In a study of Alabama nursing home residents, more than half were visually impaired yet two-thirds had no record of or reference to an eye examination in their medical charts, according to a report in the July issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Previous studies have estimated that nursing home residents have visual impairment rates anywhere from three to 15 times higher than adults of the same age living in the community, according to background information in the article. "Reasons for these high vision impairment rates among nursing home residents are not fully understood," the authors write. "A variety of factors may contribute, including that persons with vision impairment may be more likely to be admitted to nursing homes, nursing home residents may have limited accessibility to doctors' offices because of lack of transportation and escort availability, residents may not wear spectacles even though they have them, family and health care professionals may believe that cognitively impaired persons do not personally benefit from treatments to improve vision and there is a shortage of eye care professionals who routinely serve clientele living in nursing homes."
Cynthia Owsley, Ph.D., M.S.P.H., and colleagues at the University of Alabama at Birmingham assessed 380 individuals age 55 or older living at 17 nursing homes in the Birmingham area for visual impairment. Each resident and a family member or guardian was interviewed about the use of eyeglasses and eye care. "Medical records provided information on demographics, chronic medical conditions, date of last eye examination, duration of residence in the nursing home and health insurance," the authors write. All 17 facilities had licensed optometrists who regularly visited the facility to provide eye care services.
A total of 57 percent of the residents were visually impaired, defined as having visual acuity of worse than 20/40 in the better eye. This compares with rates of approximately 10 percent to 20 percent among adults 60 or older living in the community nationwide. Three-fourths of the participants had abnormal binocular contrast sensitivity, or the ability to detect boundaries between objects and changes in brightness, which is important for mobility and reading.
"It appears that routine eye care may not be taking place for a substantial segment of the nursing home residents in our sample, as implied by our data in several ways," the authors write. Although 90 percent of the residents had some form of health insurance, 66 percent of them had no reference to eye examinations in their medical records. When asked about their most recent eye exam, 28 percent said it was in the previous year, 20 percent indicated that it was more than two years ago or used words indicating that it was a very long time ago, and one-third did not know.
"Information about the extent to which this visual impairment is remediable was unavailable to the study, so whether high visual impairment rates can be interpreted as underutilization of routine eye care may be questionable. Yet some credence is lent to this possibility based on a previous study estimating that 37 percent of the visual impairment and 20 percent of the blindness among nursing home residents is remediable by refractive error correction," the authors conclude. "These findings underscore the need to better understand the causes of high visual impairment rates in nursing home residents and to evaluate interventions to improve the visual status of this population."
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(Arch Ophthalmol. 2007;125(7):925-930.
Editor's Note: This research was supported by the Retirement Research Foundation, the EyeSight Foundation of Alabama, the Pearle Vision Foundation, a National Institutes of Health grant and Research to Prevent Blindness, Inc.
Nursing home residents who received eyeglasses for uncorrected refractive error were found to have improved quality of life and decreased symptoms of depression when compared to those with refractive error who had not received eyeglasses, according to a report in the November issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Refractive error occurs when the proper degree of light does not reach the back of the eye, resulting in blurred vision. "Nursing home residents in the United States and other industrialized countries have high rates of vision impairment, with estimates ranging from three to 15 times higher than corresponding rates for community-dwelling older adults," according to background information in the article. "Studies suggest that vision impairment in about one-third of nursing home residents could largely be reversed by treatment of uncorrected refractive error (myopia [nearsightedness], hyperopia [farsightedness], presbyopia [loss of focus])."
Cynthia Owsley, Ph.D., M.S.P.H., and colleagues at the University of Alabama at Birmingham conducted a trial in which 142 nursing home residents age 55 or older were assigned to a group that would receive eyeglasses one week after check-up (78 residents) or a group that would receive eyeglasses at follow-up two months after check-up (64 residents). Vision-related quality-of-life and depressive symptoms were measured at baseline and at two months.
At baseline, both groups had similar demographic and medical characteristics and had similar visual acuity and refractive error uncorrected by eyeglasses. After two months, distance and near visual acuity for the right and left eye improved in the group that received eyeglasses, while the group that had not received eyeglasses had no change in visual acuity.
At the two-month follow-up, the group that received eyeglasses reported higher scores for general vision, reading, activities and hobbies and social interaction as well as fewer depressive symptoms.
"This study implies that there are significant, short-term quality-of-life and psychological benefits to providing the most basic of eye care services—namely, spectacle correction—to older adults residing in nursing homes," the authors conclude. "These findings underscore the need for a systematic evaluation of the factors underlying the pervasive unavailability of eye care to nursing home residents in the United States so that steps can be taken to improve service delivery and eye care utilization."
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(Arch Ophthalmol. 2007;125(11):1471-1477.
Editor's Note: This research was supported by the Retirement Research Foundation, the EyeSight Foundation of Alabama, the Pearle Vision Foundation, a National Institutes of Health grant and Research to Prevent Blindness, Inc.
