Marie-Josée Aubin

The Global Burden of Visual Difficulty in Low, Middle, and High Income Countries

Purpose Using a world-wide, population-based dataset of adults, we sought to determine the frequency of far visual difficulty and its associated risk factors. Methods The World Health Survey (WHS) was conducted in 70 countries throughout the world in 2003 using a random, multi-stage, stratified, cluster sampling design of adults ages 18 years and older. Far vision was assessed by asking “In the last 30 days, how much difficulty did you have in seeing and recognizing a person you know across the road (i.e. from a distance of about 20 meters)?”. Responses included none, mild, moderate, severe, or extreme/unable. The income status of countries was estimated using gross national income per capita data from 2003 from the World Bank. Prevalence and regression estimates were adjusted to account for the complex sample design. Results 21% of adults reported any visual difficulty. The rate varied by the income status of the country with the percentage who had any visual difficulty being 24%, 23%, and 13% in low, middle, and high income countries, respectively. Five percent of people reported severe or extreme visual difficulty with rates in low, middle, and high income countries of 6%, 5%, and 2% respectively. Risk factors for visual difficulty included older age, female sex, poorer socioeconomic status, little to no formal education, and diabetes (P<0.05). Conclusions One out of five adults in the WHS reported some degree of far visual difficulty. Given the importance of vision to living an independent life, better access to quality eye care services and life course factors affecting vision health (e.g. repeated eye infections, diet lacking vitamin A) must receive adequate attention and resources, especially in low and middle income countries.

Cataract-related vision loss and depression in a cohort of patients awaiting cataract surgery

OBJECTIVE As provinces consider what an acceptable cataract surgery wait time should be, research is needed on the risk of adverse events, such as depression, while waiting for care. We sought to determine whether worse visual acuity is related to depressive symptoms in patients waiting to have cataract surgery. DESIGN Cohort study. PARTICIPANTS Six hundred seventy-two patients awaiting cataract surgery were recruited from Maisonneuve-Rosemont Hospital in Montreal, Que. METHODS About 2 weeks before surgery and 4 months after surgery, patients completed the Visual Function-14 questionnaire, a measure of the self-report of difficulty performing visual tasks, and the 30-item Geriatric Depression Scale. Patients were also asked about systemic and ocular comorbidities. Visual acuity was measured with pinhole correction. Date of entry onto the hospital waiting list and date of cataract surgery were recorded. RESULTS Forty-one percent of patients had visual acuity of 6/18 or worse in the surgical eye, whereas 26% showed signs of depression before surgery (Geriatric Depression Scale-30 > or = 10). In a logistic regression model, those with visual acuity < or = 6/18 in their surgical eye had a 59% higher adjusted odds of depression (odds ratio 1.59, 95% CI 1.09-2.33). There was statistically significant evidence that the relationship between visual acuity and depression was mediated by greater reported difficulty on the Visual Function-14 (p < 0.05). CONCLUSIONS Patients with worse visual acuity were more likely to be depressed while waiting for cataract surgery. Shortening the wait time for cataract surgery, especially for those with worse vision, could potentially reduce the risk or shorten the duration of depression.

Visual Difficulty and Employment Status in the World

Purpose Using a world-wide, population-based dataset, we sought to examine the relationship between visual difficulty and employment status. Methods The World Health Survey was conducted in 70 countries throughout the world in 2003 using a random, multi-stage, stratified, cluster sampling design. Far vision was assessed by asking about the level of difficulty in seeing and recognizing a person you know across the road (i.e. from a distance of about 20 meters). Responses included none, mild, moderate, severe, or extreme/unable. Participants were asked about their current job, and if they were not working, the reason why (unable to find job, ill health, homemaker, studies, unpaid work, other). The occupation in the last 12 months was obtained. Multinomial regression was used accounting for the complex survey design. Results Of those who wanted to work, 79% of those with severe visual difficulty and 64% of those with extreme visual difficulty were actually working. People who had moderate, severe, or extreme visual difficulty had a higher odds of not working due to an inability to find a job and of not working due to ill health after adjusting for demographic and health factors (P<0.05). Conclusions As the major causes of visual impairment in the world are uncorrected refractive error and cataract, countries are losing a great deal of labor productivity by failing to provide for the vision health needs of their citizens and failing to help them integrate into the workforce.

Prevalence and Risk Factors for Near and Far Visual Difficulty in Burkina Faso

Purpose: To determine the prevalence and risk factors for near and far visual difficulty in Burkina Faso. Methods: Population-based data were used from the World Health Survey done in Burkina Faso in 2002–2003 (n = 4,822 adults). Near and far visual difficulty were assessed by questions about difficulty seeing and recognizing an object at arm’s length and about difficulty seeing and recognizing a person across the road. Prevalence estimates were adjusted for the multi-stage, stratified, random cluster sampling design. Logistic regression was used to identify independent risk factors. Results: The overall prevalence of any near and far visual difficulty was 10% (standard error [SE] = 0.7%) and 13% (SE = 0.9%) respectively. Prevalence estimates were strongly associated with age with 48% (SE = 4.2%) and 66% (SE = 3.9%) of those ≥ 65 years old having near or far visual difficulty (P < 0.001). Only 5% (SE = 0.6%) of people wore glasses. We identified two potentially modifiable variables associated with near visual difficulty: a cooking stove in the same room as sleeping area (Odds Ratio [OR] = 1.45, 95% Confidence Interval [CI] 1.01, 2.02) and high fruit consumption (OR = 0.65, 95% CI 0.50, 0.86). Conclusion: The prevalence of visual difficulty was high in Burkina Faso. Efforts to confirm these findings with cooking stove location and fruit consumption should be undertaken in this population.

Interaction Between Visual Acuity and Peripheral Vascular Disease with Balance: Vision, Vascular Disease, and Balance

To determine whether visual acuity is related to balance in older adults with peripheral vascular disease (PVD) or diabetes mellitus.

Factors Associated With Visual Impairment and Eye Care Utilization: The International Mobility in Aging Study

Objective:To examine factors associated with visual impairment (VI) and eye care in the International Mobility in Aging Study (IMIAS). Method: IMIAS data were analyzed (N = 1,995 with ages 65-74). Outcomes were VI defined as presenting visual acuity worse than 6/18 in the better eye and eye care utilization assessed by annual visits to eye care professionals. The Hurt–Insult–Threaten–Scream (HITS) questionnaire requested information on domestic violence. Results: Among men, VI varied from 24% in Manizales (Colombia) to 0.5% in Kingston (Canada); among women, VI ranged from 20% in Manizales to 1% in Kingston; lifetime exposure to domestic violence was associated with VI (odds ratio [OR] = 1.87; 95% confidence interval [CI] = [1.17, 3.00]). Eye care utilization varied from 72% in Kingston’s men to 25% in Tirana’s men; it was associated with domestic violence (prevalence ratio [PR] = 1.3; 95% CI = [1.1, 1.6]). Discussion: VI is more frequent where eye care utilization is low. Domestic violence may be a risk factor for VI.

Eye care utilization and its determinants in Canada

OBJECTIVE To provide the frequency and potential determinants of eye care utilization over the last 12 months among Canadians between the ages of 45 and 85 years old. DESIGN Cross-sectional population-based study. PARTICIPANTS 30,097 people in the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. METHODS Inclusion criteria included being between the ages of 45 and 85 years old, community-dwelling and living near one of the 11 data collection sites across 7 Canadian provinces. Eye care utilization was defined as the self-report of a visit to an optometrist or ophthalmologist in the past 12 months. RESULTS In the last year, 57% of 28 728 adults visited an eye care provider although there was heterogeneity between provinces. The highest eye care utilization was found in Ontario at 62%, whereas the lowest was in Newfoundland and Labrador at 50%. Of concern, 25.3% of people with diabetes above the age of 60 years had not seen an eye care provider in the last year. Our novel finding was that current smokers were less likely to use eye care compared to never smokers (odds ratio [OR] = 0.76, 95% confidence interval [CI] 0.67-0.87). Confirming previous research, men compared to women (OR = 0.67, 95% CI 0.62-0.71), people with less than a bachelors degree compared to more than a bachelors degree (OR = 0.87, 95% CI 0.79-0.95), and people making less income (linear trend p < 0.05) were less likely to use eye care. CONCLUSIONS Disparities exist in eye care utilization in Canada. Efforts should be made to reduce these disparities to reduce avoidable vision loss.

Ocular syphilis: Case Series (2000–2015) from Two Tertiary Care Centers in Montreal

Abstract Background In the past 15 years, a recrudescence of syphilis was observed in Canada, along with a surge in ocular syphilis cases. Without treatment, ocular syphilis can have serious consequences potentially leading to blindness. Our goal was to describe the demographics, clinical presentations, proportion of co-infection with HIV, treatments and visual outcomes of ocular syphilis cases. Methods Patients with a confirmed positive syphilis serology between 2000 and 2015 were identified through the reference laboratory database. A retrospective chart review was performed for those who visited the ophthalmology clinic of Hôpital Maisonneuve-Rosemont or Hôpital Notre-Dame to identify ocular syphilis cases. Results Among the 119 patients (174 eyes) identified (2.5% of the population screened), 80% were male; of which 63% were MSM. Mean presenting logMAR visual acuity was 0.70 (20/100 Snellen) and unilateral ocular involvement occurred in 54%. Ocular manifestations included interstitial keratitis (24 eyes), anterior uveitis (37 eyes), intermediate uveitis (17 eyes), posterior uveitis (31 eyes), panuveitis (27 eyes), isolated optic nerve involvement (25 eyes), and others (12 eyes) including VI nerve palsy, scleritis, and episcleritis. Cerebrospinal fluid (CSF) examination was done in 65 (55%) patients. Of those, VDRL was positive in 14 (22%) patients; white blood cells and proteins were elevated in, respectively, 28 (43%) and 39 (60%) of patients. HIV status was unknown in 39 (33%) patients; among those whose serology were performed (or previous status was known), 38 (48%) were HIV infected. Intravenous aqueous penicillin G was administered in 69 (58%), intramuscular benzathine penicillin in 25 (21%) and other antibiotics, mainly due to allergy, in three (3%) patients. Treatment allowed a visual improvement of –0.22 logMAR (gain of five lines on Snellen chart) after a mean follow-up period of 19 months. Conclusion Syphilis can manifest with a widely diversified array of ocular presentations, especially uveitis and optic nerve involvement. Therefore it is primordial to keep this diagnosis in mind when facing high-risk patients with ocular symptoms. It is of utmost importance that clinicians improve rates of lumbar puncture, HIV screening and intraveinous penicillin treatment when managing ocular syphilis. Disclosures All authors: No reported disclosures.