Status of Vision and Eye Care Among Patients in Rehabilitation Hospital Units: A Cross-Sectional Study.

OBJECTIVES: The prevalence of vision disorders is high among geriatric and hospital inpatient populations, yet they often go undetected, resulting in consequences such as falls or prolonged recovery time. A needs assessment study was conducted to investigate levels of vision and the potential prevalence of unmanaged/undiagnosed ocular disorders among adult inpatients in a hospital-based rehabilitation unit. DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: Inpatient rehabilitation units of an acute care hospital system in Ontario, Canada. Adults (n = 112) in a hospital inpatient rehabilitation unit participated from October 2018 to February 2019. METHODS: Participants were surveyed regarding their demographic, ocular, and medical data and spectacle wear. Visual acuity, contrast sensitivity, visual fields, and stereoacuity plus the spectacle condition were directly assessed. RESULTS: The majority (75%) were found to have reduced habitual vision while in hospital. Nearly 60% of participants reported at least some difficulty reading a newspaper or distinguishing a face or were "not happy with their vision." This was despite 80% of participants reporting that they had an eye care practitioner and 70% that they had an eye examination within the last 2 years. More than half (51.8%) of the participants received the recommendation to follow up with their eye care practitioner on discharge from the hospital. CONCLUSIONS AND IMPLICATIONS: Reduced vision and vision disorders has a high prevalence among hospital patients in rehabilitation units and should be evaluated at or soon after hospital intake. By incorporating vision screening tools, necessary precautions may be taken to avoid possible falls and promote recovery.

ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels.

BACKGROUND: In order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels. OBJECTIVE: The aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition. METHODS: This pilot study enrolled adults (≥55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes. RESULTS: The 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the "drag and drop" function. CONCLUSIONS: ClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow.

Cataract surgery and optimal spherical aberration: as simple as you think?

This paper reviews the optics of higher-order and spherical aberrations and discusses aspheric intraocular lenses, attempting to address 2 questions that, despite an abundance of information, remain unanswered: what amount of ocular spherical aberration has been correlated with optimum visual performance, and for what final amount of spherical aberration should the cataract surgeon aim? Finally, the paper briefly reviews recent publications and makes suggestions for future studies in the area.

Stroke and visual rehabilitation.

Many patients will experience some type of visual dysfunction following a stroke. The visual changes associated with stroke can be categorized as sensory (visual acuity and visual field), motor (extraocular muscle motility), and perceptual. These disturbances affect the patient's quality of life and can impede overall rehabilitation. Many of these impairments can be addressed by simple yet effective techniques. As a result, vision rehabilitation specialists are becoming an important part of the multidisciplinary stroke rehabilitation team.