Association between Vision Impairment and Physical Quality of Life Assessed Using National Surveillance Data.

SIGNIFICANCE: Physically unhealthy days assessments in national health surveillance datasets represent a useful metric for quantifying quality-of-life differences in those with and without vision impairment. Disproportionately poorer physical health in the visually impaired population provides further rationale for the inclusion of vision care in multidisciplinary approaches to chronic disease management. PURPOSE: This study aimed to assess the association between vision impairment and health-related quality of life using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. METHODS: Data from each of the 50 states were extracted from the 2017 Behavioral Risk Factor Surveillance System data set. Self-report of difficulty seeing was used to categorize visually impaired versus nonvisually impaired populations. Self-report number of physically unhealthy days in the previous 30 days was used to quantify quality of life. The number of unhealthy days was calculated for the visually impaired and nonvisually impaired cohorts for each state. The ratio of the number of physically unhealthy days in the visually impaired versus nonvisually impaired population was calculated for each state and for different age cohorts. RESULTS: Mean numbers of physically unhealthy days among persons with and without severe vision impairment across all states were 10.63 and 3.68 days, respectively, and demonstrated considerable geographic variability. Mean ratios of physically unhealthy healthy days in the visually impaired versus the nonvisually impaired population were 2.91 in the 18- to 39-year-old cohort, 2.87 in the 40- to 64-year-old cohort, and 2.16 in the ≥65-year-old cohort. CONCLUSIONS: National surveillance data demonstrate a greater number of physically unhealthy days in the visually impaired population, indicating a need to improve our understanding of causes that lead to reduced physical health among those with vision impairment. Additional research is needed to better understand how individuals perceive vision as part of their overall health.

The Philadelphia Glaucoma Detection and Treatment Project: Detection Rates and Initial Management.

PURPOSE: To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. DESIGN: Retrospective analysis. PARTICIPANTS: A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. METHODS: Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. MAIN OUTCOME MEASURES: Detection rates of glaucoma-related diagnoses and types of treatments administered. RESULTS: Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT, and 103 (6.2%) who were prescribed IOP-lowering medication. CONCLUSIONS: Targeting individuals at risk for glaucoma in underserved communities in Philadelphia yielded a high detection rate (39.1%) of glaucoma-related diagnoses. Providing examinations and offering treatment, including first-line laser procedures, at community-based sites providing services to older adults are effective to improve access to eye care by underserved populations.

Falls Among Persons Aged ≥65 Years With and Without Severe Vision Impairment - United States, 2014.

In 2014, an estimated 2.8 million persons aged ≥65 years in the United States reported severe vision impairment* defined as being blind or having severe difficulty seeing, even with eyeglasses. Good vision is important for maintaining balance as well as for identifying low-contrast hazards, estimating distances, and discerning spatial relationships. Conversely, having poor vision increases the risk for falls (1,2). Falls among older adults are common and can cause serious injuries, disabilities, and premature death (1,3). To date, no state-level investigations have examined the annual prevalence of falls among persons with and without severe vision impairment. CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the state-specific annual prevalence of falls among persons aged ≥65 years with and without self-reported severe vision impairment. Overall, 46.7% of persons with, and 27.7% of older adults without, self-reported severe vision impairment reported having fallen during the previous year. The state-specific annual prevalence of falls among persons aged ≥65 years with severe vision impairment ranged from 30.8% (Hawaii) to 59.1% (California). In contrast, the prevalence of falls among persons aged ≥65 years without severe vision impairment ranged from 20.4% (Hawaii) to 32.4% (Alaska). Developing fall-prevention interventions intended for persons with severe vision impairment will help states manage the impact of vision impairment and falls on health care resources, and can inform state-specific fall prevention initiatives.

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) for adults at risk for glaucoma: study rationale and design.

BACKGROUND: Primary open angle glaucoma is a chronic, progressive eye disease that is the leading cause of blindness among African Americans. Glaucoma progresses more rapidly and appears about 10 years earlier in African Americans as compared to whites. African Americans are also less likely to receive comprehensive eye care when glaucoma could be detected before irreversible blindness. Screening and follow-up protocols for managing glaucoma recommended by eye-care professional organizations are often not followed by primary eye-care providers, both ophthalmologists and optometrists. There is a pressing need to improve both the accessibility and quality of glaucoma care for African Americans. Telemedicine may be an effective solution for improving management and diagnosis of glaucoma because it depends on ocular imaging and tests that can be electronically transmitted to remote reading centers where tertiary care specialists can examine the results. We describe the Eye Care Quality and Accessibility Improvement in the Community project (EQUALITY), set to evaluate a teleglaucoma program deployed in retail-based primary eye care practices serving communities with a large percentage of African Americans. METHODS/DESIGN: We conducted an observational, 1-year prospective study based in two Walmart Vision Centers in Alabama staffed by primary care optometrists. EQUALITY focuses on new or existing adult patients who are at-risk for glaucoma or already diagnosed with glaucoma. Patients receive dilated comprehensive examinations and diagnostic testing for glaucoma, followed by the optometrist's diagnosis and a preliminary management plan. Results are transmitted to a glaucoma reading center where ophthalmologists who completed fellowship training in glaucoma review results and provide feedback to the optometrist, who manages the care of the patient. Patients also receive eye health education about glaucoma and comprehensive eye care. Research questions include diagnostic and management agreement between providers, the impact of eye health education on patients' knowledge and adherence to follow-up and medication, patient satisfaction, program cost-effectiveness, and EQUALITY's impact on Walmart pharmacy prescription rates. DISCUSSION: As eye-care delivery systems in the US strive to improve quality while reducing costs, telemedicine programs including teleglaucoma initiatives such as EQUALITY could contribute toward reaching this goal, particularly among underserved populations at-risk for chronic blinding diseases.

Visual impairment and health-related quality of life among elderly adults with age-related eye diseases.

PURPOSE: To examine the association between age-related eye disease (ARED), visual impairment, and health-related quality of life (HRQOL). METHODS: We used data from the 2006 and 2008 Behavioral Risk Factor Surveillance System to examine self-reported visual impairment and two HRQOL domains-physical impairment (including poor general health, physical unhealthy days, activity-limitation days, and disability) and mental distress (including mental unhealthy days, life dissatisfaction, major depression, lifetime depression, and anxiety) for people aged 65 years or older, by ARED status. RESULTS: People with any ARED were more likely than those without to report visual impairment as well as physical impairment and mental distress. The prevalence of visual impairment (P trend <0.001) and physical impairment (P trend <0.001) increased with increasing number of eye diseases after controlling for all covariates. There was no significant linear trend, however, in mental distress among people with one or more eye diseases. CONCLUSION: ARED was found to be associated with visual impairment and poorer HRQOL. Increasing numbers of AREDs were associated with increased levels of visual impairment and physical impairment, but were not associated with levels of mental distress.

Prevalence of Vision Loss and Associations With Age-Related Eye Diseases Among Nursing Home Residents Aged ≥65 Years.

OBJECTIVES: To examine data from Delaware nursing homes to determine prevalence of age-related eye diseases (AREDs), vision impairment, and blindness and to compare the findings with the results of 11 US investigations of vision and eye health in nursing homes. DESIGN: This is a cross-sectional, retrospective study of nursing home patients. SETTING AND PARTICIPANTS: Twenty nursing homes in Delaware participated in the study, yielding comprehensive eye examination records for 2019 study participants. METHODS: Summary statistics and regression analyses. RESULTS: The overall prevalence of vision impairment or blindness was 63.8% and was above 60% for each age, sex, and race category. Prevalence of vision impairment or blindness was 68.4% among patients with cataracts, 69.4% among patients with macular degeneration, 70.5% among patients with glaucoma, and 68.4% among patients with diabetic retinopathy. Prevalence of blindness was 14.1%. Among patients with AREDs, prevalence of blindness ranged from 15.0% for patients with cataracts to 22.6% for patients with diabetic retinopathy. When compared with other investigations, we found wide variation in vision and eye factors reported and wide variation in the prevalence of those factors. Only 4 studies diagnosed both AREDs and visual function. Seven studies reported AREDs, and 7 reported vision impairment and/or blindness. Vision impairment or blindness ranged from 29% to 67%; cataract ranged from 32% to 83%; macular degeneration ranged from 4.6% to 70.7%. Glaucoma ranged from 5.3% to 41.4%; diabetic retinopathy ranged from 1.7% to 3.1%. CONCLUSIONS AND IMPLICATIONS: Comprehensive eye examinations showed that vision impairment and blindness affected 63.8% of nursing home residents. Compared with other studies, there was a wide range of vision factors reported and wide variation in the prevalence of vision impairment or blindness and AREDs. This investigation suggests the importance of eye care in nursing homes and the importance of reporting standard vision and eye health factors to inform policy and practice.

Prevalence and correlates of depressive symptoms among United States adults with disabilities using assistive technology.

OBJECTIVES: To estimate the prevalence of current depressive symptoms (CDS) among adults that reported disabilities requiring the use of assistive technology (AT) and those that did not, and to examine the sociodemographic, comorbidity, health behavior, and social support correlates of this condition in adults who use AT. METHODS: Data from the 2006 Behavioral Risk Factor Surveillance System, a standardized telephone survey among U.S. adults, were analyzed (n=195,033). The Patient Health Questionnaire diagnostic algorithm was used to identify CDS. RESULTS: AT users were significantly more likely than AT non-users to have CDS (age-standardized: 30.4% vs. 7.4%). Among AT users, there was a dose-response relationship between depression severity and increased prevalence of health conditions, obesity, smoking, and physical inactivity. In the full covariate logistic regression model, the strongest sociodemographic variables associated with CDS among AT users were age and employment status. Other variables strongly associated with CDS were lack of social support and anxiety. CONCLUSIONS: An integrated approach to health care should be taken with adults who use AT. AT service providers, primary health care providers, and other care givers should be alert to the possibility of depression in AT users; and opportunities to prevent, detect, and treat depression among this population should not be missed.

Self-Reported Oral Health Status Among Adults Aged 40+ Years With and Without Vision Impairment: National Health Interview Study, 2008.

PURPOSE: To examine self-reported oral health among adults aged 40 years and older with and without vision impairment. DESIGN: Cross-sectional, with a nationally representative sample. METHODS: We used publicly available data from the Oral Health Module, last administered in 2008, of the National Health Interview Survey. Outcome variables included fair/poor oral health status, mouth condition compared to others the same age, mouth problems (mouth sores, difficulty eating, dry mouth, bad breath, and/or jaw pain), teeth problems (toothache; broken/missing fillings or teeth; loose, crooked, or stained teeth; and/or bleeding gums), and lack of social participation. Using descriptive statistics and multivariate logistic regression, we examined the association (P < .05) between vision impairment and oral health outcomes by age group, sociodemographics, and other explanatory variables. RESULTS: Our study sample included 12,090 adults; 12.8% of adults aged 40-64 years reported vision impairment, and among them, 44.5% reported fair/poor oral health status and 47.2% reported any mouth problems. Among adults aged ≥65 years, 17.3% reported vision impairment, of whom 36.3% reported fair/poor oral health status and 57.3% reported any mouth problems. There is a strong association between vision impairment and poorer oral health of adults; adults aged 40-64 years with vision impairment reported 90%-150% greater odds of oral health problems, including fair/poor oral health status, mouth problems, and teeth problems, compared to people without vision impairment. CONCLUSIONS: Oral health disparities exist between adults with and without vision impairment. Targeted interventions are required to improve oral health in this vulnerable population.

Disability and its correlates with chronic morbidities among U.S. adults aged 50-<65 years.

OBJECTIVE: To examine the prevalence of disability and its associations with multiple chronic morbidities in U.S. adults aged 50-<65 years. METHODS: Self-reported data on disability and chronic morbidities were collected from 95,103 participants (aged 50-<65 years) of the 2005 Behavioral Risk Factor Surveillance System. Prevalence estimates for disability and chronic morbidities were age-standardized to the 2000 U.S. population. Adjusted odds ratios for disability among people with chronic morbidities (versus those without) were estimated using logistic regression analyses. RESULTS: The age-adjusted prevalence of the six chronic morbidities ranged from 3.1% (for stroke) to 40.3% (for arthritis). Overall, the prevalence of disability was 26.3%; it was significantly higher in adults with chronic morbidities than in those without and increased linearly with the number of the chronic morbidities. Adults with any of the chronic morbidities were 1.9 to 4.5 times as likely, and adults with 1 to 5-6 of the chronic morbidities were 2.7 to 42.9 times as likely, to have disability as those without after adjustment for demographics, smoking and leisure-time exercise. CONCLUSIONS: Chronic morbidities remain major factors associated with disability in adults aged 50-<65 years. Effective interventions to prevent and manage chronic diseases from an earlier age may help reduce the risk of disability.

Effects of depressive symptoms on health behavior practices among older adults with vision loss.

OBJECTIVE: The authors examined the interface between visual impairment and depressive symptoms on health behaviors, self-care, and social participation among adults ages 65 and older. METHOD: The authors analyzed data from the 1997-2004 National Health Interview Survey on visual impairment and depressive symptoms for 49,278 adults ages 65 and older, comparing visually impaired adults (n = 8,787) with and without depressive symptoms with a reference group of adults with neither condition (n = 3,136) for outcome measures: physical health, health behaviors, and difficulties with self-care and social participation. RESULTS: Adults with visual impairment and severe depressive symptoms were more likely than adults with neither condition to smoke (14.9%, adjusted odds ratio [AOR] = 1.6), be obese (28.2%, AOR = 1.9), be physically inactive (80.5%, AOR = 3.0), have fair-poor health (76.0%, AOR = 26.5), and have difficulties with self-care (27.9%, AOR = 11.8) and social participation (52.1%, AOR = 10.9). DISCUSSION AND CONCLUSIONS: Older visually impaired adults with depressive symptoms are vulnerable to health decline and further disablement without timely interventions that target smoking cessation, healthy eating, and increased physical activity.

Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project.

BACKGROUND: Glaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres. METHODS: The analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded. RESULTS: 1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273. CONCLUSION: Glaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes.

Framing the public health of caregiving.

Caregiving has only recently been acknowledged by the nation as an important topic for millions of Americans. A psychological or sociological approach to care-giving services has been most often applied, with little attention to the population-based public health outcomes of caregivers. We conceptualize caregiving as an emerging public health issue involving complex and fluctuating roles. We contend that caregiving must be considered in the context of life span needs that vary according to the ages, developmental levels, mental health needs, and physical health demands of both caregivers and care recipients.

Supportive care needs of Americans: a major issue for women as both recipients and providers.

In 2004, there were approximately 44 million men and women in the United States who were providing unpaid care to a family member, friend, or neighbor; these caregivers represented an estimated 22.9 million households (21% of all U.S. households). The 1-year economic value of this unpaid labor force was recently estimated to be 306 billion dollars. Caregiving is an important issue for women, as they represent 61% of those providing care and 65% of those receiving care. Women caregivers tend to fare worse than men, reporting higher levels of symptoms tied to depression and anxiety and lower levels of subjective well-being, life satisfaction, and physical health. In addition, the care that women provide is not without cost to them in terms of their financial future. Still, despite the burden, most caregivers consider providing care to family and friends a rewarding experience.

State-level prevalence of cigarette smoking and treatment advice, by disability status, United States, 2004.

INTRODUCTION: To our knowledge, no study has determined whether smoking prevalence is higher among people with disabilities than among people without disabilities across all U.S. states. Neither do we know whether people with disabilities and people without disabilities receive the same quality of advice about tobacco-cessation treatment from medical providers. METHODS: We analyzed data from the 2004 Behavioral Risk Factor Surveillance System to estimate differences between people with and people without disabilities in smoking prevalence and the receipt of tobacco-cessation treatment advice from medical providers. RESULTS: We found that smoking prevalence for people with disabilities was approximately 50% higher than for people without disabilities. Smokers with disabilities were more likely than smokers without disabilities to have visited a medical provider at least once in the previous 12 months and to have received medical advice to quit. More than 40% of smokers with disabilities who were advised to quit, however, reported not being told about the types of tobacco-cessation treatment available. CONCLUSION: Ensuring that people with disabilities are included in state-based smoking cessation programs gives states an opportunity to eliminate health disparities and to improve the health and wellness of this group. Ways to reduce unmet preventive health care needs of people with disabilities include provider adoption of the Public Health Service's clinical practice guideline for treating tobacco use and dependence and the provision of smoking cessation services that include counseling and effective pharmaceutical treatment.

The Prevalence of Chronic Conditions and Poor Health Among People With and Without Vision Impairment, Aged ≥65 Years, 2010-2014.

PURPOSE: To examine the prevalence of 13 chronic conditions and fair/poor health among people aged ≥65 years in the United States with and without vision impairment. DESIGN: Cross-sectional study from the 2010-2014 National Health Interview Survey. METHODS: We examined hypertension, heart disease, high cholesterol, stroke, arthritis, asthma, chronic obstructive pulmonary disease, cancer, weak/failing kidneys, diabetes, hepatitis, depression, and hearing impairment. We used logistic regression to show the association between vision impairment and chronic conditions and the association between vision impairment and poor health for those with chronic conditions. RESULTS: People aged ≥65 years with vision impairment reported greater prevalence of chronic conditions compared to people without vision impairment. After controlling for covariates (age, sex, education, race, smoking, physical activity, and obesity), people with vision impairment were more likely than those without to report chronic conditions (hypertension: OR [odds ratio] 1.43; heart disease: OR 1.68; high cholesterol: OR 1.26; stroke: OR 1.99; arthritis; OR 1.71; asthma: OR 1.56; chronic obstructive pulmonary disease: OR 1.65; cancer: OR 1.23; weak/failing kidneys: OR 2.29; diabetes: OR 1.56; hepatitis: OR 1.30; depression: OR 1.47; hearing impairment: OR 1.91) (all P < .05). Among older people with chronic conditions, those with vision impairment and chronic conditions compared to people without vision impairment and chronic conditions were 1.66-2.98 times more likely to have fair/poor health than those without vision impairment (all P < .05). CONCLUSION: Higher prevalence of chronic conditions is strongly associated with vision impairment among the older people and poor health is strongly associated with vision impairment and chronic conditions.

Applying RE-AIM to evaluate two community-based programs designed to improve access to eye care for those at high-risk for glaucoma.

INTRODUCTION: Glaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma. METHODS: The RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions. DISCUSSION: By targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17-19%) - a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive. CONCLUSIONS: Evaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets.

Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods and Screening Results.

PURPOSE: To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN: Screening program results for a prospective randomized clinical trial. METHODS: Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS: From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities. CONCLUSION: An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.

Tritrichomonas foetus.

Tritrichomonas foetus is a venereal disease of cattle that has a clear pattern of adverse reproductive sequela in the affected female, with a carrier state in the bull in which he shows no outward signs. Given sexual rest and symptomatic treatment, the female returns to reproductive viability. In contrast, the male remains infective and is a risk to other female contacts. Prevention of the disease relies on excluding infected males and females from the population of susceptible cattle. Control of this disease requires a plan to identify, isolate, and treat infected females, and eliminate or cull infected males. Improvements in culture technique and the application of newer methods, such as polymerase chain reaction, enhance the likelihood of detecting infected animals.

Eye Care Quality and Accessibility Improvement in the Community (EQUALITY): impact of an eye health education program on patient knowledge about glaucoma and attitudes about eye care.

PURPOSE: To assess the impact of the education program of the Eye Care Quality and Accessibility Improvement in the Community (EQUALITY) telemedicine program on at-risk patients' knowledge about glaucoma and attitudes about eye care as well as to assess patient satisfaction with EQUALITY. PATIENTS AND METHODS: New or existing patients presenting for a comprehensive eye exam (CEE) at one of two retail-based primary eye clinics were enrolled based on ≥1 of the following at-risk criteria for glaucoma: African Americans ≥40 years of age, Whites ≥50 years of age, diabetes, family history of glaucoma, and/or preexisting diagnosis of glaucoma. A total of 651 patients were enrolled. A questionnaire was administered prior to the patients' CEE and prior to the patients receiving any of the evidence-based eye health education program; a follow-up questionnaire was administered 2-4 weeks later by phone. Baseline and follow-up patient responses regarding knowledge about glaucoma and attitudes about eye care were compared using McNemar's test. Logistic regression models were used to assess the association of patient-level characteristics with improvement in knowledge and attitudes. Overall patient satisfaction was summarized. RESULTS: At follow-up, all patient responses in the knowledge and attitude domains significantly improved from baseline (P≤0.01 for all questions). Those who were unemployed (odds ratio =0.63, 95% confidence interval =0.42-0.95, P=0.026) or had lower education (odds ratio =0.55, 95% confidence interval =0.29-1.02, P=0.058) were less likely to improve their knowledge after adjusting for age, sex, race, and prior glaucoma diagnosis. This association was attenuated after further adjustment for other patient-level characteristics. Ninety-eight percent (n=501) of patients reported being likely to have a CEE within the next 2 years, whereas 63% (n=326) had a CEE in the previous 2 years. Patient satisfaction with EQUALITY was high (99%). CONCLUSION: Improved knowledge about glaucoma and a high intent to pursue eye care may lead to improved detection of early disease, thus lowering the risk of blindness.

The Association of Health-Related Quality of Life with Severity of Visual Impairment among People Aged 40-64 Years: Findings from the 2006-2010 Behavioral Risk Factor Surveillance System.

PURPOSE: To examine the association of health-related quality of life (HRQoL) with severity of visual impairment among people aged 40-64 years. METHODS: We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six measures of HRQoL: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, or moderate/severe. We examined the association between visual impairment and HRQoL using logistic regression accounting for the survey's complex design. RESULTS: Overall, 23.0% of the participants reported a little difficult seeing, while 16.8% reported moderate/severe difficulty seeing. People aged 40-64 years with moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days, as well as greater life dissatisfaction, greater disability, and poorer health compared to people reporting no or a little visual impairment. After controlling for covariates (age, sex, marital status, race/ethnicity, education, income, state, year, health insurance, heart disease, stroke, heart attack, body mass index, leisure-time activity, smoking, and medical care costs), and compared to people with no visual impairment, those with moderate/severe visual impairment were more likely to have fair/poor health (odds ratio, OR, 2.01, 95% confidence interval, CI, 1.82-2.23), life dissatisfaction (OR 2.06, 95% CI 1.80-2.35), disability (OR 1.95, 95% CI 1.80-2.13), and frequent physically unhealthy days (OR 1.69, 95% CI 1.52-1.88), mentally unhealthy days (OR 1.84, 95% CI 1.66-2.05), and activity limitation days (OR 1.94, 95% CI 1.71-2.20; all p < 0.0001). CONCLUSION: Poor HRQoL was strongly associated with moderate/severe visual impairment among people aged 40-64 years.