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Biomedical subjects

Jill E Keeffe

Publications and source records attributed to Jill E Keeffe.

At least 19 recordsLinked to original sources
PubMed2006

Costs of interventions for visual impairment.

PURPOSE: To quantify the economic costs of vision loss in Australia and assess the impact of a costed intervention package to prevent avoidable vision loss. DESIGN: Existing Australian population-based data on prevalence and causes of visual impairment were used, and costs were calculated from published data for the five main causes of visual impairment. METHODS: The cost of vision loss in Australia was determined from the weighted prevalence of visual impairment; unpublished data on the indirect costs of vision; and national databases on health care costs and other economic data. A costed intervention package was developed and its economic impact modeled. Outcome measures were total costs and savings from the interventions. RESULTS: The intervention package would cost AU$188.8 million to implement in its first year but would bring a net return of AU$163.1 million in direct costs in the first year and an overall savings to the country of AU$911.1 million, a 4.8-fold return on investment. CONCLUSIONS: Three-quarters of vision loss is avoidable, and many eye care interventions are cost effective. Even a developed economy cannot afford avoidable vision loss. Priority needs to be given to the prevention and treatment of avoidable vision loss.

Australia↗
PubMed2006

Visual acuity thresholds for cataract surgery and the changing Australian population.

OBJECTIVE: To examine the relation between visual acuity thresholds for cataract surgery for the changing Australian population. METHODS: Population-based 5-year incidence data for 2594 people were used to calculate age-specific prevalence of incident cataract and existing cataract backlog. The cataract surgery rates (CSRs) per million people were estimated for different acuity thresholds for the Australian population at different times. RESULTS: In 2005, after adjusting by age, the estimated CSRs for Australia were 1470, 3110, 5080, and 6440 for visual acuities of less than 6/60, less than 6/18, less than 6/12, and less than 6/9, respectively, whereas the actual CSR was 9000. Although the acuity threshold had the greatest impact, the CSR for less than 6/12 increased 3-fold from 2300 in 1950 to 7210 in 2020 because of demographic changes. CONCLUSIONS: Demographic changes, with an increasing proportion of older people, will continue to increase the need for cataract surgery, as will a reduction in the visual impairment threshold. Plans for the future for eye care services should take these factors into account.

Adult↗
PubMed2006

Evaluation of an eye health program: the vision initiative.

PURPOSE: The aim of this study was to develop an innovative, rapid and economical assessment methodology to determine the knowledge, attitudes and behaviours regarding eye health and to determine the rates of the most common causes of visual impairment and undiagnosed eye disease. METHODS: Letters were posted to Seniors Card holders aged 70-79 in 18 randomly selected areas, stratified by socio-economic status. A questionnaire was developed to measure knowledge, attitudes and behaviours regarding eye health. Uncorrected refractive error was determined by measuring presenting and best-corrected visual acuity (VA). Diabetic retinopathy and age-related macular degeneration were assessed using digital non-mydriatic retinal photography. Glaucoma was assessed using Frequency Doubling Technology (FDT) and digital images of the optic nerve head. Cataract was determined using digital retro-illumination images of the lens taken with a non-mydriatic camera. The cost for recruiting, examining and grading images for each participant was calculated by dividing the total study cost by the number of participants examined. RESULTS: Of the 13,483 participants invited to participate in the study, appointments were made for 1860 (13.8%) people with 1,701 (91%) actually attending. Overall, missing data from the 1,695 questionnaires represented less than 1.0% and all participants attended the vision screening over a three-month period. Presenting and best-corrected visual acuity and FDT results on both eyes were obtained on 99% of the sample. The proportion of gradable digital images of the fundus in both eyes in the sample was 89%, while 90% of participants with bilateral presenting VA<6/12 had assessable lens images. The cost for recruiting, examining and grading images for each participant was approximately 150 AUS dollars. CONCLUSION: The recruitment from a mailing obtained the required sample size for the study, allowing a large sample of participants to be examined efficiently over a short period of time. It is important that the most common causes of visual impairment and undiagnosed eye disease can be determined using this rapid assessment methodology.

Aged↗
PubMed2006

Utilization of eye care services in Victoria.

PURPOSE: To determine baseline eye care utilization by older Victorians in order to assess change in 2 years after an eye health promotion campaign. METHODS: A letter of invitation to participate was sent to all people aged 70-79 years in randomly selected Melbourne postcode areas. A questionnaire was designed to allow gathering of eye health-related information. Eye exams included autorefraction, frequency doubling technology and non-mydriatic fundus photography. Results were compared with the Melbourne Vision Impairment Project . RESULTS: A total of 1695 people with a mean age of 74 years were recruited. The overall proportion with visual impairment was 8% (134/1695), of which 27% (36/134) was due to non-refractive causes. Only 31% (11/36) of visually impaired people knew about low-vision services, of whom 20% (7/36) had used them. Of all people with diabetes, only 52% (96/184) had a dilated eye exam within the recommended 2 years (Melbourne Vision Impairment Project 44%). CONCLUSIONS: Compliance rates with recommendations for 2-yearly eye exams for people with diabetes have not improved since the last major eye health study in Victoria 10 years ago. The same is true for the rate of undiagnosed glaucoma, suggesting that messages about eye examinations need to be promoted for older people at high risk of vision loss, for example, those with diabetes and at risk of vision loss from glaucoma.

Aged↗
PubMed2006

Rapid and cost-effective method to assess vision disorders in a population.

PURPOSE: The aim was to develop a means of rapidly assessing eye health in a cost- and time-effective way to monitor changes over time. METHODS: Key features of the five main eye diseases that cause vision loss in Australia were assessed. Participation was volunteer-based from randomly selected Melbourne suburbs. Recruitment was by mail. Anterior segments and fundi were photographed with a digital non-mydriatic fundus camera. Visual fields were tested with Frequency Doubling Technology. A questionnaire collected information about demographics, general health and lifestyle. Findings from this rapid assessment were compared with those from a population-based study. RESULTS: A total of 1695 people, aged between 70 and 79 years (mean 74), were recruited. The rates and causes of visual impairment were similar between the rapid assessment method and the population-based study. Among the 134 people (8%) with visual impairment at presentation, 98 (73%) had undercorrected refractive error, 17 (13%) had age-related macular degeneration, 11 (8%) had cataract, 2 (2%) had diabetic retinopathy and 2 (2%) had glaucoma. Screening costs per participant were only about AU$145, compared with AU$433 in the Melbourne Visual Impairment Project (VIP). The application of Frequency Doubling Technology as well as the use of a non-mydriatic digital camera for fundus and lens photography resulted in an average examination time of less than half the time needed in the VIP. Data collection took 3 months rather than 4 years in the VIP. CONCLUSION: The rapid assessment method was efficient in time and cost and produced results comparable to a normal population-based survey. Repeating the study design for a similarly sampled group every 2 years would allow the assessment of changes in the prevalence of undiagnosed eye disease.

Aged↗
PubMed2006

The agreement between the Heidelberg Retina Tomograph and a digital nonmydriatic retinal camera in assessing area cup-to-disc ratio.

PURPOSE: To determine the repeatability and agreement between a digital camera (monoscopic and stereoscopic images) and the Heidelberg Retina Tomograph (HRT; Heidelberg Engineering, Heidelberg, Germany) in determining cup-to-disc ratio. A secondary purpose was to determine the monoscopic and stereoscopic thresholds that maximize specificity and sensitivity when compared with the HRT. METHODS: Community living participants aged between 70 and 79 years had their optic discs imaged with a digital nonmydriatic retinal camera (NMRC) and the HRT. Intraclass correlation coefficients (ICCs) and 95% tolerance limits of change were used to determine repeatability characteristics of the instruments. The agreement between the HRT- and NMRC-derived area cup-to-disc ratios was assessed using weighted kappa statistics and receiver operator characteristic (ROC) curves. RESULTS: The agreements between the monoscopic and stereoscopic images and HRT were assessed for 1238 and 1173 eyes, respectively. The reliability measures for both NMRC techniques and HRT were almost perfect (ICC = 0.84-0.99) with narrow tolerance limits of change (9.2%-18.4%) and very small systemic biases (P < 0.05). The agreement between the HRT and both NMRC techniques was substantial, with a weighted kappa = 0.83. The HRT gave a marginally larger area cup-to-disc ratio than the monoscopic and stereoscopic images by 0.008 and 0.006, respectively (P < 0.001). The areas under the ROC curves for both NMRC techniques were 0.98, indicating excellent discriminating characteristics (P < 0.001). An area cup-to-disc ratio cutoff of > or =0.5 for the monoscopic and stereoscopic NMRC was highly specific (94.1% and 91.6%) and sensitive (87.5% and 97.2%, respectively) in determining an HRT-derived area cup-to-disc ratio >0.6. CONCLUSIONS: The monoscopic and stereoscopic digital images showed excellent repeatability and demonstrated substantial agreement with the HRT. The results indicate that the digital NMRC could be a reliable and useful instrument for assessing area cup-to-disc ratio and screening for glaucoma-suspect eyes in the community.

Aged↗
PubMed2006

Impact of impaired vision and eye disease on quality of life in Andhra Pradesh.

PURPOSE: To determine the impact of visual impairment and eye diseases on quality of life (QOL) in an older population of Andhra Pradesh in southern India. METHODS: The World Health Organization (WHO) QOL (WHOQOL) instrument was adapted as a health-related quality of life (HRQOL) instrument for administration to adults participating in the Andhra Pradesh Eye Disease Study. Participants aged 40 years and older (n = 3702), 99.4% of the 3723 eligible, who underwent interview and detailed dilated ocular eye evaluation by trained professionals were included in this study. Psychometric properties of the HRQOL instrument were evaluated among visually impaired people. Relationships among overall QOL scores and presenting visual acuity in the better eye, specific eye diseases, and demographic variables were examined. RESULTS: Internal consistency was high for the entire questionnaire (alpha = 0.94). Each item of the QOL scale had an adequate item-total correlation (range, 0.25-0.77) greater than 0.2. After adjusting for demographic variables and ocular disease, Subjects with blindness had significantly lower QOL scores. Subjects with glaucoma or corneal disease independent of visual acuity had lower scores than subjects without those eye diseases. Subjects with cataract or retinal disease had significantly lower scores than those without cataract or retinal disease in the model without visual acuity but not when visual acuity was added to the model. CONCLUSIONS: Decreased QOL was associated with the presence of glaucoma or corneal disease independent of visual acuity and with cataract or retinal disease as a function of visual acuity. Visual impairment from uncorrected refractive errors was not associated with decreased QOL.

Adult↗
PubMed2006

The Impact of Vision Impairment Questionnaire: an evaluation of its measurement properties using Rasch analysis.

PURPOSE: To explore the psychometric properties of the Impact of Vision Impairment scale (IVI) by using Rasch analysis. METHODS: Three hundred fourteen first-time referrals to low-vision clinics completed the 32-item IVI. The data were Rasch-analyzed with a partial credit model using RUMM2020 software (RUMM Laboratory, Perth, WA, Australia). The overall fit of the model, response scale, individual item fit, differential item functioning, unidimensionality, and person-separation reliability were assessed. RESULTS: Initially, 26 items displayed disordered thresholds. However, collapsing the response scale to three categories (4 items) and four categories (28 items) produced ordered response thresholds for all items. Four items with high proportions of missing responses, poor spread, high skewness, and deviation between observed and expected model curves were then removed. This adjustment produced overall fit to the Rasch model (item-trait interaction chi(2) = 118.3; P = 0.32). The final mean (SD) person and item fit residuals ere 0.06 (0.85) and -0.20 (1.45), respectively. The person-separation reliability was 0.9, indicating that the scale was able to discriminate between several different groups of participants. The revised scale was well targeted to the participants, with similar mean locations for items (0.00) and persons (0.16). A significant difference between participants of mild, moderate, and severe visual impairment (ANOVA; P 0.001) supported the criterion validity of the Rasch-scaled IVI. CONCLUSIONS: The results provide support for the measurement properties of the Rasch-scaled 28-item version of the IVI and of its potential for assessing outcomes of low-vision rehabilitation. A raw score-to-Rasch person measure conversion is supplied.

Adult↗
PubMed2005

Vision loss in Australia.

OBJECTIVE: To assess the prevalence and causes of vision loss in Australia and to project these data into the future. DESIGN: Synthesis of data from two cross-sectional population-based cohort studies--the Melbourne Visual Impairment Project and the Blue Mountains Eye Study--and extrapolation to the entire Australian population. SETTING AND PARTICIPANTS: 8376 community and 533 nursing home residents recruited between 1992 and 1996 in urban and rural Victoria and New South Wales. MAIN OUTCOME MEASURES: Age-standardised prevalence of low vision (visual acuity < 6/12) and blindness (visual acuity < 6/60) (both measured in the best eye, with spectacles if usually worn for distance vision), and their causes for the Australian population for 2000 to 2024, projected from Australian Bureau of Statistics population data. RESULTS: In 2004, 480,300 Australians were estimated to have low vision, including 50,600 with blindness. The most common causes of low vision were undercorrected refractive error (62%), cataract (14%) and age-related macular degeneration (10%). The latter was responsible for almost half of all cases of blindness. The numbers of people with low vision and blindness are projected to almost double by 2024. CONCLUSIONS: Vision loss in Australia is a much bigger problem than is usually recognised; 76% of low vision is caused by uncorrected refractive error or cataract, both readily treatable. However, the prevention and treatment of macular degeneration poses a major challenge.

Adult↗
PubMed2005

Performance of community-based glaucoma screening using Frequency Doubling Technology and Heidelberg Retinal Tomography.

PURPOSE: To assess the performance of a community-based glaucoma screening algorithm in the general population. METHODS: A total of 659 individuals aged 50-90 years were screened for glaucoma. Presenting visual acuity, family history of glaucoma, FDT perimetry, and HRT tests were assessed. Additional samples of participants served as control groups. Participants identified as glaucoma positive received a full ophthalmic examination. Based on this exam a consensus diagnosis was made which served as the gold standard. RESULTS: The optimal screening strategy combining visual acuity and family history with FDT and HRT had sensitivities, specificities, positive predictive values and negative predictive values of 96.8%, 89.7%, 31.9%, and 99.8% respectively for detecting glaucoma. CONCLUSIONS: By combining assessments of presenting visual acuity and family history of glaucoma with Frequency Doubling Technology perimetry and Heidelberg Retina Tomography, we devised a community glaucoma-screening algorithm that showed a high sensitivity and specificity for detecting glaucoma in the general population.

Aged↗
PubMed2004

The impact of diabetic retinopathy on participation in daily living.

OBJECTIVE: To determine the restriction of participation in daily activities of people with diabetic retinopathy using the Impact of Vision Impairment questionnaire. METHODS: Individuals with diabetic retinopathy and a visual acuity (VA) worse than 20/40 or 6/12 in the better eye were eligible. Participants answered demographic questions and had VA information abstracted from medical records. If VA information was unavailable, it was assessed by an orthoptist. MAIN OUTCOME MEASURES: All participants completed the Impact of Vision Impairment questionnaire, which was either self-administered or interviewer administered. The physical and mental health components were assessed using the Medical Outcomes Study 12-Item Short Form (SF-12) questionnaire. RESULTS: Forty-five participants (mean age, 67.5 years) were recruited, with almost 70% (30/45) recording a VA worse than 20/60 or 6/18 in the better eye. The median duration of vision loss was 2.0 years. The highest restriction was reported for the Leisure and Work, Mobility, and Consumer and Social Interaction domains (mean, 3.0, 2.8, and 2.8, respectively), compared with the Emotional Reaction to Visual Loss and Household and Personal Care domains (mean, 2.3 and 2.1, respectively) (P<.005). The activities with the greatest restriction of participation were reading print, mobility, work, and leisure. A poorer VA in the better eye correlated independently with increased restriction of participation, as measured by the Impact of Vision Impairment questionnaire scores (partial correlations, 0.29-0.41; P< or =.03). CONCLUSION: Low-vision rehabilitation services aiming to improve outdoor mobility, print reading, participation in leisure activities, and psychological health may be an effective strategy to help people with diabetic retinopathy increase their participation in daily activities.

Activities of Daily Living↗
PubMed2004

The determinants of participation in activities of daily living in people with impaired vision.

PURPOSE: To investigate the determinants of participation in daily activities in people with impaired vision using the Impact of Vision Impairment (IVI) instrument. DESIGN: Cross-sectional study. METHODS: We recruited 319 participants with no vision rehabilitation history, distance visual acuity (VA) <6/12 (better eye), the ability to converse in English, and 18 years or older. Participants completed the 32-item IVI questionnaire and provided demographic, personal, cultural, and environmental details on vision-related functioning. Visual acuity data were either abstracted from the participants' files or assessed by qualified personnel. Participants also completed the SF-12 to evaluate physical (PCS-12) and mental health (MCS-12). RESULTS: The areas of greatest restriction of participation were associated with reading, outdoor mobility, participation in leisure activities, and shopping. In stepwise linear regression presenting VA, the PCS-12 and MCS-12 explained the variance in leisure and work (60 participants or 19%), consumer and social interaction (92 participants or 30%), household and personal care (76 participants or 24%), mobility (92 participants or 30%), emotional reaction to visual loss and (106 participants or 33%), and total IVI score (114 participants or 36%). Having age-related macular degeneration contributed marginally to the IVI domains and total score (P <.05-.01), except for the emotional domain. Belonging to a social group explained 3% and 2% of the variance in the consumer and social interaction and emotional domains, respectively (P <.05). CONCLUSIONS: Distance VA and physical and mental health explained more than a third of the variance of the total score, suggesting that an intervention aimed at improving quality of life may include strategies to improve not only vision-related rehabilitation but also mental and physical health.

Activities of Daily Living↗
PubMed2004

Detection of undiagnosed glaucoma by eye health professionals.

PURPOSE: To examine the clinical features of undiagnosed open-angle glaucoma (OAG) in people who have attended an eye care provider within the previous 12 months and to suggest strategies to assist in the early detection of glaucoma. DESIGN: Population based cross-sectional study. PARTICIPANTS: Permanent residents aged 40 years and older at recruitment during 1992 through 1996. METHODS: A cluster-stratified random sample of 4744 participants from the urban and rural cohorts was studied. Structured standardized interviews and dilated ocular examinations were conducted in all eligible participants. Data on demographic characteristics, prior knowledge of eye disease, use of eye care services, intraocular pressures, cup-to-disc ratios, visual fields, and photography of optic discs were obtained. All suspected glaucoma cases were submitted to a panel of 6 ophthalmologists to determine glaucoma diagnosis. MAIN OUTCOME MEASURES: Clinical features of participants seen by eye health professionals within the previous 12 months who have previously undiagnosed OAG, previously diagnosed OAG, and no glaucoma. RESULTS: Thirty-five previously undiagnosed and 43 previously diagnosed participants had visited an optometrist or ophthalmologist or both in the previous 12 months. Age and gender were not significantly different between the undiagnosed and diagnosed glaucoma cases. After logistic regression, the type of eye professional seen (odds ratio [OR], 45.17; 95% confidence interval [95% CI], 5.89-346.17; P = 0.0002) and the presence of visual field defects (OR, 0.06; 95% CI, 0.01-0.69, P = 0.020) were the only statistically significant variables between the diagnosed and undiagnosed glaucoma groups. CONCLUSIONS: Raised intraocular pressure should not be relied on as the only triggering factor in glaucoma investigations.

Adult↗
PubMed2004

The need for routine eye examinations.

PURPOSE: To determine the incidence and causes of vision loss to assist in the objective determination of the preferred frequency of routine screening for those with normal vision. METHODS: A prospective, population-based study of people aged 40 or more years. Standardized examination protocols were used that included presenting and best corrected visual acuity, visual field testing, and comprehensive eye examination with dilation. RESULTS: There were 2529 people with a full data set, including 1590 with a normal baseline examination. The 5-year incidence of vision loss (<6/12 presenting acuity in the worse eye) was 2.39%. Overall, 24 (63%) of 38 of those with vision loss had noticed a change in their vision, and 18 (75%) of these 24 had attended an eye examination. This left only 14 (0.88%) people who had had normal baseline examination results and had asymptomatic vision loss develop over this 5-year period. CONCLUSIONS: Frequent routine eye examinations of those with normal examination results will have a low yield and may not be cost effective. Health promotion messages should target those who notice a change in vision and those at higher risk such as those with diabetes or a family history of eye disease.

Adult↗
PubMed2003

Measurement of indirect costs for people with vision impairment.

From a societal perspective, chronic eye diseases can affect not only the person who has vision impairment but also the economics of that society. To obtain comprehensive medical and non-medical expenditures for people with impaired vision, direct and indirect costs should be collected. Indirect costs are usually not included in cost evaluation in health economics due to the difficulty of the data collection and analysis. Questionnaires and cost diaries have been developed in this study to estimate total resource use, expenses, and lost production from the participants or their caregivers due to the participants' vision loss. Pilot testing was conducted to verify the format, clarity of instructions, relevance of content and completeness of the questionnaires and diary. Modifications were then made to the format from feedback from the participants. Diaries using large print, audio and Braille facilitate data collection for people with impaired vision.

Cost of Illness↗
PubMed2003

Associations between glaucomatous visual field loss and participation in activities of daily living.

PURPOSE: This study investigated the association between visual field loss and participation in daily activities in individuals with glaucoma. METHODS: Seventy-nine patients were recruited from the Royal Victorian Eye and Ear Hospital. Visual fields were assessed using the Esterman binocular visual field tests and participation in daily activities was assessed using the Impact of Vision Impairment (IVI) questionnaire. Visual acuity and contrast sensitivity were also measured. RESULTS: There was no independent relationship between visual field loss and IVI score (r = -0.20; P = 0.09), except for the mobility domain (r = 0.25; P = 0.03). Mobility was the most affected domain of the IVI (mean = 1.2). Over a quarter of the patients reported experiencing moderate to severe restriction with mobility activities despite relatively minor binocular field loss. CONCLUSION: Mobility is the area in which glaucoma patients encounter difficulties even when the visual field and visual acuity are relatively good. Questions related to mobility could be asked to identify those patients who need rehabilitation.

Activities of Daily Living↗
PubMed2003

Barriers to accessing low vision services.

AIM: To investigate barriers to accessing low vision services in Australia. METHODS: Adults with a vision impairment (<6/12 in the better eye and/or significant visual field defect), who were current patients at the Royal Victorian Eye and Ear Hospital (RVEEH), were interviewed. The questions investigated self-perceived vision difficulties, duration of vision loss and satisfaction with vision and also examined issues of awareness of low vision services and referral to services. Focus groups were also conducted with vision impaired (<6/12 in the better eye) patients from the RVEEH, listeners of the Radio for the Print Handicapped and peer workers at Vision Australia Foundation. The discussions were recorded and transcribed. RESULTS: The questionnaire revealed that referral to low vision services was associated with a greater degree of vision loss (p = 0.002) and a greater self-perception of low vision (p = 0.005) but that referral was not associated with satisfaction (p = 0.144) or difficulties related to vision (p = 0.169). Participants with mild and moderate vision impairment each reported similar levels of difficulties with daily activities and satisfaction with their vision (p > 0.05). However, there was a significant difference in the level of difficulties experienced with daily activities between those with mild-moderate and severe vision impairment (p < 0.05). The participants of the focus groups identified barriers to accessing low vision services related to awareness of services among the general public and eye care professionals, understanding of low vision and the services available, acceptance of low vision, the referral process, and transport. CONCLUSION: In addition to the expected difficulties with lack of awareness of services by people with low vision, many people do not understand what the services provide and do not identify themselves as having low vision. Knowledge of these barriers, from the perspective of people with low vision, can now be used to guide the development and content of future health-promotion campaigns.

Activities of Daily Living↗