The Impact of Eyeglasses on Vision-Related Quality of Life in American Indian/Alaska Natives

doi:10.1016/j.ajo.2010.06.043

American Journal of Ophthalmology

Volume 151, Issue 1, January 2011, Pages 175-182.e2

https://doi.org/10.1016/j.ajo.2010.06.043 Get rights and content

Purpose

To determine the change in vision-related quality-of-life scores after providing eyeglasses to American Indian/Alaska Natives with undercorrected refractive error.

Study Design

Prospective, comparative (nonrandomized) interventional study.

Methods

We compared a group with undercorrected refractive error to a control group who did not need a change in eyeglasses. Undercorrected refractive error was defined as distance visual acuity 20/40 or worse in the better-seeing eye that could be improved by at least 2 lines in Snellen visual acuity. Intervention was the provision of new glasses to the undercorrected refractive error group members, based on results of manifest refraction. The main outcome measures were the differences in the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) scores from baseline (Time 1) to the time after providing eyeglasses (Time 2).

Results

The NEI VFQ-25 median Composite score at Time 1 was significantly lower in those with undercorrected refractive error when compared to the control group (75 vs 92, P = .001). The median Composite score for the undercorrected refractive error group improved to 96 (P < .001) at Time 2 when compared to Time 1, while the control group remained stable at 93 (P = .417). The undercorrected refractive error group showed significantly greater improvement than the control group in 8 of 12 subscale scores and in the overall Composite score (all P values ≤ .05). A multivariate linear regression analysis, which controlled for differences in age, percent self-identified American Indian/Alaskan Native, and best-corrected visual acuity between the undercorrected refractive error and control group, showed eyeglasses to be significantly associated with improvement in NEI VFQ-25 composite score.

Conclusion

Visual impairment from undercorrected refractive error is common in American Indian/Alaskan Natives. Providing eyeglasses results in a large, significant increase in vision-related quality of life.

Section snippets

Selection Criteria

We enrolled American Indian/Alaskan Native participants who were 18 years or older from 2 locations in the Northwest region of the United States and 1 location from the Midwest. We recruited participants into 1 of 2 groups: the undercorrected refractive error group (if presenting distance visual acuity was 20/40 or worse in the better-seeing eye and manifest refraction showed an improvement of at least 2 lines), or the control group (if presenting distance vision was either better than 20/40 or

Participants

We enrolled 114 participants: 76 into the control group, 26 into the undercorrected refractive error group, and 12 participants (11%) who did not complete the NEI VFQ-25 questionnaire at Time 2. Therefore, we report data for 102 (89%) participants. We found no statistically significant differences (P > .05) in age, sex, percent American Indian/Alaskan Native heritage, Time 1 Composite scores, measures of self-reported depression, or visual acuity between those who completed and those who did

Discussion

This study examines the impact of eyeglasses on vision-related quality of life in American Indian/Alaskan Natives. To our knowledge, little published information exists regarding the effect of eyeglasses on vision-related quality of life, and none at all in American Indian/Alaskan Native populations. We found that eyeglasses resulted in a large improvement in vision-related quality of life, even when controlling for various differences between the groups.

Tina McClure is a Senior Research Assistant and Clinical Trials Coordinator at Devers Eye Institute, Portland, Oregon. She completed a Bachelor of Science degree in Psychology from Portland State University. She has a special interest in psychometrics, questionnaire design, and quality of life outcomes, with an emphasis on the effect of depression on vision-related outcomes. She has previously published on quality of life outcomes in American Indian/Alaskan Natives.

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The reduction of horizontal inequity in unmet refractive error: The Shahroud Eye Cohort Study, 2009–2014
2019, Journal of Current Ophthalmology
Citation Excerpt :
These studies found that the prevalence of unmet refractive error is remarkable, as well as the factors which are effective on them.6,10,11,15,16 Some also suggested that UREs are distributed unequally especially among the individuals with a low economic status and suburban population.3,17,18 Although previous studies demonstrated the relationship between economic status and the prevalence of UREs, the unmet refractive error, and the use of spectacles in different parts of the world,6,10,16,19 to the best of our knowledge, no study has investigated economic inequity in unmet refractive error.
To measure Horizontal Inequity Index (HI) of unmet refractive error and its changes between 2009 and 2014 in Iran.
The data used in this study was taken from population-based study, Shahroud Eye Cohort Study. The number of participants analyzed in first (2009) and second phases of study (2014) were 5190 and 4737, respectively, and individuals between 40 and 64 years were included. The HI was determined by using the Concentration Index (C) based on the nonlinear (Probit) model, and C was decomposed to identify and quantify the contribution of each factor.
After adjusting for need variables, the results demonstrated that the HI in unmet refractive need decreased from −0.288 (95% CI: 0.370, −0.206) in the 2009 to −0.132 (95% CI: 0.290, −0.028) in 2014. Decomposition of the C showed that level of education and economic status were the greatest contributors with shares of 26.2% and 17.9%, respectively, in reducing the amount of HI in unmet refractive error between 2009 and 2014.
The current study demonstrated that unmet refractive error did not have an equal distribution among economic quintiles, despite the same need for correcting refractive errors. Reducing the amount of HI in unmet refractive error between 2009 and 2014 indicated an improvement in the unmet need in the five years period between two phases of study.
Perception of health-related quality of life using the EURO-QOL in older adults in Bogotá, Colombia
2016, European Geriatric Medicine
Citation Excerpt :
In multivariate analyzes, a variable interestingly and favorably associated was use of glasses with usual activities and mobility. This association is important because it provides evidence for the benefit of the use of glasses as a tool or aid to improve the performance of people in their daily lives [27]. Older age decreased the odds for problems in anxiety/depression.
Measure health-related quality of life using the EuroQol instrument in people aged 60 years and older using the survey of Health, well-being and aging (SABE) Bogotá.
The EQ-5D portion of EuroQol instrument was used to assess health-related quality of life (HRQOL) in the SABE Bogotá study, a cross-sectional study conducted in 2000 community-dwelling older adults in 2012. Bivariate and multivariate analyses were used to identify factors associated to poor HRQOL. Statistical significance was set at 0.05.
A total of 46.9% of participants reported pain/discomfort, 29% reported impaired mobility, 27.5% reported anxiety/depression, 20.7% reported limitations with usual activities and 11.4% reported self-care issues. Some factors associated with poor HRQOL in the different dimensions were: older age, receiving aid from relatives, listless mood, cognitive/functional impairment and comorbidities. In multivariate analyses, factors most frequently associated with poor HRQOL were functional and cognitive impairment and comorbidities such as joint disease (JD), stroke and chronic obstructive pulmonary disease (COPD).
In our study, debilitating and highly symptomatic diseases like JD, COPD and cognitive impairment significantly increase the odds of poor HRQOL. The EuroQol is a useful instrument that can help clinicians in Colombia better assess quality of life among older adults.
Frame detection using gradients fuzzy logic and morphological processing for distant color eye images in an intelligent iris recognition system
2015, Applied Soft Computing Journal
Citation Excerpt :
Current studies on the iris recognition system show that the eye images were captured without the cooperation of the person, at different distances and in motion (also known as non-cooperative environment) in order to make the system more accurate and reliable in identifying and verifying a person in a real environment [15,28]. For this reason, the captured eye image has very low quality [26], varying lighting conditions [27,35] and contains a noise factor such as the occlusion of spectacles [14,17,20,28,33]. Spectacles (also known as eyeglasses) are defined as a frame that contains lenses, which are normally used for vision correction [20], eye protection [19] and esthetics or fashion purposes [5,18].
The capture of an eye image with the occlusion of spectacles in a non-cooperative environment compromises the accuracy in identifying a person in an iris recognition system. This is due to the obstruction of the iris by the frame which tends to produce an incorrect estimation of the initial center of the iris and the pupil during the iris segmentation process. In addition, it also causes incorrect localization of the upper eyelid during the process of iris segmentation and sometimes, the edges of the frame are wrongly identified as the edges of the upper eyelid. A frame detection method which involves the combination of two gradients, namely the Sobel operator and high pass filter, followed by fuzzy logic and the dilation operation of morphological processing is proposed to identify the frame on the basis of different frame factors in the capture of a distant eye image. In addition, a different color space is applied and only a single channel is used for the process of frame detection. The proposed frame detection method provides the highest frame detection rate compared to the other methods, with a detection rate of more than 80.0%. For the accuracy of the iris localization, upper eyelid localization and iris recognition system, the proposed method gives more than 96.5% accuracy compared to the other methods. The index of decidability showed that the proposed method gives more than 2.35 index compared to the existing methods.
Predictive value of screening tests for visually significant eye disease
2015, American Journal of Ophthalmology
Citation Excerpt :
This study includes data from the previously published Tribal Vision Project,12–15 a cross-sectional eye disease prevalence study in American Indian and Alaskan Native participants.
To determine the predictive value of ophthalmic screening tests with visually significant eye disease in a cohort of American Indian/Alaskan Natives from the Pacific Northwest.
Validity assessment of a possible screening protocol.
Ophthalmic technicians performed a screening examination including medical and ocular history, best-corrected visual acuity, limbal anterior chamber depth assessment, frequency-doubling technology perimetry (FDT, C-20-5), confocal scanning laser ophthalmoscopy, nonmydriatic digital photography, and tonometry on 429 participants. An ophthalmologist performed a comprehensive eye examination on subjects with 1 or more abnormal screening tests and a random selection of those with normal screening tests. We used univariate and multivariate logistic regression to determine the association between abnormal screening test results and visually significant eye disease. We also determined the predictive value of screening tests with ocular disease.
Univariate analysis identified history of eye disease or diabetes mellitus (P < .001), visual acuity <20/40 (P < .001), abnormal/poor-quality confocal scanning laser ophthalmoscopy (P < .001), abnormal FDT (P < .001), and abnormal/poor-quality nonmydriatic imaging (P < .001) as associated with visually significant eye disease. A multivariate analysis found visually significant eye disease to be associated (P < .001; receiver operating characteristic curve area = 0.827, negative predictive value = 84%) with 4 screening tests: visual acuity <20/40, abnormal/poor-quality nonmydriatic imaging, abnormal FDT, and abnormal/poor-quality confocal scanning laser ophthalmoscopy.
Ophthalmic technicians performing a subset of screening tests may provide an accurate and efficient means of screening for eye disease in an American Indian/Alaskan Native population. Confirmation of these results in other populations, particularly those with a different profile of disease prevalence, is needed.
Analysis of uveitis in a Canadian aboriginal population
2014, Canadian Journal of Ophthalmology
To compare patient demographics, uveitis characteristics, and outcomes in aboriginal First Nations (FN) versus non-aboriginal non-FN uveitis patients.
Case–control study.
Forty-three FN patients (80 eyes) and 45 control non-FN uveitis patients (69 eyes).
Retrospective chart review comparing patient demographics (age, sex, residency), disease characteristics (laterality, anatomic classifications, granulomatous and chronic inflammation, systemic associations, specific uveitis diagnoses), and disease severity-related outcomes (therapies, visual outcomes, complications) between FN versus control patients.
Mean age at disease onset was significantly younger in FN patients (30.4 years) versus control patients (40.2 years; p < 0.0001). Bilateral uveitis was significantly more common in the FN group (86%) versus control patients (51%; p = 0.0005), and granulomatous uveitis was significantly more common in FN patients (53%) than among control patients (11%; p < 0.0001). There was no significant difference in rates of chronic uveitis between groups, identified in 74% of FN versus 60% of control subjects (p = 0.15). Anatomically, panuveitis was the prevalent form of uveitis within the FN group, occurring in 67% (versus 16% in control patients), whereas anterior uveitis was the prevalent anatomic classification in control patients, occurring in 73% (versus 26% in FN patients; p < 0.001). Vogt–Koyanagi–Harada (VKH) syndrome was the predominant causative uveitis diagnosis within the FN group, identified in 56% of FN patients versus 0% of control subjects (p < 0.001). Idiopathic uveitis was the predominant causative diagnosis within the control group and was identified in 40% of control patients, compared with 19% of FN uveitis patients (p = 0.002). All therapies except anterior segment surgeries (p = 0.88) were required more often in FN, including systemic corticosteroids (p = 0.002), injected corticosteroids (p = 0.042), systemic immunosuppression (p = 0.021), glaucoma therapy (p = 0.005), laser (p < 0.001), and posterior segment surgeries (p = 0.002). Complication rates were higher in FN patients (p < 0.001). Final visual outcome was worse in FN patients (35% FN ≤ 20/200 versus 9% control subjects; p = 0.001).
Multiple findings differed strikingly between FN and control patients. Uveitis in FN patients was characterized by significantly younger age of onset. FN patients were more likely to have bilateral disease, panuveitis, and granulomatous disease. With respect to specific uveitic entities, VKH was more common in FN patients. FN patients also required more aggressive therapies, and yet had higher complication rates and had poorer visual outcomes.
Comparaison des démographies, caractéristiques de lʼuvéite et résultats entre patients autochtones des Premières Nations (PN) et les patients uvéitiques non autochtones.
Étude de cas témoins.
43 patients PN (80 yeux) et 45 patients témoins non-PN ayant une uvéite (69 yeux).
Revue rétrospective des dossiers comparant les démographies (âge, sexe, résidence), les caractéristiques médicales (latéralité, classifications anatomiques, inflammations granulomateuses et chroniques, associations systémiques, diagnostics précis dʼuvéite) et les résultats reliés à la gravité de la maladie (traitements, résultats visuels, complications) entre les patients des PN et les témoins.
La moyenne dʼâge au début de la maladie était significativement plus jeune chez les patients PN (30,4 ans) versus celle des témoins (40,2 ans; p < 0,0001). Lʼuvéite bilatérale était significativement plus répandue dans le groupe PN (86 %) versus les témoins (51 %; p = 0,0005) et lʼuvéite granulomateuse était significativement plus répandue chez les patients PN (53 %) versus les témoins (11 %; p < 0,0001). Il nʼy avait pas de différence significative dans les taux dʼuvéite chronique entre les groupes, relevés chez 74 % des PN versus 60 % des témoins (p = 0,15). Anatomiquement, la panuvéite était la forme prédominante dʼuvéite dans le groupe PN avec une proportion de 67 % (contre 16 % chez les témoins), alors que la classification anatomique de lʼuvéite antérieure prédominait chez les témoins avec un taux de 73 % (contre 26 % chez les PN; 0<0,001). Le syndrome de Vogt Koyanagi Harada (VKH) était le diagnostic étiologique de lʼuvéite prédominant chez le groupe PN, soit 56 % des patients PN versus 0 % chez les témoins (p < 0,001). Lʼuvéite idiopathique a été le diagnostic étiologique prédominant chez le groupe témoin, soit 40 % comparativement à 19 % chez les PN (p = 0,002). Toutes les thérapies, sauf les chirurgies du segment antérieur (p = 0,88), ont été requises plus souvent chez les PN, y compris les corticostéroïdes systémiques p = 0,21), les corticostéroïdes injectés (p = 0,042), lʼimmunosuppression systémique (p = 0,002), la thérapie du glaucome (p = 0,005), les chirurgies au laser (p < 0,001) et du segment postérieur (p = 0,002). Les taux de complication étaient plus élevés chez les PN (p < 0,001) et le résultat visuel final était pire chez les PN (35 % PN ≤ 20/200 versus 9 % chez les témoins p = 0,001).
Beaucoup de données diffèrent considérablement entre les patients des Premières Nations et les témoins. Lʼuvéite des PN se caractérisait par lʼâge significativement plus jeune au début. Ces patients étaient plus sujets à avoir des maladies bilatérales, des panuvéites et des maladies granulomateuses. Quant aux entités uvéitiques spécifiques, le VKH était plus répandu chez les patients des Premières Nations. Ceux-ci avaient requis des thérapies plus agressives, pour des taux plus élevés de complications et de plus faibles résultats visuels.
Refractive error and vision related quality of life
2024, BMC Ophthalmology

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Steven L. Mansberger, MD, MPH, is an Associate Scientist and Director of Glaucoma Services for Devers Eye Institute in Portland, Oregon. He completed a medical degree from Indiana University, an ophthalmology residency at the University of California, San Diego, a glaucoma fellowship at Devers Eye Institute, and a Masters in Public Health (MPH Biostatistics/Epidemiology) from Oregon Health Science University. He is an Editorial Board member of Journal of Glaucoma and American Journal of Ophthalmology.

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Original articleThe Impact of Eyeglasses on Vision-Related Quality of Life in American Indian/Alaska Natives

Purpose

Study Design

Methods

Results

Conclusion

Section snippets

Selection Criteria

Participants

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

J Cataract Refract Surg

Am J Ophthalmol

Ophthalmology

Summary health statistics for U.S. adults: National Health Interview Survey, 2007

Vital Health Stat 10

Five-year incidence of bilateral cause-specific visual impairment in the Melbourne Visual Impairment Project

Invest Ophthalmol Vis Sci

Blindness, visual impairment and the problem of uncorrected refractive error in a Mexican-American population: Proyecto VER

Invest Ophthalmol Vis Sci

Blindness and visual impairment in an American urban populationThe Baltimore Eye Survey

Arch Ophthalmol

Prevalence of visual impairment in the United States

JAMA

Assessment of vision-related quality of life in an older population subsample: The Blue Mountains Eye Study

Ophthalmic Epidemiol

Visual acuity impairment and mortality in US adults

Arch Ophthalmol

Visual impairment and eye abnormalities in Oklahoma Indians

Arch Ophthalmol

Causes of visual impairment and common eye problems in Northwest American Indians and Alaska Natives

Am J Public Health

What causes astigmatism?

J Am Optom Assoc

Practice among American Indians; study of clinical findings

Opt J Rev Optom

Distribution of astigmatism among Sioux Indians in South Dakota

J Am Optom Assoc

Refractive errors and axial length among Alaskan Eskimos

Acta Ophthalmol (Copenh)

Effect of refractive error correction on health-related quality of life and depression in older nursing home residents

Arch Ophthalmol

Original article
The Impact of Eyeglasses on Vision-Related Quality of Life in American Indian/Alaska Natives