Ee-Munn Chia

Hearing impairment and health-related quality of life : The blue mountains hearing study

Objectives: To assess the association between hearing impairment and health-related quality of life (HRQOL) in an older population, using the self-administered 36-item Short-Form Health Survey (SF-36). Design: Participants of the Blue Mountains Hearing Study (BMHS, N = 2956) attended a comprehensive interview and hearing examination in which both self-reported and measured hearing impairments were assessed. Hearing impairment was defined as the pure-tone average of air-conduction hearing thresholds >25 decibels hearing level (dB HL) for the four frequencies (0.5 to 4.0 kHz) in the better ear. Results: Of the 2431 participants with complete data (mean age, 67.0 yr), 1347 (55.4%) did not have measured hearing loss, whereas 324 (13.3%) had unilateral (285 mild, 22 moderate, 17 severe) and 760 (31.3%) had bilateral hearing impairment (478 mild, 207 moderate, 75 severe). After adjusting for demographic and medical confounders, bilateral hearing impairment was associated with poorer SF-36 scores in both physical and mental domains (fall in physical component score, PCS of 1.4 points, p = 0.025; fall in mental component score, MCS of 1.0 point, p = 0.13), with poorer scores associated with more severe levels of impairment (PCS ptrend = 0.04, MCS ptrend = 0.003). Participants with bilateral hearing impairment who habitually used hearing aids had a slightly better PCS (mean, 43.1; standard error [SE], 0.9) than those with the same impairment who did not have hearing aids or who only used them occasionally (mean, 41.2; SE 0.5), although this finding was not statistically significant (p = 0.055). Persons with self-reported hearing loss had significantly poorer HRQOL than corresponding persons without, but persons with unilateral or high-frequency hearing loss did not have significantly different HRQOL scores than their corresponding counterparts. Conclusions: This study quantifies the associated disease burden of age-related hearing impairment on health-related quality of life in a population-based cohort of older persons.

Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study

This report describes the prevalence of self‐reported dry eye syndrome and associations with systemic and ocular factors in an older Australian population. Participants of the Extension Blue Mountains Eye Study, aged 50 or older (mean age 60.8 years, n = 1174) completed a comprehensive eye examination and dry eye questionnaire. At least one dry eye symptom was reported by 57.5% of participants, with 16.6% reporting moderate to severe symptoms, more frequent in women (age‐adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1−2.2). Three or more symptoms were reported by 15.3% of participants, also more frequent in women (age‐adjusted OR 1.7, CI 1.2−2.4). No age‐related trends or significant ocular associations were observed. After adjusting for age and sex, systemic factors significantly associated with dry eye syndrome included history of arthritis, asthma, gout, use of corticosteroids, antidepressants and hormone replacement therapy. In this older population, dry eye syndrome was common and has associations with female gender and systemic diseases.

Unilateral visual impairment and health related quality of life: the Blue Mountains Eye Study

Background: There has been considerable recent interest in the impact of unilateral visual impairment on functional status and wellbeing, particularly in relation to second eye cataract surgery. Aim: To determine if unilateral visual impairment has a measurable impact on health related quality of life (HRQOL) in an older community, as assessed by the generic, multidimensional 36 item short form health survey (SF-36). Methods: All participants of the second cross sectional Blue Mountains Eye Study (n = 3508) were invited to attend comprehensive eye examinations and complete an SF-36 questionnaire. Unilateral visual impairment was defined as visual acuity (VA) <6/12 in the worse eye and ≥6/12 in the better eye. Mild visual impairment was defined as VA <6/12 but ≥6/24, moderate as VA <6/24 but ≥6/60, and severe (blindness) as VA <6/60 in the worse eye. Cases with amblyopia (n = 48) were excluded. Results: Complete data were available for 3108 participants; 227 (7.3%) had unilateral visual impairment (148 mild, 29 moderate, 50 severe). Moderate to severe non-correctable unilateral impairment was associated with poorer SF-36 profiles. After adjusting for age and sex, this group had significantly poorer scores than the unimpaired group in three of eight domains (p<0.05); limitations as a result of physical problems, social function, limitations because of emotional problems, and in the mental component score. Mental domains were more affected than physical domains. Unilateral impairment from undercorrected refraction did not measurably affect HRQOL. Conclusions: Moderate to severe non-correctable unilateral visual impairment caused by eye diseases such as cataract had a measurable impact on HRQOL.

Assessment of Vision-Related Quality of Life in an Older Population Subsample: The Blue Mountains Eye Study

Purpose: To assess visual functioning and vision-specific health-related quality of life (HRQOL) in an older, community-dwelling-based population subsample, using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Methods: Three-quarters (76%, n = 892) of Extension Blue Mountains Eye Study participants (aged ≥ 50 years, mean 60.8 years) completed the self-administered NEI-VFQ-25, an instrument consisting of 12 dimensions and one summary composite score, and comprehensive eye examinations, including monocular distance visual acuity. Visual impairment was defined as visual acuity < 6/12. Unilateral and bilateral visual impairment was defined by the worse eye and better eye, respectively. Correctable visual impairment was defined as that which improved, and non-correctable visual impairment as that which persisted after subjective refraction. Mild visual impairment was defined as visual acuity < 6/12 but ≥ 6/24, moderate as < 6/24 but ≥ 6/60, and severe as < 6/60. Results: There were no significant differences in age, sex, or vision status between NEI-VFQ-25 responders and non-responders. Men had significantly better scores in three subscales than women but there were no significant differences in their overall composite scores (men 88.5± 0.5; women 88.1± 0.4). Persons aged 60–69 years had the best NEI-VFQ-25 profiles (mean composite score ± standard error, 90.2 ± 0.5; 50–59 years, 88.5 ± 0.4; ≥70 years, 86.2 ± 0.8). Presenting bilateral visual impairment (77.1 ± 1.4) was associated with significantly poorer functioning than unilateral (87.5 ± 0.8) or no visual impairment (89.4 ± 0.3). Increasing levels of impairment were associated with poorer levels of visual functioning. The impact of impairment was principally from non-correctable (49.2 ± 2.6) rather than refractive impairments (85.3 ± 1.4), although the latter accounted for over three-quarters (77.5%) of presenting bilateral impairment. Non-correctable unilateral impairment (85.3 ± 1.1) was associated with poorer functioning than no impairment. Conclusions: The findings from this community-dwelling older population show that the NEI-VFQ-25 differentiates well between various levels of visual impairment with regard to the magnitude of their impact on vision-specific quality of life. Greater impacts were noted among persons with bilateral compared to unilateral impairment, with increasing impacts at greater severities of visual impairment. Visual impairment from refractive errors is more frequent than from underlying pathologic disorders, but the impact of correctable visual impairment was considerably milder than the impact of non-correctable visual impairment.

Patterns of glaucomatous visual field defects in an older population: the Blue Mountains Eye Study

This report aims to describe the frequency of different patterns of visual field loss in open‐angle glaucoma (OAG). The Blue Mountains Eye Study examined 3654 persons (aged 49+) during 1992−1994. Humphrey supra‐threshold visual fields were performed in 88.9%. Those classified as glaucoma suspects had 30−2 full‐threshold fields (9.2%). Of OAG cases (n = 108) with field tests in both eyes (n = 97), unilateral defects were present in 49 (50.5%) and bilateral in 48 (49.5%). Advanced field loss was found in 16 (15.4%) subjects and in 22 (10.9%) eyes, with bilateral loss present in 6 (6.2%) cases. Of all eyes of OAG cases (n = 201), 49 (24.4%) had no defects, 52 (25.9%) upper, 61 (30.3%) lower, and 17 (8.5%) had combined upper and lower loss. Of the upper and lower cases (n = 113), the types of defects included nasal step (36), arcuate (26), nasal plus arcuate (26), and hemispherical defects (25). Of subjects with fields in at least one eye (n = 104), there was a similar proportion in the worse eye of upper defects (28.8%), lower (31.7%), and combined upper and lower (24.0%). Undiagnosed OAG was more frequent in unilateral (65.3%) than bilateral (34.7%) cases (P = 0.003). This study reports the pattern of typical glaucomatous field loss in an older Australian population.

Sensory Impairment, Use of Community Support Services, and Quality of Life in Aged Care Clients

Objective: To assess influences from visual or hearing impairment on use of community support services and health-related quality of life in aged care clients. Method: The authors sampled 284 frail elderly individuals presenting for assessment in Sydney, Australia. Moderate to severe visual impairment was defined as visual acuity <20/80 (better eye), and moderate to severe hearing loss as hearing thresholds >40 decibels (better ear). Community support services included home-delivered meals, home help, and community nurse visits. Results: After adjusting for age, sex, and two or more comorbid conditions, moderate to severe visual impairment, but not moderate to severe hearing loss, was significantly associated with increased use of community services (adjusted odds ratio 2.8, 95% confidence interval = 1.0—7.8). Conclusion: Moderate to severe visual impairment was associated with an increased likelihood of community service utilization in this aged care client sample.

Correlation between vision- and health-related quality of life scores.

Purpose:  To examine the correlation between health‐related quality of life (HRQOL) scores [assessed using the generic Short Form Health Survey (SF‐36) questionnaire] and vision‐related quality of life (VRQOL) scores [assessed using the National Eye Institute Visual Function Questionnaire (NEI‐VFQ25)].

Long-term Changes in Visual Acuity in an Older Population over a 15-Year Period: The Blue Mountains Eye Study

PURPOSE To describe the change in visual acuity (VA) and incidence of visual impairment (VI) in an older population over a 15-year period. DESIGN Population-based cohort. PARTICIPANTS Of the 3654 participants of the Blue Mountains Eye Study (BMES) baseline examination from 1992 through 1994, 1149 were re-examined during the 15-year follow-up between 2007 and 2010. METHODS Best-corrected VA by means of subjective refraction was measured with a logarithm of the minimum angle of resolution chart using Early Treatment Diabetic Retinopathy Study methods at each examination. MAIN OUTCOME MEASURES Unilateral VI was defined as VA worse than 20/40 and blindness was defined as VA worse than 20/200 in the worse eye. Incident bilateral VI and blindness were determined according to VA in the better eye at the 15-year visit. Doubling of the visual angle was defined as a loss of 15 letters or more from baseline to the 15-year visit. Halving of the visual angle was defined as a VA improvement of 15 letters or more over the same period. Causes of VI were determined at examination, by photographic grading, and from medical records. RESULTS Cumulative 15-year incidence of unilateral and bilateral VI was 12.3% (95% confidence interval [CI], 11.0-13.6) and 5.2% (95% CI, 4.3-6.1), respectively, and for unilateral and bilateral blindness, the cumulative incidence was 3.7% (95% CI, 3.0-4.4) and 0.9% (95% CI, 0.5-1.3), respectively. These incidence rates increased significantly with increasing age (P<0.01 for trend). Doubling and halving of the visual angle occurred in 6.9% (95% CI, 5.9-7.9) and 1.6% (95% CI, 1.0-2.2) of participants, respectively. Cataract accounted for 48.5% of unilateral and bilateral incident VI, followed by age-related macular degeneration (26.9%). Age-related macular degeneration accounted for 56.9% of unilateral and bilateral incident blindness cases, followed by cataract (20.7%). CONCLUSIONS These data provide population-based estimates of long-term incidence of visual impairment among older persons. Our estimate for cumulative incidence of blindness, accounting for competing risk of death, was similar to that of the Beaver Dam Eye Study (BDES) after age standardization. However, our estimate for cumulative incidence of VI was lower compared with that observed in the BDES population. This difference may be explained in part by a higher mortality rate among our population. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.