Optometry and Vision Science最新文献

Purpose: This study aimed to assess intrasession repeatability, diurnal intravisit and day-to-day intervisit reproducibility of qualitative tear film lipid layer interferometry grading obtained from the Keratograph 5M (Oculus Optikgeräte GmbH, Wetzlar, Germany), and automated quantitative layer thickness measurements obtained from the TearScience LipiView II Ocular Surface Interferometer (Johnson & Johnson Vision, Milpitas, CA), in community residents, not stratified by dry eye or blepharitis status.

Methods: Forty community residents (24 women, 16 men; age mean ± standard deviation, 36 ± 14 years) were recruited in an investigator-masked, randomized, crossover study. Participants attended two sessions 6 hours apart on the same day and a third session on a separate day. During each session, tear film lipid layer grading and thickness measurements were performed in triplicate, in a masked manner, with 10-minute intervals between each measurement.

Results: There were no significant differences in lipid layer grading and thickness measurements in all pairwise intrasession, diurnal intravisit, and day-to-day intervisit comparisons (all p≥0.19), and positive correlations were observed in all cases (all p<0.001). The weighted Cohen κ coefficients for intrasession repeatability and diurnal intravisit and day-to-day intervisit reproducibility of qualitative lipid layer grading ranged from 0.670 to 0.867. The test-retest repeatability of quantitative lipid layer thickness measurements ranged from 4.5 to 11.7 nm, and the Bland-Altman biases were within the order of 3 nm in all pairwise comparisons. The intraclass correlation coefficients for lipid layer thickness measurements exceeded 0.80 for all intrasession comparisons and were between 0.60 and 0.80 for all diurnal intravisit and day-to-day intervisit comparisons.

Conclusions: Both qualitative grading and automated quantitative thickness measurements of tear film lipid layer interferometry demonstrated relatively favorable levels of intrasession repeatability and diurnal intravisit and day-to-day intervisit reproducibility. The study findings would support the use of either qualitative or quantitative measurement in clinical and research settings, as a reliable tool for assessing lipid layer interferometry.

Significance: Visual acuity (VA) depends on many factors. When the goal is to assess retinal health rather than performance, then using a 3-mm pupil reduces unwanted wavefront aberrations. The axis of astigmatism can still potentially change with age.

Purpose: When VA measurements are intended to quantify the status of the retina, extraneous optical aberrations can make the measured VA worse and introduce variability, particularly in aging eyes. Our study quantifies wavefront aberrations for a 3-mm pupil, which is similar to the theoretical optical size for best VA, versus a 5-mm pupil.

Methods: The wavefront aberrations of normally sighted adults (N = 39; age, 41.9 ± 16.3 years) were measured for a 3- and 5-mm pupil setting without pupil dilation, using a commercially available and semiautomatic instrument (Pentacam AXL WAV; Oculus Optikgeraete GmbH, Wetzlar, Germany). The mean wavefront errors from the average of three measurements with three samples each were computed for each Zernike term orders 1 to 6 and correlated with age. The difference of measurement 1 and measurement 2 provided the test-retest values.

Results: Each 3-mm pupil measurements had a reduced average aberration for all 26 aberrations Zernike values, and 21 of 26 were statistically significant (p<0.05). The variability of the Zernike values was less for the 3-mm pupil than for the 5-mm pupil for all 26 measured aberrations pooled (Zernike orders 1 to 6), which was statistically significant ( F = 54.625, p<0.001). Most mean aberrations did not vary significantly with age for a 3-mm pupil, except for vertical astigmatism, horizontal coma, spherical aberration, and vertical quadrafoil. Against-the-rule astigmatism was more common in subjects >60 than <40 years old (p=0.05).

Conclusions: The findings of this study indicate that measurements of VA to assess retinal health could be made less dependent on unrelated and unwanted anterior segment factors by using a 3-mm pupil, because the wavefront aberrations for a 3-mm pupil were less than those for a 5-mm pupil. The change with age in vertical astigmatism more than oblique is consistent with the expected increase in proportion of against-the-rule astigmatism.

Background: The prevalence of visual impairment among individuals living in long-term care (LTC) is substantial, yet eye care is often disregarded and inadequately addressed. This neglect contributes to a decline in quality of life for residents. Thus, understanding the challenges faced by stakeholders in providing eye care for residents might suggest opportunities to improve eye health outcomes.

Aim: This study aimed to identify factors influencing access to eye care services in LTC, focusing on key stakeholders including residents, family members, aged care staff, and eye care professionals.

Methods: We included studies on vision/eye care-related challenges and/or management of eye conditions for people living in LTC facilities. We performed literature searches using Cochrane Database of Systematic Reviews, PubMed, CINAHL/EBSCO, EMBASE, APA PsycINFO, and Web of Science database. The search was limited to articles in English language, published between January 2013 and September 2023. Factors influencing the vision/eye care for residents were mapped to respective stakeholders, and we visualized how they interacted within the LTC system in providing eye care.

Results: Eleven studies were included in the review. We found that the challenges to appropriate eye care in LTC are present across all stakeholder groups. These challenges include limited awareness of eye health, logistical difficulties in coordinating and managing eye care within LTC settings, and negative beliefs and attitudes toward prioritizing eye care for residents.

Conclusions and implications: This review highlights that barriers to eye care in LTC communities exist at multiple levels and involve a range of stakeholders. In order to improve eye care, interventions should be at the system level, considering the influence of all key stakeholders rather than employing a targeted approach.

Significance: Several studies indicate that dual sensory loss (DSL) is related to cognitive impairment. However, there are still no conclusive data on the role of each individual deficit on cognitive performance when both co-occur in the same person.

Purpose: This study aimed to analyze the possible association between sensory deficit and cognitive impairment in a sample of older adults and whether this association differs in subjects with DSL compared with those with single or no sensory impairment.

Methods: Participants of this study were older adult users of gerontological centers in an urban area of Galicia (Spain). All subjects underwent visual and auditory screening tests to detect the presence of DSL. The Spanish version of the Mini-Mental State Examination test was used to identify cognitive impairment. Hearing loss was defined according to Ventry and Weinstein's criteria. Visual impairment was defined as a binocular presenting visual acuity <0.5 (20/40). The presence of DSL was established on the basis of the definitions of the single deficits.

Results: A total of 534 subjects were examined. Older adults with DSL had the worst results in the Mini-Mental test, and those without sensory impairment had the best. The likelihood of cognitive impairment was greater in older adults with DSL than in those without sensory impairment (odds ratio, 6.06 [3.14 to 11.65]). When only visual impairment was present, the likelihood of cognitive impairment was 3.73 times higher (0.95 to 3.09) than that of subjects with no sensory impairment. Hearing loss alone seems not to be significantly associated with a higher risk of cognitive impairment.

Conclusions: The results of this study highlight the importance of continuing research in DSL for the prevention of cognitive impairment, the design of intervention plans, and the optimization of health resources.

Purpose: There is evidence that wearing multifocal glasses increases the risk of falls in older people, especially when walking on stairs and in unfamiliar settings. However, it is not clear whether all types of multifocal glasses are equally associated with falls. This study comprised a secondary analysis of data from the VISIBLE randomized controlled trial to determine whether fall rates differ among older bifocal, trifocal, and progressive addition lens glasses wearers.

Methods: Two hundred eighty-one regular wearers of multifocal glasses (mean age, 80.3 years; standard deviation, 6.8 years) who were at increased risk of falls and used multifocal glasses three or more times per week participated in the study. Participants were classified into three groups: bifocal (n = 170), trifocal (n = 33), and progressive addition lens glasses wearers (n = 78). Participants underwent assessments of vision, sensorimotor function and balance (assessed with the Physiological Profile Assessment), Timed Up and Go performance, and activity levels and were then followed up for falls for 13 months.

Results: Two hundred sixty-eight participants (95.4%) were followed up for falls for 6+ months over the following 13 months: 51 bifocal glasses wearers (31.5%) suffered multiple falls compared with 15 trifocal glasses wearers (46.9%) and 33 progressive addition lens glasses wearers (44.6%) (p=0.071). When adjusting for established fall risk factors, participants wearing progressive addition lens glasses had over twice the odds of suffering multiple falls compared with bifocal glasses wearers (odds ratio, 2.23; 95% confidence interval, 1.08 to 4.58).

Conclusions: These findings suggest that progressive addition lens glasses increase the risk of falls more than bifocal glasses possibly due to visual distortions and reduced awareness of blurred distant objects in the lower visual field. Education of the risks posed by progressive addition lens glasses and training in optimal glasses use may help protect older people from falls.

Purpose: This study investigated how obstacle contrast altered gait behavior of healthy younger and older adults.

Methods: Twenty normally sighted adults, 11 older (mean [standard deviation] age, 68.1 [5.1] years) and 9 younger (mean [standard deviation] age, 21.1 [2.1] years), walked along a 6-m, black carpeted walkway and stepped over a single obstacle positioned 4 m from the start. The obstacle varied in height (0 [no obstacle], 1, and 19 cm) and contrast (6% ["low"] and 90% ["high"] Michelson contrast). Each subject completed 10 trials for each of the 5 conditions in an unblocked, random order. Lower limb kinematics were recorded using 13 motion capture cameras. Visual acuity and contrast sensitivity were measured. A repeated-measures analysis of variance was used to assess age group differences in trail toe position before crossing, lead and trail foot clearance over the obstacle, lead heel position after crossing, and obstacle crossing speed. Planned comparisons were done with Bonferroni correction. Independent t tests were used to compare vision and survey variables between groups.

Results: Visual acuity was similar in both groups (p=0.17), although contrast sensitivity was better in the younger than older adults (p=0.001). Main effects were found for age: compared with younger adults, older adults showed a farther back trail foot position, greater trail foot clearance, closer lead heel position, and slower obstacle crossing speed (p<0.001 for all effects). Main effects were found for obstacle contrast: compared with low-contrast obstacles, for high-contrast obstacles, the trail foot position was farther back, both lead and trail foot clearance were greater, and lead heel position was closer (p<0.024 for all effects).

Conclusions: Obstacle contrast impacts gait behavior for younger and older adults. It is possible that the visual characteristics of an obstacle are enhanced for high-contrast obstacles, causing changes to gait behavior that may increase safety.

Significance: Previous evidence showed that transient receptor potential vanilloid 4 (TRPV4) inhibition was protective of retinal ganglion cell (RGC) loss after chronic intraocular pressure (IOP) elevation in young animals. However, the role of TRPV4 in mechanosensing IOP changes in the aging eye is not well understood.

Purpose: This study compared the recovery of retinal function and structure after acute IOP elevation in 3- and 12-month-old mouse eyes with and without TRPV4 inhibition.

Methods: We examined retinal TRPV4 expression in 2-month-old rodent eyes using immunohistochemistry and transcript analysis of isolated macroglia and RGCs. To modulate TRPV4, mice were treated daily with either vehicle or a TRPV4 antagonist (HC-067047 10 mg/kg) delivered intraperitoneally for 7 days before and 7 days after IOP elevation (50 mmHg for 30 minutes). Retinal function and structure were assessed using dark-adapted full-field electroretinography and optical coherence tomography, respectively.

Results: We showed that Müller cells strongly expressed TRPV4. Seven days after IOP elevation, RGC functional recovery was significantly poorer in older mice treated with TRPV4 antagonist compared with age-matched vehicle controls (-54 ± 7% vs. -24 ± 10%, p=0.046) and their younger TRPV4 antagonist-treated counterparts (-5 ± 5%, p<0.001).

Conclusions: This study showed that there was an age-related deficit in RGC functional recovery from IOP elevation with TRPV4 inhibition.