1: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):128-34. 

Visual acuity and mortality in older people and factors on the pathway.

Kulmala J, Era P, Tormakangas T, Parssinen O, Rantanen T, Heikkinen E.

Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland.
jenni.kulmala@sport.jyu.fi

PURPOSE: To examine vision as a predictor of mortality in older people and the
role of mobility, depressed mood, chronic diseases, body mass index, physical
activity and injurious accidents in this possible association. METHODS: 223
persons aged 75 and 193 persons aged 80 years at the baseline participated in
visual acuity measurements. Visual acuity (VA) of < 0.3 in the better eye was
defined as visual impairment, VA of > or = 0.3 but < or = 0.5 as lowered vision
and VA > 0.5 as normal VA. Death dates were received from the official register.
Cox regression models were used to determine the relative risks of mortality and
to study what factors lie on the pathway from poor vision to mortality. RESULTS:
Over the 10-year follow-up, 107 (48%) persons aged 75 years and 138 (72%) aged
80 years at the baseline died. The risk for mortality among the 75-year-olds
with lowered vision was 1.98 (95 % CI 1.25-3.13) and with visual impairment 1.90
(95% CI 1.12-3.20) compared to those with normal VA. Lower walking speed,
physical inactivity, cardiovascular diseases, injurious accidents, diabetes and
depressed mood each attenuated the risk markedly. Nevertheless, lowered vision
remained a significant predictor of mortality even after including all these
variables in the model. Among the 80-year-olds vision did not correlate with
mortality. CONCLUSIONS: Lowered vision and severe visual impairment predicted
mortality in the 75-year-old but not 80-year-old population. The increased risk
was partially explained by lower walking speed, physical inactivity,
cardiovascular diseases, depressed mood, diabetes and injurious accidents.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18432497 [PubMed - in process]

2: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):121-7. 

Survey of older drivers\' experiences with Florida\'s mandatory vision
re-screening law for licensure.

McGwin G Jr, McCartt AT, Braitman KA, Owsley C.

Department of Ophthalmology, School of Medicine, University of Alabama at
Birmingham, Birmingham, Alabama 35294-0009, USA. mcgwin@uab.edu

PURPOSE: To document the license renewal experiences of Florida drivers ages 80
and older who must pass a visual acuity test when renewing their driver\'s
license. METHODS: Study participants (n = 1,242 drivers) were contacted via
telephone and completed a survey regarding their experiences with the license
renewal process. RESULTS: The majority (80.2%) of those eligible for license
renewal reportedly attempted to do so and 88.0% succeeded the first time they
tried. A large percentage of drivers (88%) who failed the vision test said they
sought treatment, and 77.6% of drivers who reattempted renewal reportedly passed
the test. About half of drivers who did not seek renewal said they thought they
would fail the vision test. The majority of those choosing not to renew their
license (99.5%) reported using transportation alternatives. CONCLUSIONS: This
study suggests that the Florida vision screening re-licensure law is not a
deterrent to seeking license renewal for the > or = 80-year-old population.
Furthermore, only a small percentage of Florida drivers ages > or = 80 years and
older reported that they failed the visual acuity screening test and were denied
license renewal.

Publication Types:
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov\'t

PMID: 18432496 [PubMed - in process]

3: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):114-20. 

Defining the content for a new quality of life questionnaire for students with
low vision (the Impact of Vision Impairment on Children: IVI_C).

Cochrane G, Lamoureux E, Keeffe J.

The Centre for Eye Research Australia, Dept of Ophthalmology, University of
Melbourne, Melbourne, Australia. g.cochrane@pgrad.unimelb.edu.au

PURPOSE: To obtain statements describing the impact of vision impairment on
participation in every day activities of school-aged children (8-18 years)
capturing their opinion, as the primary step in developing a pediatric
vision-related quality of life instrument. METHODS: Separate focus groups for
students with low vision, parents and teachers plus in-depth individual
interviews were conducted in Victoria, Australia. Focus groups followed a topic
guide, were digitally audio recorded and transcribed verbatim. Statements were
identified, coded and ascribed into major themes. RESULTS: 102 participants
provided just over 2600 statements (an average of 146 statements per verbatim
transcript) which were classified into 5 themes: school/specialist instruction,
social interaction, family, community and vision impairment peer interaction.
The identified areas likely to facilitate good participation in every day
activities, and accounted for 79% of the statements were class teacher knowledge
and specialist support (40%) and social interaction (39%). The student
perspective focused on communication skills and orientation and mobility whereas
the specialist instructors\' emphasis was on specialist support. Emphases across
the themes varied between focus groups and highlight the benefit of including
the perspectives of all stakeholders in questionnaire design. CONCLUSIONS: The
multi-perspective development strategy for a new questionnaire has established
that it is crucial to integrate different stakeholders\' perspectives. By doing
so, it will be possible to develop a balanced questionnaire.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18432495 [PubMed - in process]

4: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):105-13. 

Assessing participation in daily living and the effectiveness of rehabiliation
in age related macular degeneration patients using the impact of vision
impairment scale.

Lamoureux EL, Pallant JF, Pesudovs K, Tennant A, Rees G, O\'Connor PM, Keeffe JE.

Centre for Eye Research Australia-The University of Melbourne, Victoria, 3002,
Australia. ecosse@unimelb.edu.au

PURPOSE: To assess if the Impact of Vision Impairment (IVI) is a valid
instrument to measure participation in daily activities and rehabilitation in
patients with age-related macular degeneration (AMD) and varying levels of
visual impairment. METHODS: Participants, recruited from a public eye hospital
and low vision centers, completed the IVI questionnaire. The IVI and its three
subscales were assessed for fit to the Rasch model. Unidimensionality, item fit,
response category performance, and targeting of items to patients were assessed.
Confirmatory factor analysis (CFA) was used to assess the three-factor model of
the IVI in this sample of AMD patients. RESULTS: 219 patients (mean +/- SD age =
83.5 +/- 7.4 yr) were recruited. Of these, 22%, 55% and 23% had mild (<
6/12-6/18), moderate (< 6/18-6/60) and severe (< 6/60) vision loss,
respectively. The IVI total and three subscales displayed discrete thresholds
indicating that the respondents understood the response categories. The IVI
items fitted the scale and unidimensionality was established. Person separation
reliability for the IVI score was substantial (0.94) indicating that the scale
can discriminate between several groups of AMD patients. The IVI items were
significantly targeted to the AMD patients with the means of the two
distributions shown to be very close (0.0 and 0.1, respectively). Substantial
targeting was also evident for the subscales. Poorer visual acuity was
significantly associated (ANOVA; F (2, 216) = 23.4; p < 0.001) with greater
restriction of participation suggesting that the IVI has substantial construct
validity. CFA supported the IVI three-factor model which includes items from the
"emotional well-being, "reading and accessing information" and "mobility and
independence" subscales. CONCLUSIONS: Clinicians and researchers can reliably
use the IVI to assess the impact on daily life and the effectiveness of clinical
trials and rehabilitation interventions in patients with AMD across a range of
vision loss.

PMID: 18432494 [PubMed - in process]

5: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):99-104. 

Reversal in gender valuations of cataract surgery after the implementation of
free screening and low-priced high-quality surgery in a rural population of
southern China.

Baruwa E, Tzu J, Congdon N, He M, Frick KD.

Department of International Health, Johns Hopkins Bloomberg School of Public
Health, Baltimore, Maryland, USA. ebaruwa@jhsph.edu

PURPOSE: To assess the impact of community outreach and the availability of
low-cost surgeries [500 Renminbi (RMB) or 65 United States dollars (US$) per
surgery] on the willingness to pay for cataract surgery among male and female
rural-dwelling Chinese. METHODS: Cross-sectional willingness-to-pay surveys were
conducted at the initiation of a cataract outreach programme in June 2001 and
then again in July 2006. Respondents underwent visual acuity testing and
provided socio-demographic data. RESULTS: In 2001 and 2006, 325 and 303
subjects, respectively, were interviewed. On average the 2006 sample subjects
were of similar age, more likely to be female (p < 0.01), illiterate (p < 0.01),
and less likely to come from a household with annual income of less than US$789
(62% vs. 87%, p < 0.01). Familiarity with cataract surgery increased from 21.2%
to 44.4% over the 5 years for male subjects (p < 0.01) and 15.8%-44.4% among
females (p < 0.01). The proportion of respondents willing to pay at least 500
RMB for surgery increased from 67% to 88% (p < 0.01) among male subjects and
from 50% to 91% (p < 0.01) among females. CONCLUSIONS: Five years of access to
free cataract testing and low-cost surgery programmes appears to have improved
the familiarity with cataract surgery and increased the willingness to pay at
least 500 RMB (US$65) for it in this rural population. Elderly women are now as
likely as men to be willing to pay at least 500 RMB, reversing gender
differences present 5 years ago.

PMID: 18432493 [PubMed - in process]

6: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):92-8. 

The economic costs and benefits of dog guides for the blind.

Wirth KE, Rein DB.

Harvard School of Public Health, Boston, Massachusetts 02115, USA.
kwirth@hsph.harvard.edu

PURPOSE: To document the economic costs and benefits associated with providing
dog guide services for blind individuals able to benefit from them. METHODS:
This study estimates the annual cost of dog guide services accounting for cost
offsets associated with reduced informal and formal care costs over the working
life of the animal (8 years). We estimated the cost per dog guide trained using
previously unpublished survey data from dog guide training schools in the United
States. We also estimated the incremental economic benefits as the reduction in
costs associated with formal and informal care using published studies and a set
of reasonable assumptions. Costs were discounted to 2006$ using a 3% discount
rate. RESULTS: We found the average total cost per dog guide over its working
life was $40,598, of which $21,568 were off-set by reductions in other costs.
The costs associated with dog guides included $35,536 in dog acquisition costs
and $5,061 for annual maintenance over the animal\'s working life. The economic
benefits included $16,324 and $5,244 in reduced formal and informal care costs,
respectively. The average net cost of dog guide ownership per year over the
working life of the animal was $2,379. CONCLUSIONS: Using available information
and reasonable assumptions, this study documents the costs of dog guides
accounting for a limited number of cost off-setting elements. However, given
limited available evidence, further study of the impact of guide dogs on the
lives of blind individuals who use them should be conducted to validate this
study\'s results.

Publication Types:
    Research Support, U.S. Gov\'t, P.H.S.

PMID: 18432492 [PubMed - in process]

7: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):84-91. 

Economic evaluation of blind rehabilitation for veterans with macular diseases
in the Department of Veterans Affairs.

Stroupe KT, Stelmack JA, Tang XC, Reda DJ, Moran D, Rinne S, Mancil R, Wei Y,
Cummings R, Mancil G, Ellis N, Massof RW.

Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines
Jr. Veterans Affairs Hospital, Hines, Illinois 60141, USA. Kevin.Stroupe@va.gov

PURPOSE: The Department of Veterans Affairs (VA) Low Vision Intervention Trial
(LOVIT) developed an outpatient low-vision programme for patients with macular
diseases providing low-vision rehabilitation comparable to VA inpatient blind
rehabilitation centres (BRCs). This programme targets veterans who do not need
or chose not to participate in a comprehensive inpatient blind rehabilitation
programme. We examined costs and consequences using veterans in LOVIT and
comparable veterans in an inpatient BRC. METHODS: We compared costs and
consequences between treatment patients who participated in LOVIT, a two-site
randomized clinical trial, and a sample of comparable patients who received
treatment at a VA inpatient BRC. We measured consequences as the change in
functional visual ability from baseline to follow-up (LOVIT: 4 months after
randomization; BRC: 3 months after discharge) using the VA Low Vision Visual
Functioning Questionnaire (VA LV VFQ-48). RESULTS: There were 55 LOVIT and 121
BRC patients for our analyses. Average costs were $38,627.3 higher for BRC
patients ($5,054.4 +/- $404.7 SD for LOVIT vs. $43,681.7 +/- $8,853.6 SD for
BRC, p < 0.0001). Thus, the BRC cost $38,627.3 per patient more than the LOVIT
programme (95% CI: $17,414 to $273,482). There was a greater improvement in
overall visual ability, mobility, and visual motor skill scores for BRC
patients; however, there was no significant difference in improvement in reading
ability or visual information processing scores. CONCLUSIONS: As VA increases
outpatient blind rehabilitation services, LOVIT provides a model for expanding
outpatient low-vision rehabilitation services for veterans at substantially
lower costs than current inpatient BRC services.

Publication Types:
    Research Support, U.S. Gov\'t, Non-P.H.S.

PMID: 18432491 [PubMed - in process]

8: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):76-83. 

An introduction to decision analysis in the economic evaluation of the
prevention and treatment of vision-related diseases.

Kymes SM.

Department of Ophthalmology and Visual Sciences, Washington University School of
Medicine, St. Louis, Missouri 63110-1093, USA. kymes@vrcc.wustl.edu

Economic evaluation in the form of reports of cost-effectiveness of the
treatment and prevention of disease has only recently found widespread
application in the visual sciences. While economic evaluation takes a number of
forms: cost-minimization analysis, cost-benefit analysis, and cost-effectiveness
analysis--it is the latter that is seen most often in the evaluation of
vision-related health programs. Cost-effectiveness analysis is in particular
seen most commonly in its very particular form of cost-utility analysis.
Decision analysis is the analytic method most commonly used to perform
cost-effectiveness analysis. In decision analysis, the expected cost and
effectiveness of a health program are estimated in a rigorous fashion. In this
report, we take the reader through the process of decision analysis including
building the tree; populating the model with parameters for risk, cost and
benefit; estimating expected cost and benefit; and deterministic and
probabilistic sensitivity analysis. Examples employed include prominent studies
of the cost-effectiveness of photodynamic therapy for treatment of neovascular
macular degeneration and the treatment ocular hypertension to prevent glaucoma.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18432490 [PubMed - in process]

9: Ophthalmic Epidemiol. 2008 Mar-Apr;15(2):73-5. 

Epidemiological economics.

Frick KD.

Department of Health Policy and Management, Bloomberg School of Public Health,
Johns Hopkins University, Baltimore, Maryland 21205-1901, USA. kfrick@jhsph.edu

Publication Types:
    Introductory Journal Article
    Research Support, Non-U.S. Gov\'t

PMID: 18432489 [PubMed - in process]