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Detecting glaucoma with RADAAR: the Bridlington Eye Assessment Project.

AIMS: To develop a diagnostic algorithm using rim/disc area asymmetry ratio (RADAAR) to discriminate between normal and glaucomatous eyes using the Heidelberg retina tomograph (HRT). METHODS: RADAAR was calculated by dividing rim/disc area ratio of the larger disc by that of the smaller disc. RADAAR normal tolerances in each disc sector were generated using 611 population based normal elderly individuals (mean age 72.5 years). Overall status for each individual was equal to the worst disc sector. Sensitivity was assessed in 45 patients with open angle glaucoma. RESULTS: RADAAR variance was significantly greater in glaucoma compared with normality in all disc sectors (p<0.001). Normal RADAAR limits were not dependent on age or sex. Overall, at the 99th percentile limit, the diagnostic algorithm's specificity was 95.1% with a sensitivity of 55.6%. Males with glaucoma showed greater RADAAR variance than females. Corresponding sensitivity of the diagnostic algorithm was 63.0% and 44.4% in males and females respectively, although this difference was not statistically significant (p = 0.43). CONCLUSION: The RADAAR diagnostic algorithm detected glaucoma with moderate sensitivity but was limited by significant numbers of glaucoma patients with symmetrical optic disc changes. RADAAR may have greater sensitivity in males than in females although this requires confirmation in further studies.

Aged↗

Amblyopia.

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Amblyopia↗

Incidence of cases of ocular trauma admitted to hospital and incidence of blinding outcome.

AIMS: To provide epidemiological data on the current burden of serious eye injuries utilising the hospital eye service, to inform the planning and provision of eye health care, and health and safety strategies for the prevention of ocular injuries. METHODS: A prospective observational study was carried out of all patients with ocular trauma admitted to hospitals in Scotland, under the care of a consultant ophthalmologist, during a 1 year period. The population of Scotland represented the population at risk of injury. Visual outcome (Snellen visual acuity in the injured eye) was measured at the time of final discharge from ophthalmic care and at follow up. RESULTS: All ophthalmic departments in Scotland participated and a total of 415 residents of Scotland were admitted. The 1 year cumulative incidence of ocular trauma necessitating admission to hospital is estimated to be 8.14 per 100 000 population (95% CI 7.38 to 8.97). Some 13.2% (n = 26/197) of patients discharged from follow up had a poor visual outcome with a visual acuity less than 6/12 in the injured eye. Some 10.7% (21/197) patients at this time had a blinding outcome in the injured eye (visual acuity less than 6/60). No patient was registered blind or partially sighted during the study period. The home was the single most frequent place for blinding injuries to occur (52%, n = 11/21), followed by the workplace 24% (n = 5/21). The 1 year cumulative incidence of blinding outcome from serious ocular trauma is estimated to be 0.41 per 100 000 population per year (95% CI 0.26 to 0.64). CONCLUSION: The current burden of serious ocular trauma presenting to the hospital eye service has been quantified from this population based study, and for the first time, a direct estimate of the incidence of the subsequent blinding outcome from these injuries has been provided. Ocular trauma remains an important cause of avoidable and, predominantly, monocular visual morbidity (visual impairment and blindness), with over half of the blinding injuries now occurring in the home. Health education and safety strategies should now consider targeting the home for the prevention of the serious eye injuries in addition to the traditional work, sports, and leisure environments and their related activities.

Adolescent↗

Measuring visual symptoms in British cataract patients: the cataract symptom scale.

AIMS: To develop and validate a scale for the measurement of visual symptoms and functional disability due to cataract in older UK residents. METHODS: In depth semistructured interviews were undertaken with 44 consecutive patients awaiting cataract surgery. Patients were asked to describe visual symptoms and problems with social functioning which were then incorporated into a questionnaire, the cataract symptom scale (CSS). The CSS was further examined in a cohort of 118 consecutive cataract patients awaiting surgery. Further assessments in these patients included visual acuity, visual function using an existing scale (the VF-14), activities of daily living, perceived health status, anxiety and depression, and a global assessment of how much patients felt their visual symptoms affected their daily life. RESULTS: A 15 item scale was derived which was simple to administer to older patients and had a high internal consistency. The test-retest correlation coefficient for the total instrument score was r = 0.91 (p<0.0001). The CSS correlated well with the VF-14 and to a lesser extent with visual acuity in the better eye, activities of daily living, perceived health status, anxiety and depression, and the patients' global assessment of visual symptoms. CONCLUSION: The CSS provides information regarding the symptomatic and functional status of older cataract patients resident in the UK which cannot be obtained by measurement of visual acuity alone.

Activities of Daily Living↗

Creation and testing of a practical visual function assessment for use in Africa: correlation with visual acuity, contrast sensitivity, and near vision in Malawian adults.

AIM: To develop and test a practical visual function assessment for use in developing countries. METHODS: Using focus group discussions and interviews with eyecare workers and low vision specialists in Malawi, 13 questions related to visual characteristics of activities of daily living were designed. Patients presenting to an eye clinic were recruited and interviewed. Visual acuity, near vision, and contrast sensitivity were measured. Analysis sought to determine the degree of correlation between the vision indices and visual function. RESULTS: The visual function questionnaire was easy to administer. Visual function correlated with visual acuity, contrast sensitivity, near vision, and patient reported visual problem. People with a higher frequency of "not applicable" responses had lower visual function scores. Multivariate modelling revealed that visual acuity and number of questions felt to be applicable were independently associated with visual function. Reducing the questionnaire to nine questions did not affect the degree of correlation with any of the visual indices. CONCLUSION: The authors' visual function assessment correlates well with different measures of visual acuity. People with reduced vision for a prolonged period may no longer consider doing certain tasks and the number of questions considered appropriate by an individual may be an additional measure of visual function. Assessment of visual function by health workers may be a valuable tool in improving surgical uptake by encouraging both health personnel and patients to recognise that they have difficulties undertaking activities of daily living as well as a measure of monitoring and evaluating cataract outcomes.

Contrast Sensitivity↗

Visual acuity measurements in a national sample of British elderly people.

BACKGROUND: Despite the fact that visual function has an important role in the quality of life in later years, very few studies have measured visual acuity in population based nationwide samples of British elderly people. Such measurements were carried out in the context of the national diet and nutrition survey of people aged 65 years or over (NDNS). METHODS: NDNS participants, who were living in 80 different randomly selected postcode areas of mainland Britain, were visited at their home by a nurse who measured visual acuity at 3 metres, using the Glasgow acuity card (GAC) method. In addition, a brief questionnaire related to ocular health was administered. RESULTS: Visual acuity was measured in 1362 NDNS participants who were not classified as mentally impaired. Visual impairment (using the WHO low vision criteria) was measured in 195 (14.3%) subjects. Prevalence of visual impairment increased significantly with age (65-74 years 3.1%; 75-84 years 11.6%; 85+ years 35.5%, p<0.001 for trend). Impaired vision was more common in subjects living in a nursing home (odds ratio adjusted for age 2.59 (95% CI 2.23 to 2. 96)) and in women (odds ratio adjusted for age 1.55 (95% CI 1.21 to 1.89)). 132 (9.7%) subjects had previously undergone cataract surgery and another 157 (11.5%) had been told that they currently had cataract. Vision improved 0.2 log units or more (at least one Snellen line) with the aid of a pinhole occluder in 289 subjects (21. 2%). CONCLUSION: Results of this nationwide, community based study confirm that problems with poor distance visual acuity exist in a substantial part of the elderly community, particularly in women and people living in nursing homes.

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Correction of refractive error in the Victorian population: the feasibility of "off the shelf" spectacles.

AIMS: To assess the feasibility of providing a stock of ready made spectacles for correction of refractive error in the general population. METHODS: Data were collected in the Visual Impairment Project, a population based survey of Victorian residents aged 40 years or older in randomly selected urban and rural sample areas. This included a refractive eye examination and the proportion of subjects with hypermetropia, emmetropia (defined as -1.0 to +1.0D spherical equivalent), and myopia documented in the 40-60 year age group. RESULTS: 2595 (54.8%) participants were aged between 40 and 60 years. Those with a best corrected visual acuity of less than 6/12, astigmatism of more than 1.25D, and anisometropia of more than 0.5D were excluded. 516 participants had refractive error which was deemed suitable for correction by "off the shelf" spectacles. This represents 19.9% of all participants between 40 and 60 years of age. Provision of spectacles in 0.5D increments would provide suitable stock spectacles for 85.5% of a -3.0 to +3.0D range or 89.2% of a -3.50 to +3.50D range. CONCLUSIONS: Ready made "off the shelf" spectacles could significantly alleviate visual morbidity due to refractive error in up to 20% of an urban population in Australia. This approach may also be useful in developing countries with poor access to optometric services.

Adult↗