and received significantly less pain medication (either p.r.n. or scheduled) than the cognitively intact elderly. Implications for practice and research are discussed.     

A normative, community-based study of Mini-Mental State in elderly adults: the effect of age and educational level

We investigated community-based data of the Mini-Mental State Examination (MMSE) scores of elderly residents along with the effects of age and educational level. MMSE was planned for all residents over 65 years of age in a town in northern Japan. The number of elders who took the MMSE was 2,266 (90%). The score significantly declined with age and lower educational level, although no effect of sex was apparent. For the MMSE subitems, all the values except for that of naming showed effects of both age and educational level. Those screened by MMSE who fell in the range of cognitive impairment (< 24) accounted for 21.8% and those with severe cognitive impairment (< 18) constituted 6.0%. Despite the differences in language and culture, the mean scores are remarkably similar between Japan and other countries. This is the first normative, community-based study of MMSE among elderly adults in Japan.     

Visual impairment in Swedish children. III. Diagnoses

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.     

Age differences in reading with distraction: Sensory or inhibitory deficits?

Two experiments examined how sensory acuity affects age differences in susceptibility to interference in the reading-with-distraction task. In both experiments, older and younger adults read texts in an italic font and were required to ignore distractor words in an upright font. Experiment 1 examined whether the age-related increase in distractibility can be simulated in younger adults by reducing their visual acuity. Experiment 2 investigated whether the age differences in distractibility disappear if visual acuity is equated across all participants in both age groups. Both experiments showed that an impairment in visual acuity leads to increased interference in the reading-with-distraction task. However, older adults were much more impaired by the distractor material than younger adults with reduced visual acuity (Experiment 1). The age differences in the reading-with-distraction task persisted when visual acuity was equated between older and younger adults (Experiment 2). We conclude that the age-related increase in susceptibility to interference in the reading-with-distraction task is not solely due to perceptual deficits of older adults but arises from a deficit in higher cognitive processes such as inhibitory attention. Nevertheless, sensory acuity has to be taken into account as a potential confounding factor in perceptually demanding visual attention tasks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The regulation of neovascularization of matrix metalloproteinases and their inhibitors

This study sought to produce a cognitive profile of herpes simplex encephalitis (HSE) survivors from a large group of definitively diagnosed, acyclovir-treated participants. Results from 22 adults who underwent a battery of neuropsychological tests indicated anterograde memory dysfunction to be the most severe and common deficit (although the variation was great), with less severe and less frequent impairments in the areas of retrograde memory, executive functions, and language functioning. Overall, neuropsychological outcome was unimpaired in six participants, mildly impaired in thirteen, moderately impaired in one, severely impaired in two. Older participants and those with a lower level of consciousness before the start of treatment produced poorer scores on certain aspects of cognitive outcome (p < 0.05). A significantly better cognitive outcome was found in participants for whom there was a short delay (fewer than 5 days) between symptom onset and acyclovir treatment compared with those participants for whom there was a longer delay. The two children in the study had disparate results on most tests, the exception being those assessing memory functioning on which both children had scores at population norms. On a naming task designed to explore category-specific knowledge deficits, the adults as a group made more errors on pictures of living things than nonliving things (matched pair-wise for word frequency and visual familiarity), although this difference disappeared on a smaller subset of pictures also matched for visual complexity.     

Effects of depressive symptoms on health behavior practices among older adults with vision loss.

Objective: The authors examined the interface between visual impairment and depressive symptoms on health behaviors, self-care, and social participation among adults ages 65 and older. Method: The authors analyzed data from the 1997–2004 National Health Interview Survey on visual impairment and depressive symptoms for 49,278 adults ages 65 and older, comparing visually impaired adults (n = 8,787) with and without depressive symptoms with a reference group of adults with neither condition (n = 3,136) for outcome measures: physical health, health behaviors, and difficulties with self-care and social participation. Results: Adults with visual impairment and severe depressive symptoms were more likely than adults with neither condition to smoke (14.9%, adjusted odds ratio [AOR] = 1.6), be obese (28.2%, AOR = 1.9), be physically inactive (80.5%, AOR = 3.0), have fair–poor health (76.0%, AOR = 26.5), and have difficulties with self-care (27.9%, AOR = 11.8) and social participation (52.1%, AOR = 10.9). Discussion and Conclusions: Older visually impaired adults with depressive symptoms are vulnerable to health decline and further disablement without timely interventions that target smoking cessation, healthy eating, and increased physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of blindness and visual impairment in the region of Ségou, Mali. A baseline survey for a primary eye care programme

A community-based cross-sectional study on the prevalence and causes of blindness and visual impairment was conducted between July and August 1990 in three rural districts in Ségou region, Mali. The study population consisted of 5871 villagers. In the study area, the overall prevalence of bilateral blindness was 1.7% (standardized rate for age 2.0% +/- 0.4%), of bilateral visual impairment 1.7% (2.1% +/- 0.4%), of unilateral blindness 1.7% (2.2% +/- 0.4%) and of unilateral visual impairment 1.0% (1.2 +/- 0.3%). No important differences were found between districts. Cataract was the most common cause of visual loss (54%) and was most prevalent among those over 50 years of age. In 43%, unilateral blindness was associated with trauma. Other major eye diseases accounting for high percentages of visual impairment were trachoma and glaucoma. Xerophthalmia appeared to be a major public health problem among children in the age group 0-5. It was concluded that blindness is a major public health problem in this region. Some recommendations are given for strengthening integrated primary eye care at the district level in Ségou region.     

Service use and mental impairment among the elderly: Arguments for consultation and education.

Compared the service use patterns of older adults with varying levels of mental impairment, and assessed the effects of services received on their mental health status over a 1-yr period. Data were obtained from a US General Accounting Office (1977, 1979) study of 531 elderly persons (mean age 76.1 yrs), which included administration of a modified version of the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Ss were interviewed twice, 1 yr apart. 174 Ss were classified as having a mild psychiatric impairment, and 118 Ss had a severe psychiatric impairment. The existence of mental impairment was related to marital status, race, and level of education. Usage of mental health services was low, although mentally impaired Ss were more likely than unimpaired Ss to use social and medical services. Results also suggest that such services can have an important effect on the mental health of older persons. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Role of Primary and Secondary Control in Adaptation to Age-Related Vision Loss: A Study of Older Adults With Macular Degeneration.

This study examines the effect of primary and secondary control on 3 major outcomes experienced by visually impaired older adults, that is, functional ability, adaptation to vision loss, and positive affect. The authors' theoretical model is based on the J. Heckhausen and R. Schulz (1995) control framework, as well as a conceptual integration of these outcomes, and they hypothesized that control beliefs can substantially contribute to explaining interindividual differences in these outcomes. A path model applied to data from a sample (N = 90) of visually impaired older adults, suffering from age-related macular degeneration, the major cause of vision loss in old age, generally supports this expectation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The causes of childhood blindness in South Africa

OBJECTIVES: 1. To ascertain the causes of severe visual impairment and blindness in children in schools for the blind in South Africa. 2. To determine the major avoidable causes. 3. To determine causation by ethnic group. DESIGN: A cross-sectional survey, undertaken at 15 of the 16 schools for the blind in South Africa, during May-September 1996, using standard WHO methodology. SUBJECTS: Children less than 16 years of age on May 1996. RESULTS: Of 1,615 eligible children, 1,311 were examined. According to WHO categories of visual impairment, using the corrected visual acuity in the better eye, 30.4% of children were blind (< 3/60, BL), 12.6% had severe visual impairment (< 6/60-3/60, SVI), 42.3% were visually impaired (< 6/18-6/60), and 12.0% had no impairment (6/18 or better). The anatomical sites of SVI/BL in 564 children were: retina 38.5%; optic nerve 15.2%; cornea/phthisis bulbi 11.0% and glaucoma 6.7%. Aetiological categories of SVI/BL were: hereditary diseases 33.0%; intra-uterine factors 0.9%; perinatal conditions 13.1%; acquired conditions of childhood 11.5%. In 41.5% the underlying cause could not be determined. In 38.8% of children with SVI/BL the cause was avoidable, i.e. preventable or treatable. The main causes varied between ethnic groups, the major difference being the higher proportion of retinopathy of prematurity in white and Indian children. CONCLUSIONS: The study suggests that 38.8% of causes of SVI or blindness in children in schools for the blind in South Africa are avoidable, and that specific control measures need to be targeted at different ethnic groups.     

Effects of prenatal cocaine exposure on embryonic expression of sonic hedgehog

PURPOSE: To estimate the impact of visual impairment in older Australians on the use of community support services. METHODS: In the Blue Mountains Eye Study, 3654 people aged 49 or older were examined- 82.4% of eligible residents in an area west of Sydney, Australia. Presenting and best-corrected visual acuities were measured using a LogMAR chart. Subjects were categorized as having visual impairment if their better eye read 40 or fewer letters (20/40 or worse). Interview data included marital and other socioeconomic status measures, living status (alone or with spouse or other person), use of community support services, reliance on regular help from nonspouse family members or friends, and perceived ability to go out alone. RESULTS: After adjusting for age, gender, education, living status, walking disability, and health-related factors, for each one-line (five-letter) decrease in best-corrected visual acuity, there was a corresponding increase in reliance on community support services (odds ratio [OR], 1.17; 95% confidence interval, [CI] 1.07-1.28) or combined community and family support (OR 1.22; 95% CI, 1.12-1.32). Visually impaired persons were three times as likely to use regular support services provided by the municipality (OR 3.1; 95% CI, 1.8-5.1). A similar increased reliance on regular help from community, nonspouse family members, or friends was found. Visually impaired persons were also much more likely to state that they thought they were unable to go out alone (OR 6.2; 95% CI, 2.6-14.3). The findings were similar when presenting visual acuity was used to define visual impairment or after subjects with walking disabilities were excluded. Visual impairment seemed to have a greater effect on use of community support services in women than in men. CONCLUSIONS: After adjustment was made for confounding factors, visual impairment was found to affect significantly and negatively the independence of elderly people, particularly older women. Presenting visual acuity closely approximated best-corrected visual acuity in its impact on the use of community support services.     

Correlates of locus of desired control in two samples of elderly persons: Community residents and hospitalized patients.

Describes the correlates of a new measure of desired control in 2 groups of elderly persons. Study 1 examined the desired control correlates for 88 elderly community residents (mean age 75 yrs). As predicted, desired control was significantly negatively correlated with depression and positively correlated with health, knowledge of services for the elderly, and use of services for the elderly. Study 2 examined the correlates of desired control for 77 male patients in a chronic care hospital ward (mean age 72 yrs). Desired control was significantly correlated with 4 of 5 indices of psychological adjustment. The 2 studies together indicate the breadth of relationships of desired control to diverse aspects of psychological well-being, including a measure of subjective senescence. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation of the cognitive test for the blind as an assessment of intellectual functioning.

Objective: To investigate the concurrent validity of the Cognitive Test for the Blind (CTB) as an intellectual assessment for the visually impaired or blind (VI/B) population. The ecological validity of the CTB was also examined. Design: Correlational analyses. Participants: Two hundred ninety-two persons with visual impairment or blindness. Main Outcome Measure: The CTB Verbal section, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Verbal section, and the Survey of Functional Adaptive Behavior. Results: A correlation of .72 was obtained between the CTB and the WAIS-R. The correlations of the CTB Total and WAIS-R Verbal sections with overall adaptive functioning were .50 and .47, respectively. Conclusions: The CTB offers valid assessment of intellectual functioning for persons with visual impairment or blindness, as well as other useful information that may aid in the treatment planning process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evaluation of intervention programmes for communicatively impaired elderly people

A study is described which examined the efficacy of group intervention programmes using trained volunteers as agents of intervention with elderly nursing home residents with communication impairments. A series of intervention programmes, which consisted of six weekly sessions, was designed. Sessions were a combination of information giving, discussion and practical components where residents could practise newly acquired skills. Sessions covered a number of core components--the communication process, comprehension, expression and pragmatics, as well as information that was specific to the communication impairment. Volunteers were trained to administer the programme. Four groups of communicatively impaired elderly people were included in the study--a group of hearing-impaired residents, those with communication impairment subsequent to Parkinson's disease, those with communication impairment subsequent to cerebrovascular accident and those in varying stages of dementia. Results indicated that, although the residents studied responded very individually to the intervention strategies, with several subjects failing to demonstrate any gains in communicative competence from pre- to post-intervention, positive gains in communication skills and self-management of communicative impairment were observed for a number of subjects. Complicating factors such as general health and well-being are considered as uncontrollable variables in the measurement of performance in the elderly.     

Effects of age on cross-modal emotion perception.

Efficient navigation of our social world depends on the generation, interpretation, and combination of social signals within different sensory systems. However, the influence of healthy adult aging on multisensory integration of emotional stimuli remains poorly explored. This article comprises 2 studies that directly address issues of age differences on cross-modal emotional matching and explicit identification. The first study compared 25 younger adults (19–40 years) and 25 older adults (60–80 years) on their ability to match cross-modal congruent and incongruent emotional stimuli. The second study looked at performance of 20 younger (19–40) and 20 older adults (60–80) on explicit emotion identification when information was presented congruently in faces and voices or only in faces or in voices. In Study 1, older adults performed as well as younger adults on tasks in which congruent auditory and visual emotional information were presented concurrently, but there were age-related differences in matching incongruent cross-modal information. Results from Study 2 indicated that though older adults were impaired at identifying emotions from 1 modality (faces or voices alone), they benefited from congruent multisensory information as age differences were eliminated. The findings are discussed in relation to social, emotional, and cognitive changes with age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult age differences in the effects of sentence context and stimulus degradation during visual word recognition.

I investigated adult age differences in the efficiency of feature-extraction processes during visual word recognition. Participants were 24 young adults (M age?=?21.0 years) and 24 older adults (M age?=?66.5 years). On each trial, subjects made a word/nonword discrimination (i.e., lexical decision) regarding a target letter-string that was presented as the final item of a sentence context. The target was presented either intact or degraded visually (by the presence of asterisks between adjacent letters). Age differences in lexical decision speed were greater for degraded targets than for intact targets, suggesting an age-related slowing in the extraction of feature-level information. For degraded word targets, however, the amount of performance benefit provided by the sentence context was greater for older adults than for young adults. It thus appears that an age-related deficiency at an early stage of word recognition is accompanied by an increased contribution from semantic context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)