An action as simple as addressing uncorrected refractive errors in elderly patients can elevate their vision-specific quality of life and improve their overall functioning.
Dr. Coleman, professor of ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine, and professor of epidemiology, School of Public Health, University of California, Los Angeles, reported that the "correction of uncorrected refractive error, the most common cause of visual impairment in older individuals, improves the vision-specific quality of life of community-dwelling older individuals."
Refractive errors that are left untreated unfortunately are not isolated disorders in an elderly population, because those individuals in turn are exposed to the increased risk of falls, fractures, isolation, and mortality. Considering this high cost to society, Dr. Coleman said, it is surprising that interventions as simple as corrective lenses and magnifiers are not used more often.
The participants were identified through screening examinations held in various communities in Los Angeles. The subjects had to have binocular visual acuity that was 20/32 or worse and could be improved by at least 10 letters.
A total of 131 people who were aged 65 or more years were included. Sixty-six individuals were randomly assigned to receive a prescription and a voucher for immediately available free glasses, a magnifier, or both. Sixty-five subjects served as the control group, and they received a prescription and a voucher for use after the end of the 3-month follow-up period.
"The primary outcome measure in this study was a change in vision-specific functioning as measured using the 25-item National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ)," she explained. "The NEI-VFQ is a vision-targeted, health-related, quality-of-life questionnaire that uses a standardized focus group method to develop measures of functioning in three areas: general health and vision, difficulty with visual activities, and emotional responses to vision problems."
The secondary outcomes were measures of the distance and near visual acuity and an assessment of overall functioning using the Rosow-Breslau function questionnaire. This questionnaire poses three questions as to the subject's ability to walk a quarter of a mile, to climb up and down at least two steps, and to perform heavy chores, defined as yard work or washing windows.
The results at the 3-month follow-up visit showed that "the participants who received prescriptions for eyeglasses/magnifiers and vouchers experienced better self-reported general vision, near visual acuity, distance visual acuity, mental health, and composite scores as reported on the NEI-VFQ than participants who received the prescription and voucher after the 3-month follow-up visit," Dr. Coleman reported. The results between the two groups reached statistical significance (p < 0.01). The subjects were found to have significant improvements in their perception of their general vision (p < 0.01), distance visual acuity (p = 0.03), near visual acuity (p = 0.04), and mental health (p = 0.02).
"In addition, there was a trend for participants who received prescriptions for eyeglasses, magnifiers, and vouchers immediately to experience better overall function on the Rosow-Breslau scale," she said. A subgroup analysis of subjects with age-related macular degeneration showed that the NEI-VFQ scores for those randomly assigned to immediate treatment improved; those randomly assigned to delayed treatment at the 3-month time point worsened.