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      Impact of Low Vision on Well-Being in 10 European Countries

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          Background: Because of the growing life expectancy in developed countries and the exponential increase in vision loss with increasing age, a growing number of elderly persons will eventually suffer from visual impairment and blindness. This paper describes the association between self-reported vision and well-being in individuals aged 50 years and older and their families. Methods: Using binary logistic regressions on data from the 2004 Survey of Health, Ageing and Retirement in Europe (SHARE), we analysed the association between self-reported corrected vision in general, corrected distance vision and corrected reading vision on 11 variables capturing emotional well-being, future hopes and perspectives, and concentration on daily activities. Results: For 22,486 individuals from 10 European countries, aged 64.23 ± 10.52 years, lower vision was associated with a highly significant negative impact on all measured aspects of well-being. Conclusions: These data from a large population base in Europe provide evidence that persons with low vision have a higher probability of concentration problems during reading and entertainment; losing interest and enjoyment in their activities; feeling fatigued, irritable, sad, and tearful; having less hope for the future; and wishing for death. Effective measures of early detection, prevention, rehabilitation, education and research, as well as a holistic view of a patient, could help counter these problems, thereby improving mental and physical health and reducing the economic impact of low vision.

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          Most cited references 20

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          What is the concordance between the medical record and patient self-report as data sources for ambulatory care?

          The validity of quality of care assessments relies upon data quality, yet little is known about the relative completeness and validity of data sources for evaluating the quality of care. We evaluated concordance between ambulatory medical record and patient survey data. Levels of concordance, variations by type of item, sources of disagreement between data sources, and implications for quality of care assessment efforts are discussed. This was an observational study that included 1270 patients sampled from 39 West Coast medical organizations with at least 1 of the following: diabetes, ischemic heart disease, asthma or chronic obstructive pulmonary disease, or low back pain. Items from both data sources were grouped into 4 conceptual domains: diagnosis, clinical services delivered, counseling and referral, and medication use. We present total agreement, kappa, sensitivity, and specificity at the item and domain-levels and for all items combined. We found good concordance between survey and medical records overall, but there was substantial variation within and across domains. The worst concordance was in the counseling and referrals domain, the best in the medication use domain. Patients were able to report with good sensitivity on memorable items. Quality ratings are likely to vary in differing directions, depending on the data source used. The most appropriate data source for analyses of components of and overall quality of care must be considered in light of study objectives and resources. We recommend data collection from multiple sources to most accurately portray the patient and provider experience of medical care.
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            Is Open Access

            Quality of life in age-related macular degeneration: a review of the literature

            Background The Age-related Macular Degeneration Alliance International commissioned a review of the literature on quality of life (QoL) in macular degeneration (MD) with a view to increasing awareness of MD, reducing its impact and improving services for people with MD worldwide. Method A systematic review was conducted using electronic databases, conference proceedings and key journal hand search checks. The resulting 'White Paper' was posted on the AMD Alliance website and is reproduced here. Review MD is a chronic, largely untreatable eye condition which leads to loss of central vision needed for tasks such as reading, watching TV, driving, recognising faces. It is the most common cause of blindness in the Western world. Shock of diagnosis, coupled with lack of information and support are a common experience. Incidence of depression is twice that found in the community-dwelling elderly, fuelled by functional decline and loss of leisure activities. Some people feel suicidal. MD threatens independence, especially when comorbidity exacerbates functional limitations. Rehabilitation, including low vision aid (LVA) provision and training, peer support and education, can improve functional and psychological outcomes but many people do not receive services likely to benefit them. Medical treatments, suitable for only a small minority of people with MD, can improve vision but most limit progress of MD, at least for a time, rather than cure. The White Paper considers difficulties associated with inappropriate use of health status measures and misinterpretation of utility values as QoL measures: evidence suggests they have poor validity in MD. Conclusion There is considerable evidence for the major damage done to QoL by MD which is underestimated by health status and utility measures. Medical treatments are limited to a small proportion of people. However, much can be done to improve QoL by early diagnosis of MD with good communication of prognosis and continuing support. Support could include provision of LVAs, peer support, education and effective help in adjusting to MD. It is vital that appropriate measures of visual function and QoL be used in building a sound evidence base for the effectiveness of rehabilitation and treatment.
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              Impact of unilateral and bilateral vision loss on quality of life.

              To investigate whether unilateral vision loss reduced any aspects of quality of life in comparison with normal vision and to compare its impact with that of bilateral vision loss. This study used cluster stratified random sample of 3271 urban participants recruited between 1992 and 1994 for the Melbourne Visual Impairment Project. All predictors and outcomes were from the 5 year follow up examinations conducted in 1997-9. There were 2530 participants who attended the follow up survey and had measurement of presenting visual acuity. Both unilateral and bilateral vision loss were significantly associated with increased odds of having problems in visual functions including reading the telephone book, newspaper, watching television, and seeing faces. Non-correctable by refraction unilateral vision loss increased the odds of falling when away from home (OR = 2.86, 95% CI 1.16 to 7.08), getting help with chores (OR = 3.09, 95% CI 1.40 to 6.83), and becoming dependent (getting help with meals and chores) (OR = 7.50, 95% CI 1.97 to 28.6). Non-correctable bilateral visual loss was associated with many activities of daily living except falling. Non-correctable unilateral vision loss was associated with issues of safety and independent living while non-correctable bilateral vision loss was associated with nursing home placement, emotional wellbeing, use of community services, and activities of daily living. Correctable or treatable vision loss should be detected and attended to.

                Author and article information

                S. Karger AG
                May 2008
                22 May 2008
                : 222
                : 3
                : 205-212
                aResearch Institute for Labour Economics and Labour Law, University of St. Gallen, bInstitute of Ophthalmology, Kantonsspital St. Gallen, St. Gallen, and cUniversity of Bern, Bern, Switzerland; dInstitute for Consumer and Household Economics, University of Hohenheim, Stuttgart, Germany
                126085 Ophthalmologica 2008;222:205–212
                © 2008 S. Karger AG, Basel

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                Page count
                Tables: 5, References: 36, Pages: 8
                Original Paper


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