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Visual spatial abilities and fall risk: an assessment tool for individuals with dementia.

Risk of falling is a major concern of long-term care facilities with residents diagnosed with dementia. Use of a brief cognitive assessment focusing on visual spatial abilities could be one strategy in the prevention of falls in residents with dementia. The objective of this study was to determine if a clock test could predict a risk of falls in residents diagnosed with dementia. Three hundred sixty-four individuals with dementia participated (92 men and 272 women; ages 37 to 100, mean 80.5 years, median 83 years). Each participant was given the Reality Comprehension Clock Test (RCCT) three times, and Mini Mental-Status Examination (MMSE) two times to determine criterion-related validity, test-retest reliability, internal consistency; and to set and evaluate a risk of falls score based on the Visual Spatial Score (VSS) component produced by the RCCT. Significant findings included .72 (p < .01) correlation between the RCCT and the MMSE, .90 (p < .01) correlation between the first administration of the RCCT and the second administration of the RCCT; an alpha of .95 (p, < .001) and an F value of 7.6 (p < .001) producing a risk of falls initial VSS of 5 or lower compared to 9 or greater. Chi-square of 6.3 for 30 days (p,< .01), 11.08 for 60 days (p < .01) and 13.3 for 90 days (p < .01) indicated a significant difference in the number of falls occurring in the high risk group (VSS of 5 or lower) compared to the low/ no risk group (VSS of 9 or higher). A risk factor analysis suggested that residents in the higher risk group were three times more likely to have fallen than residents in the low risk group. Knowing a resident's visual spatial ability offers health care providers an opportunity to implement a resident-specific intervention that addresses their cognitive ability and visual spatial deficit that may reduce the resident's risk of falling.

Accidental Falls↗

The visually inattentive preterm infant.

A retrospective study was made of 16 premature infants who were visually inattentive despite normal eye findings and a lack of factors predisposing them to cerebral blindness. A comparison of this study group with other premature infants who were visually attentive revealed a much greater incidence of upper motor neuron disease and mental retardation in the study infants.

Female↗

Calibration of photoscreeners for single-subject, contact-induced hyperopic anisometropia.

BACKGROUND: In 1999, the threshold anisometropic hyperopia for photoscreening toddlers and preschoolers was determined to be 1.50 D. We compared crescent size from induced anisometropic hyperopia using three commercially available photoscreeners and compared them with miniature digital video cameras, which have a flash-to-lens dimension similar to two of the three photoscreeners. Photoscreeners were compared with a remote autorefractor. METHODS: Anisometropia was induced by placing several known minus contact lenses (-1.00, -1.50, and -2.00 D) in the nondominant eye of a visually healthy, orthophoric emmetrope older than 3 years. Photographs were taken in light and dim conditions with all three cameras with and without the contact lenses. Corneal diameter, pupil diameter, and crescent location were determined. A protocol for flash initiation, focus, and distance was determined for the digital cameras. RESULTS: Under light and dim ambient light, no camera yielded a significant hyperopic crescent for emmetropia (no contact lens) or induced 1.0-D anisometropia. We propose a simple measure, "delta center crescent" distance from the center of the pupil to the edge of the crescent. Delta center crescent less than 1.5 mm identified most examples of threshold hyperopic anisometropia. The ideal distance for photoscreening using the digital cameras is approximately 1.6 m, whereas the commercially available photoscreeners focus at 1.0 m. CONCLUSIONS: We have developed a protocol for photoscreening and its interpretation with a miniature digital video camera weighing 400 g and costing approximately dollar 1,000. Threshold anisometropic hyperopia can be determined from digital still or audio-labeled video flash images if the pupils are at least 4 mm.

Amblyopia↗

Profile of amblyopia in a hospital referral practice.

OBJECTIVE: Evaluation of the clinical profile and distribution of different sub-types of amblyopia in a referral eye hospital in India. METHODS: This was a prospective hospital-based observational study, evaluating the clinical profile of patients with amblyopia presenting to a referral strabismology practice. The examination included assessment of the visual acuity, the refractive status, the fixation pattern, the grade of binocularity, and evaluation of the associated strabismus, if any before treatment was started. RESULTS: The average age of the patients at presentation was 7.97?6.18 years with 81 out of 683 patients (11.8%) presenting above the age of 20 years. The best-corrected visual acuity (BCVA) was less than 6/60 in the amblyopic eye in 121 out of 733 eyes (16.5%). Strabismic amblyopia was the most common sub-type of amblyopia seen (274/733 eyes, 37.38%). Though patients with anisometropic amblyopia presented at a later age (average of 10.03+/-6.92 years), they had better visual acuity, binocular functions, and centricity of fixation at all ages, relative to other sub-types of amblyopia. The BCVA did not show any co-relation with the age of presentation [co-relation co-efficient (CF) of 0.074], refractive status of the amblyopic eye (CF of 0.078), the type of amblyopia (CF of 0.196), or the type of strabismus present (CF of 0.079). However, a very significant co-relation was seen between the BCVA and the fixation pattern of the amblyopic eye (CF of 0.817). CONCLUSIONS: Lack of knowledge and awareness about amblyopia and its appropriate timely management has been the main cause for the late presentations and significant visual impairment associated with the condition.

Adolescent↗

Ophthalmic survey of an old people's home in Nigeria.

BACKGROUND: Old people's home is a relatively new experience in Nigeria. Data on the pattern of ocular morbidity among inmates are examined with the aim of making suitable recommendations. METHOD: An old people's home in Port Harcourt was the site of this survey carried out in February 2004. The following data was collected from all inmates-name, sex, age, length of stay, visual acuity, main cause of ocular morbidity, past medical history. Intraocular pressure was measured as indicated. Refractions were carried out on the spot. RESULTS: The male to female ratio of the 20 inmates was 2:3. The age range was from 70-105 years with a mean of 85 years, 7 months +/- 12.14 (SD). The mean duration of stay was 7 years with 50% staying there less than 5 years. 60% had associated systemic illnesses. 85% had visual acuity of less than 3/60 in the better eye. Cataract was the cause of 40% of the ocular morbidity and also caused 57% of the blindness. CONCLUSION: This study emphasizes the need for regular check up of our geriatric population to enable early detection of ocular health problems and thus prevent avoidable disability and dependency. Social support and health insurance could also improve outcome and uptake of treatment options.

Aged↗

The prevalence of glaucoma in an onchoendemic community in South-Eastern Nigeria.

METHODOLOGY: With the aim of examining all the adults aged 30 years and above a survey was conducted in Alum-Inyi, a mesoendemic Community in South-Eastern Nigeria. The people were subjected to basic ophthalmic tests for the diagnosis of glaucoma namely corrected and uncorrected visual acuity at 6 metres using an illiterate E-chart, with pinhole assessment if visual acuity < 6/18; direct ophthalmoscopy to assess the vertical cup-disc ratio through undilated pupils and Schiotz indentation tonometry. In addition, static visual field analysis using the MK 1 Friedman visual field analyser was carried out in any glaucoma suspect. RESULTS: Of 664 eligible persons examined (out of the estimated total of 946), 14 definite cases of glaucoma were identified, giving a prevalence of 2.10% in the 30 years of age and older population. The mean vertical cup-disc ratio for the non-glaucoma cases were 0.30 (+0.004) and 0.31 (+/- 0.004) and 0.31 (+/- 0.09) in the right and left eyes respective. Among the glaucoma cases, the average vertical cup-disc ratio in the right and left eye were 0.63 (+/- 0.05) and 0.70 (+/- 0.06 respectively. No physiological cup of > or = 0.6 was recorded in our study. The mean iOP in the right and left eyes respectively were 18.54 (+/- 0.15) and 19.42 (+/- 0.14) in the nonglaucomatous cases and 26.39 (+/- 1.75) and 27.46 (+/- 2.59) in the glaucoma cases. CONCLUSION: Despite its limitations, this study confirms that the prevalence of glaucoma varies from one African population or population of African origin to another. It agrees with other reports that the risk of glaucoma increases with age.

Adult↗

[Prevalence of diabetic retinopathy in the region of Girona. Study of related factors].

PURPOSE: To determine of the prevalence of diabetic retinopathy in the general diabetic population in the Girona region and epidemiologic study of the related factors. METHODS: A population-based cross-sectional study of a randomised sample taken of 401 diabetics in the Girona region. Descriptive statistical analysis of the ocular lesions in relation to diabetic retinopathy and analysis of logistic regression in order to determine the related factors. RESULTS: 30.6% (IC 95%: 26.5-35.5) of the sample presented some degree of diabetic retinopathy, 19.4% (IC 95%: 15.4-24.0) at the initial stage, 8.4% (IC 95%: 5.8-1.9) pre-proliferative and 2.6% (IC 95%: 1.3-5.1) at a proliferative stage. Regarding the type of diabetes, 53% of the patients with type 1 diabetes and 34.2% of those with type 2 diabetes had retinopathy. Retinopathy was observed in 15.7% of diabetics with less than 10 years of diabetes evolution, 51.3% in those between 10 and 20 years and 62.8% in those with more than 20 years. The concentration of HbA1C was significantly associated with the degree of retinopathy. Of those patients with retinopathy, 60.3% were insulin-treated, 30.6% with oral hypoglucemiants and 10.3% on diet only. Patients with family antecedents of retinopathy presented a prevalence three times greater than those without. CONCLUSIONS: Approximately one in three diabetic patients exhibited some degree of retinopathy in this study dealing with a population-based cohort of diabetic patients in Spain. The prevalence was greater among type I diabetic patients. As expected, years of evolution of the disease, type of treatment and diabetic metabolic control were the most significant factors influencing the presence of retinopathy.

Aged↗

Reliability and validity of the Test of Visual-Perceptual Skills (Non-Motor)--Revised for Chinese preschoolers.

OBJECTIVE: The reliability and validity of the Test of Visual-Perceptual Skills (Non-Motor)-Revised (TVPS-R) were examined for its usefulness on Hong Kong Chinese preschoolers. METHOD: Content validity was evaluated by six experts. Test-retest reliability, construct validity, and criterion validity were examined on 66 typically developing preschoolers while concurrent validity was examined on these preschoolers plus 52 preschoolers with visual-perception difficulties. RESULTS: Test-retest reliability was high for the total score (intraclass correlation coefficient [ICC] =.88), but not for all subtests (ICC ranged .38 to .77) or for individual items (mean kappa = 0.32). The standard error of measurement (SEM; 1.53) and internal consistency (Cronbach's alpha = .90) were satisfactory. Evidence supporting the test's validity included a significant developmental trend (F = 4.99, p < .001), a lack of gender bias (F = .04, p = .84), and positive known-group differentiation (Wilks's lambda = 52.42, p < .001). The correlation between the Motor-Free Visual-Perceptual Test-Revised composite score and the TVPS-R composite was moderate at r = .60. CONCLUSIONS: When based on the total scores, the TVPS-R was reliable and valid. The use of subtest scores and item scores for decision making or treatment planning is not recommended.

Analysis of Variance↗

Early detection of diabetic retinopathy.

Diabetic retinopathy remains a leading cause of blindness in Australia. Most cases can be prevented by timely laser photocoagulation and this requires early detection of asymptomatic retinopathy. The Australian Diabetes Society recommends regular retinal examinations through dilated pupils, either at diagnosis of diabetes (onset over 30 years), or five years after diagnosis (onset under 30 years). Examination should be repeated at least every two years, or more frequently in the presence of visual symptoms, pregnancy or other risk factors. Diabetic patients and primary care physicians should be better informed about the effectiveness of timely treatment of diabetic retinopathy and the need for regular eye examinations, either by general practitioners or through referral to ophthalmologists.

Adult↗

Advances in the management of AIDS-related cytomegalovirus retinitis.

Cytomegalovirus (CMV) retinitis, a common complication of the acquired immunodeficiency syndrome (AIDS), is increasing in frequency as patients infected with the human immunodeficiency virus (HIV) live longer. In recent years, the lifetime risk for CMV disease in HIV-infected persons has increased from 24.9% to 44.9%. Cytomegalovirus retinitis is usually diagnosed clinically: Almost all patients are CMV seropositive and have CD4+ counts less than 50 cells/mm3. Specific diagnostic tests that use antigen detection or quantitation of circulating nucleic acid to detect CMV are being developed, but they have not been validated for routine clinical use. Such tests would help predict disease, diagnose acute retinitis, and monitor therapy. Therapy with systemic agents, including intravenous ganciclovir, intravenous foscarnet, and intravenous cidofovir, is effective. However, it is cumbersome, costly, and associated with considerable toxicity, therapy encouraging investigation of other therapeutic approaches. Intravitreous injections with antiviral agents are effective, but the short half-life of available agents makes these injections inconvenient. Intraocular implants that slowly release ganciclovir have been effective for both acute therapy and long-term maintenance, but they need to be directly compared with intravenous and oral regimens to determine which regimen will optimally maximize convenience, preserve vision, and improve survival. Cytomegalovirus retinitis could be prevented by improved antiretroviral therapies or by immune-based therapies that would prolong the time during which patients remain immunocompetent. Once patients become immunologically susceptible to CMV end-organ disease (when their CD4+ counts decrease to < 50 cells/ mm3), specific chemotherapy with oral ganciclovir is promising, but the cost, inconvenience, toxicity, and conflicting reports of efficacy associated with this strategy mean that it needs careful assessment before it can be considered standard treatment. Management of CMV retinitis is on the verge of major changes. In the next few years, improvements in diagnostic, therapeutic, and preventive tools should reduce morbidity and mortality from this disease.

AIDS-Related Opportunistic Infections↗

Diabetic retinopathy.

The authors describe the serious condition diabetic retinopathy, which can lead to blindness. They discuss the nurse's role in caring for patients with this condition, as well as in education.

Diabetic Retinopathy↗