Macular Degeneration: Broman A

Friedman DS, West SK, Munoz B, Park W, Deremeik J, Massof R, Frick K, Broman A, McGill W, Gilbert D, German P. · Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. · Arch Ophthalmol. · Pubmed #15249367 No free full text.

Abstract: OBJECTIVE: To determine the prevalence and causes of low vision in a large sample of nursing home residents. METHODS: Twenty-eight nursing homes on the Eastern Shore of Maryland and Delaware were enrolled in a clinical trial to assess the impact of vision restoration/rehabilitation on nursing home residents. Visual acuity was measured using both recognition charts and preferential looking techniques. An ophthalmologist examined all residents with visual acuity worse than 20/40 in the better-seeing eye and determined the primary cause for decreased vision. Results are reported for the better-seeing eye. RESULTS: Of 2544 eligible residents, 1591 (63%) participated, but 286 residents were unable to respond to visual acuity testing. Of the remaining 1307 residents, 496 (37%) had best-corrected visual acuity worse than 20/40 in the better-seeing eye. Causes were ascribed for 412 subjects. Rates of low vision were similar between African American subjects and white subjects (39% and 38%, respectively; age-adjusted P =.18). Cataract was the leading cause of low vision, responsible for 37% of low vision among white subjects and 54% of low vision among African American subjects. Macular degeneration was responsible for 29% of low vision among white subjects but only 7% among African American subjects. Glaucoma caused low vision in 4% of white subjects and 10% of African American subjects. Refractive error was not a frequent cause of low vision in nursing home residents. CONCLUSIONS: Low vision is highly prevalent among nursing home residents, with 37% having visual acuity worse than 20/40 in the better-seeing eye. Differences in causes of low vision between African American subjects and white subjects were noted, with African American subjects more likely to have vision loss on the basis of cataract, a readily treated condition. Appropriate interventions for nursing home residents, who face significant obstacles in accessing eye care services, have the potential to improve the quality of life of this at-risk older population.

Sunness JS, Rubin GS, Broman A, Applegate CA, Bressler NM, Hawkins BS. · The Richard E Hoover Rehabilitation Services for Low Vision and Blindness, Greater Baltimore Medical Center, Baltimore, Maryland 21204, USA. · Ophthalmology. · Pubmed #18486216 No free full text.

Abstract: OBJECTIVE: To show that low luminance visual dysfunction is predictive of subsequent visual acuity (VA) loss in eyes with geographic atrophy (GA) resulting from age-related macular degeneration (AMD). DESIGN: Cohort study examining the prospective natural history study of GA from 1992 through 2000 at the Wilmer Eye Institute. PARTICIPANTS: Ninety-one participants with GA resulting from AMD without choroidal neovascularization in at least 1 eye who completed a 2-year study examination. METHODS: Annual examinations included measurement of best-corrected VA, low luminance VA, Pelli-Robson contrast sensitivity, reading speed, examination, and fundus photography. The total GA area was quantified, as was the GA within a 10.2-mm(2) circle centered on the fovea. MAIN OUTCOME MEASURES: Visual acuity loss at 2 years and risk factors for visual loss. RESULTS: Participants with baseline VA of 20/50 or more had a 40% 2-year rate of VA loss of 3 lines or more, compared with 13% for the participants with worse baseline acuities. The baseline low-luminance deficit (LLD) in VA was a strong predictor of subsequent VA loss for all levels of baseline VA. Within the good baseline VA group, the relative risk (RR) of 3-line loss for the worse LLD group compared with the better LLD group was 2.88 (95% confidence interval [CI], 1.13-7.35). The LLD is a stable and reproducible measure. Other significant visual function predictors of subsequent VA loss in eyes with good baseline VA included foveal dark-adapted sensitivity (RR, 4.20; 95% CI, 1.39-12.71) and reduced reading rate (RR, 2.43; 95% CI, 1.11-5.31). The rate of VA loss within the good acuity group was higher when the GA included 25% to 75% of the central 10.2 mm(2) than in eyes with GA including less than 25% or more than 75% of the central 10.2 mm(2). The following were not significant predictors of subsequent VA loss among these participants: age, gender, fellow eye diagnosis, fellow eye VA, baseline GA area, and GA enlargement rate. CONCLUSIONS: Visual function measures can predict the risk of future VA loss in subjects with GA and good baseline VA. They may allow identification of the highest risk group for VA loss, enabling more efficient design of clinical trials. They also may be appropriate surrogate measures of foveal health in short-term treatment trials.

Rodriguez J, Sanchez R, Munoz B, West SK, Broman A, Snyder RW, Klein R, Quigley H. · Department of Ophthalmology, University of Arizona, Tucson, AZ, USA. · Ophthalmology. · Pubmed #11927431 No free full text.

Abstract: OBJECTIVE: To describe the causes of blindness and visual impairment in a population-based sample of Hispanics. DESIGN: A cross-sectional study. PARTICIPANTS: A random sample of 4774 Hispanic residents of Santa Cruz and Pima Counties in Southern Arizona aged 40 years and older who participated in Proyecto VER (Vision Evaluation and Research). TESTING: Subjects were interviewed and underwent a thorough ophthalmic examination. Presenting and best-corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol, followed by a standardized ophthalmic examination to determine the causes of visual loss. Anterior and posterior segment specialists in ophthalmology confirmed the causes. MAIN OUTCOME MEASURES: Causes of visual loss (best-corrected acuity worse than 20/40). RESULTS: The response rate of eligible participants was more than 70%. Best-corrected acuity in the better seeing eye worse than 20/40 increased from 0.3% in those aged 40 to 49 to 5.6% in those aged 65 and older. The leading cause was cataract, accounting for 42% of all visual loss, followed by age-related macular degeneration (15%), and diabetic retinopathy (13%). Among 14 people who were bilaterally blind, open-angle glaucoma was the leading cause. Women had higher age-adjusted prevalence of severe cataract compared with men and were more likely to be visually impaired from cataract, diabetic retinopathy, and open-angle glaucoma, although gender differences were not statistically significant. CONCLUSIONS: Causes of visual impairment differ from those reported in Caucasian populations, with open-angle glaucoma being the leading cause of blindness. Further work on gender-based obstacles to eye care in the Hispanic community may be warranted.