Visual Functioning and Health-related Quality-of-Life are Compromised in Patients with Uveitis.

PURPOSE: To assess the vision-related (VR) and health-related (HR) quality-of-life (QoL) of patients with uveitis. METHODS: In total, 60 patients with uveitis, 81 patients with diabetic retinopathy (DR), and 70 healthy subjects completed the National Eye Institute Visual Functioning Questionnaire and the Medical Outcome Study 36-Item Short Form. RESULTS: Patients with uveitis reported lower HR- and VR-QoL than healthy subjects (p<0.05) and lower VR-QoL (p<0.001) than patients with DR. For patients with uveitis, multiple linear regression analyses indicated that lower HR-QoL scores were predicted by younger age (p<0.01), while lower VR-QoL scores were predicted by poorer visual acuity (p<0.001), ocular comorbidities (p<0.05), and female sex (p<0.05). CONCLUSIONS: Patients with uveitis have significantly poorer VR- and HR-QoL than healthy control subjects. Uveitis has a more debilitating impact on VR-QoL than DR.

Manchester iStent study: early results from a prospective UK case series.

BACKGROUND: To evaluate the 6-month efficacy and safety of the iStent microtrabecular bypass stent in patients with open-angle glaucoma. DESIGN: A prospective, uncontrolled, interventional case series. PARTICIPANTS: Forty-four eyes with open-angle glaucoma were reported. METHODS: All subjects underwent ab interno implantation of a single iStent together with (n = 40) or without (n = 4) cataract surgery. MAIN OUTCOME MEASURES: Patients were assessed at postoperative week 1, months 1 and 3, and quarterly, thereafter. Data collected included visual acuity, intraocular pressure measurement using Goldmann tonometry, number of glaucoma medications, and number and type of complications. RESULTS: The mean age of the sample was 76.8 years. The mean duration since glaucoma diagnosis was 5.3 years (standard deviation 2.9 years). The mean visual acuity was 0.53 logMAR at baseline that improved to 0.23 at 6 months postoperatively. The mean baseline intraocular pressure was 21.1 mmHg, and this decreased significantly to 16.7 mmHg at 6 months (P < 0.01). The mean number of drops prescribed preoperatively was 2.3, which decreased to 0.6 at 6 months (P < 0.01). Sixty-six per cent of patients were drop-free at 6 months. One patient developed an hyphaema following surgery; no other adverse events were recorded. CONCLUSIONS: The iStent proved to be a safe and effective treatment for patients with open-angle glaucoma over our 6-month follow up period. Insertion resulted in a significant decrease in intraocular pressure as well as the number of topical antiglaucoma medications required for adequate intraocular pressure control.

Retrospective study of an as required dosing regimen of intravitreal bevacizumab in neovascular age-related macular degeneration in an Australian population.

PURPOSE: To investigate the efficacy of intravitreal bevacizumab for the treatment of neovascular age-related macular degeneration (AMD) using an as required dosing regimen. METHODS: A retrospective study of 210 patients (231 eyes) with choroidal neovascularization resulting from neovasacular AMD. Patients were treated with 1.25 mg intravitreal bevacizumab at a vitreoretinal practice in Adelaide, South Australia. Patients were followed up at 2-4 weeks and then at 1-month intervals; repeat injections were offered in the event of recurrence. Recurrence was defined as either a decrease of best-corrected visual acuity or an increase in macular oedema, subretinal fluid or intraretinal fluid on optical coherence tomography, after complete or partial resolution in previous follow-up visits. Patient data were collected for 12 months of follow up or until the patient's treatment was changed to ranibizumab. RESULTS: Significant improvement in visual acuity and central retinal thickness was demonstrated at 1 month with an improvement of vision from logMAR equivalent 0.76 to 0.68 (P < 0.001) and a decrease of central retinal thickness from 306 µm to 244 µm (P < 0.001). This overall improvement was continued throughout the 12-month follow-up period; however, follow up was poor with 12-month data available for only a small number of patients (7.8%). Ocular and systemic side-effects were rare at 3.5% and 0.4%, respectively. CONCLUSION: Eyes with neovascular AMD treated with intravitreal bevacizumab for up to 12 months had significant functional and anatomical improvement. Further studies need to confirm the long-term safety and efficacy of this treatment.

Change in function and spectacle-use 2 months after providing presbyopic spectacles in rural Tanzania.

AIMS: To examine near vision spectacle retention and use, and changes in self-reported and performance-based near vision, 2 months after the provision of near vision spectacles. METHODS: We conducted a 2-month follow-up of a population-based cohort of persons in rural Tanzania with near vision impairment who had received spectacles. Previously, residents age >or=40 years were examined for distance and near vision acuity. Those with presbyopia and hyperopia ('functional presbyopia') were given near vision spectacles. At baseline, subjects were asked to thread a needle; they were also asked questions on the perception of their near vision, ability to be independent and general health. At 2 months, subjects were again queried. Questions on the perceived affordability of replacement spectacles were also asked. RESULTS: Of the 866 people provided with spectacles, 89% were seen at 2 months. Ninety-two per cent were still using the spectacles. Users were more likely to have any education (51.8%) than non-users (28.3%) (p<0.001). Only 31% had successfully threaded a needle at baseline, increasing to 91% at follow-up (p<0.001). Spectacle-users showed a significant improvement in satisfaction with near vision and ability to be independent, but no change in perception of general health, from baseline to follow-up. Men were more likely than women to be able to afford spectacles and to know where to get them. CONCLUSIONS: Our cohort maintained their spectacles and reported tangible improvements associated with their use. The value of simple reading spectacles for those with near vision impairment suggests that a greater emphasis on near vision is needed in the Vision 2020 agenda.

Impact of presbyopia on quality of life in a rural African setting.

PURPOSE: To determine the impact of uncorrected presbyopia on quality of life in rural Tanzania. DESIGN: Cross-sectional study. PARTICIPANTS: Population-based sample of 1709 village and town-dwelling adults aged 40 and older in the Kongwa district in rural Tanzania. METHODS: Subjects underwent distance and near visual acuity testing to determine presbyopia. A near vision-related quality of life questionnaire was administered by trained interviewers to determine the degree of self-rated difficulty with tasks appropriate to life in a rural African setting, and how much near vision loss contributed to this difficulty. MAIN OUTCOME MEASURES: Near vision-related quality of life. RESULTS: Complete data were available for 1564 (92%) of the subjects. The prevalence rate of presbyopia was 62%. The majority of presbyopes (94%) did not have corrective near vision glasses. Compared with nonpresbyopes, being presbyopic increased the odds of reporting some difficulty with near vision tasks by 2-fold (odds ratio [OR], 2.04; 95% confidence interval [CI]: 1.57-2.66), odds of reporting moderate difficulty by 5-fold (OR 5.01; 95% CI: 3.19-7.89), and odds of reporting high difficulty by >8-fold (OR 8.52; 95% CI 3.13-23.10). The degree of presbyopia was associated with increasing difficulty with daily tasks (P<0.0001). CONCLUSIONS: This is the first study to demonstrate that uncorrected presbyopia has a significant impact on vision-related quality of life in a rural African setting. The high prevalence of presbyopia, and increased aging of the population in developing countries, suggests that the World Health Organization's Vision 2020 refraction agenda should place greater emphasis on presbyopia.

Population-based study of presbyopia in rural Tanzania.

OBJECTIVE: To determine the prevalence of presbyopia in a rural African population. DESIGN: Cross-sectional prevalence study. PARTICIPANTS: One thousand seven hundred nine persons age 40 years and older who resided in 3 villages and randomly selected neighborhoods of Kongwa town, Tanzania. METHODS: Eligible persons were refracted and given best distance correction. Near vision was tested and corrected to the nearest 0.5 diopter. Presbyopia was defined as at least 1 line of improvement on a near visual acuity chart with an addition of a plus lens. RESULTS: A total of 61.7% of eligible participants were presbyopic. A higher prevalence of presbyopia was associated with increased age, female gender, higher educational level, and residence in town (odds ratio = 3.09; 95% confidence interval: 2.46-3.90). The odds of developing presbyopia increased 16% per year of age from age 40 to 50, but the increase was nonsignificant at 1% per year after age 50. More severe presbyopia was associated with female gender and less with education. CONCLUSIONS: This study provides the first population-based data on prevalence of presbyopia in a large, random sample of older Africans and suggests a high rate of presbyopia. Presbyopia plateaus after age 50, and it is more common in females. In addition, the 3-fold increased odds in town versus village dwellers was unexpected and suggests that research of other factors, including environmental factors, is warranted.

Measures of visual function and percentage of preferred walking speed in older adults: the Salisbury Eye Evaluation Project.

PURPOSE: The purpose of this study was to determine the association of static (visual acuity, visual fields, and contrast sensitivity) and dynamic (dynamic visual acuity and motion threshold) measures of vision with mobility performance on a mobility course with obstacles. METHODS: A cross-sectional population-based study of 1504 persons aged 72 to 92 years enrolled in the third round of the Salisbury Eye Evaluation Project. Standardized examinations were used to test binocular visual acuity, better eye-contrast sensitivity, visual fields, dynamic visual acuity, and motion threshold. Cognitive status was assessed by using the standardized Mini-Mental State Examination. Participants were timed when walking a straight 4-m distance and when walking through a mobility course seeded with obstacles. The percentage of preferred walking speed (PPWS) for each subject was calculated as the ratio of mobility course speed to a 4-m walking speed expressed as a percentage. RESULTS: The mean age of the participants was 78.2 years. The mean 4-m walking speed was 0.82 m/s, whereas the mean mobility course speed was 0.47 m/s. The mean PPWS was 57.1%. All vision variables except visual acuity were associated with PPWS in univariate analyses. Multivariate models found visual fields and the cognitive state to be associated with PPWS. There was no association with dynamic measures of vision. CONCLUSIONS: The mobility performance, as measured by PPWS, was associated with visual fields but not with visual acuity, contrast sensitivity, or dynamic vision measures. Deficits in cognition also play an important role in predicting mobility performance.

Secondary mania of vascular origin in elderly patients: a report of two clinical cases.

The concept of secondary mania continues to be debated together with unresolved or partially resolved issues such as lateralization, localization, age of onset, disinhibition syndromes, and others. We have described two patients with secondary mania following a stroke. One had a large left hemisphere cerebral infarction and the symptoms arose about 2.5 years later, possibly triggered by a transient ischemic attack involving the right hemisphere. The other had an infarction in the right posterior artery territory extending to the thalamus and internal capsule together with infarctions in the deep border zones of both hemispheres at the level of the centrum semiovale with the manic symptoms concomitant with the onset of the event. The clinical and neuro-anatomic mechanisms that underlie the diverse locations of secondary mania are discussed. The cerebral components of secondary mania and disinhibition syndromes are very similar and it is proposed that disinhibition syndromes, secondary hypomania and secondary mania with and without psychotic symptoms are simply a continuum of severity of mood disorder and secondary mania with psychotic symptoms may be an extreme form. The concept of secondary mania in the elderly is not likely to disappear although several unresolved issues remain. For the neurophysician, geriatrician, and the psychiatrist there is much to be attained by simplifying the issues and accepting the view that secondary mania is a discrete entity.

Screaming, shrieking and muttering: the noise-makers amongst dementia patients.

We have described twelve dementia patients with noise making. We categorized noise making into (i) persistent screaming, (ii) perseverative vocalization, (iii) continuous chattering, muttering, singing or humming, and (iv) swearing, grunting and bizarre noise-making. The patients' ages ranged from 70 to 92 years with a mean of 78. There were four males and eight females. Five had Alzheimer's disease and the remaining seven vascular dementia. Five exhibited mild to moderate aggression while another five displayed severe aggression. All but one had motor restlessness and four had delusions or hallucinations. In ten patients the dementia was moderate to severe with five having total dissolution of speech. All but two were in the third stage of the illness and were totally dependent for basic self care. There was a wide network of anatomical structures involved in the twelve patients. The findings are related to what is known of the neuroanatomic location of the lesions and the role of frontal subcortical circuitry and neurotransmitter systems in relation to behavior. Noise-making could be explained by damage to the frontal lobe or interruption of the complex subcortical circuits and related brain chemistry. Treatment of patients with noise-making remains a challenge.