Barbara L. Brody

Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration

OBJECTIVE To examine (1) the prevalence of depressive disorders in community-dwelling adults with advanced age-related macular degeneration (AMD) and (2) the relationship in this population between depression, visual acuity, the number of comorbid medical conditions, disability caused by vision loss as measured by the National Eye Institute-Vision Function Questionnaire (NEI-VFQ) and the vision-specific Sickness Impact Profile (SIPV), and disability caused by overall health status as measured by the Sickness Impact Profile-68 (SIP). DESIGN Analysis of cross-sectional baseline data from a randomized clinical trial. PARTICIPANTS Participants were 151 adults aged 60 and older (mean age, 80 years) with advanced macular degeneration whose vision was 20/60 or worse in their better eye. METHODS Subjects were interviewed using measures of depression, disability, and chronic medical conditions. Visual acuity was obtained. Nonparametric correlation analyses and linear regression analyses were performed. MAIN OUTCOME MEASURES Structured Clinical Interview for DSM-IV (SCID-IV), Geriatric Depression Scale (GDS), NEI-VFQ, SIPV, and SIP. RESULTS Of the participants, 32.5% (n = 49) met SCID-IV criteria for depressive disorder, twice the rate observed in previous studies of community-dwelling elderly. Over and above depression (GDS), visual acuity aided in prediction of the level of vision-specific disability (NEI-VFQ and SIPV). CONCLUSIONS Depressive disorder is a significant problem for the elderly afflicted with advanced macular degeneration. Further research on psychopharmacologic and psychotherapeutic interventions for depressed AMD patients is warranted to improve depression and enhance functioning. Over and above depression, visual acuity aided in predicting vision-specific disability. Treatment strategies that teach patients to cope with vision loss should be developed and evaluated.

Ametropia, Preschoolers' Cognitive Abilities, and Effects of Spectacle Correction

OBJECTIVES To examine cognitive abilities of low-income preschoolers with uncorrected ametropia and effects of spectacle correction. METHODS Baseline and 6-week data from a longitudinal controlled study were analyzed. Subjects were 70 preschoolers (mean age, 4.6 years; 60.0% were female; and 85.7% were Latino), including 35 children with previously uncorrected ametropia and 35 emmetropic control subjects. Ametropia was defined as bilateral hyperopia of 4.00 diopters (D) or more in children aged 3 to 5 years, astigmatism of 2.00 D or more in children aged 3 years and 1.50 D or more in children aged 4 and 5 years, or a combination of both. Emmetropia was defined as 2.00 sphere diopters or less and 1.00 cylinder diopter or less in both eyes. Ametropes were assessed before and 6 weeks after correction and compared with control subjects. Primary and secondary outcome measures were Beery-Buktenica Developmental Test of Visual-Motor Integration and Wechsler Preschool and Primary Scale of Intelligence-Revised scores, respectively. RESULTS At baseline, uncorrected ametropes scored significantly lower on the Beery-Buktenica Developmental Test of Visual-Motor Integration (P = .005) and the Wechsler Preschool and Primary Scale of Intelligence-Revised performance scale (P = .01). After 6 weeks of correction, the ametropic group significantly improved on the Beery-Buktenica Developmental Test of Visual-Motor Integration compared with emmetropic control subjects (P = .02). CONCLUSIONS Preschoolers with uncorrected ametropia had significant reduction in visual-motor function. Wearing spectacles for 6 weeks improved Beery-Buktenica Developmental Test of Visual-Motor Integration scores to emmetropic levels.

Refractive errors in low-income preschoolers

Purpose: To estimate the overall prevalence of refractive errors in a study population of low-income preschoolers in San Diego County. Methods: The study sample included 507 preschool children selected from a study population of all 3–5 year-old children in Head Start and San Diego Unified School District preschools (74% Latino). The sample was examined by optometrists in the mobile clinic of the University of California, San Diego, Department of Ophthalmology with retinoscopy under cycloplegia to assess the presence of refractive errors defined as myopia ≥2D in 3–4 year-olds and ≥1D in > 4 year-olds; hyperopia ≥4D in 3–4 year-olds and ≥3D in > 4 year-olds; and astigmatism ≥1.75D in 3–4 year-olds and ≥1.5D in > 4 year-olds. Anisometropia was defined as ≥1.25D difference between the eyes. Emmetropia was defined as refractive errors below these levels. Results: A total of 16% (n = 81 children) (95% confidence interval: 15.4–16.5) met study definitions of refractive errors in at least one eye. Myopia was found in 3%, (OD Mean Sphere = 2.4D); hyperopia in 7.5% (OD Mean Sphere = 3.8D); astigmatism in 5.5% (OD Mean Cylinder = 2.3D); and 84% were emmetropic (OD Mean Sphere = 1.3D). Conclusions: Hyperopia and astigmatism were the most frequent refractive errors in this sample of low-income preschoolers, most of whom were Latino.

A new objective digital computerized vision screening system.

PURPOSE Fewer than 40% of children in the crucial younger-than-4 age group are evaluated for visual problems by pediatricians. This is due to impracticality from either a clinical or practice efficiency standpoint. Current photoscreening methods require trained readers and suffer from significant subjectivity and interobserver variability. We report a cross-sectional, double-masked study using new digital imaging with objective, automated, computerized image analysis. METHODS Two-hundred six children aged 9 months to 16 years were prospectively studied in a University-based pediatric ophthalmology practice. Images were taken by volunteers with a modified digital camera which, when downloaded, were analyzed within 35 seconds by new image analysis software. The analysis was compared to a masked review of a complete pediatric ophthalmic exam. RESULTS Overall agreement between physician and the objective computerized analysis was 86.9%. Positive predictive value was 91%, sensitivity was 89%, and specificity was 83%. CONCLUSIONS This automated digital imaging screening system eliminates human bias and provides accurate and immediate results. The system requires no special expertise.

Computer use among patients with age-related macular degeneration.

Purpose: Age-related macular degeneration (AMD) is the leading cause of incurable vision loss in older adults in industrialized countries and is on a trajectory to disable a growing number of persons as societies age. To assess the potential of using telemedicine for expansion of an in-person AMD self-management program, we examined the extent of computer use in a sample of older adults with AMD. Methods: 160 older adult volunteers (mean age = 76 years; female = 51%) with AMD (mean visual acuity in better eye: 20/40; worse eye: 20/90) were randomly selected from members of the San Diego County AMD Registry. Computer use was assessed with a Health and Impact Questionnaire. Dependent measures were Snellen visual acuity, National Eye Institute-Visual Function Questionnaire, the AMD Self-Efficacy Questionnaire, and the Geriatric Depression Scale. Results: Overall 70.6% reported computer use at least once per month. By age and gender stratum, 76.5% of men aged 60–74 years, 73.3% of men aged 75 years and over, 74.3% of women aged 60–74 years, and 60.9% of women aged 75 years and over used computers. In logistic regression analyses controlling for age and gender, computer use was associated with better visual acuity (P = 0.029), higher education (P = 0.002), and self-efficacy for communication (P = 0.027). Conclusion: The majority of older adults with AMD in our sample used computers, with use highest among more educated and visually intact patients. Computer use to access the Internet is feasible in AMD patients and should be encouraged. The inclusion of computer use in measures of AMD-related functioning appears warranted.