Challenges faced by older adults with vision loss: a qualitative study with implications for rehabilitation

2011 ◽  
Vol 26 (8) ◽  
pp. 748-757 ◽  
Author(s):  
Verena R Cimarolli ◽  
Kathrin Boerner ◽  
Mark Brennan-Ing ◽  
Joann P Reinhardt ◽  
Amy Horowitz
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Vision Loss ◽  
Age Related Macular Degeneration ◽  
Functional Domain ◽  
Social Challenges ◽  
Age Related ◽  
Vision Rehabilitation ◽  
Almost All ◽  
Over Time

Objective: To provide an in-depth assessment of challenges faced by older adults with recent vision loss and to determine changes in the nature of these challenges over time for the purpose of informing the design of vision rehabilitation services. Design: Longitudinal, qualitative study with three time points. Setting: Vision rehabilitation agency. Subjects: Three hundred and sixty-four older adults aged 65 with significant vision impairment due to age-related macular degeneration. Interventions: In-person interviews conducted at baseline, one year and two years and coded using a qualitative analytical approach. Main measures: Open-ended questions assessing challenges faced due to vision loss in functional, social and psychological life domains. Results: Almost all participants reported a wide variety of challenges across all three domains with the most variety in the functional domain. Over a two-year period, functional challenges (e.g. using transportation) increased, social challenges (e.g. recognizing people) remained stable, and psychological challenges (e.g. negative affect) decreased overall. Conclusions: Although functional challenges are predominant, social and psychological challenges are quite common and need to be addressed in vision rehabilitation. Rehabilitation planning should also consider that vision-related challenges can change over time.

The benefits and barriers to technology acquisition: Understanding the decision-making processes of older adults with age-related vision loss (ARVL)

2016 ◽  
Vol 80 (2) ◽  
pp. 123-131 ◽  
Author(s):  
Colleen McGrath ◽  
Arlene Astell
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Vision Loss ◽  
Low Vision ◽  
Occupational Engagement ◽  
Technology Acquisition ◽  
Age Related ◽  
Decision Making Processes ◽  
Vision Rehabilitation ◽  
Barriers To Technology

Introduction While research has investigated the factors influencing acquisition and use of technologies/assistive devices by older adults, few studies have addressed the decision-making processes regarding technology adoption of older adults with age-related vision loss. Method This critical ethnography engaged 10 older adults with age-related vision loss in narrative interviews, participant observation sessions, and semi-structured in-depth interviews to understand their decision-making processes related to the acquisition and use of low vision assistive devices to support occupational engagement. Findings Study findings focused on the benefits and barriers to technology acquisition and use. Benefits of technology acquisition included: enhanced occupational engagement; independence; safety; insurance; and validation of the disability, while the barriers to technology acquisition included: cost; training; usability; lack of awareness of low vision rehabilitation services; fear of being taken advantage of; and desire to preserve a preferred self-image. Conclusion Considering the low uptake of vision rehabilitation services, the study findings are important to occupational therapy. A better understanding of the perceived benefits and barriers to technology adoption from the perspective of older adults will help occupational therapists maximize treatment planning designed to enhance the occupational engagement of older adults aging with vision loss.

scholarly journals Effect of Reading Rehabilitation for Age-Related Macular Degeneration on Cognitive Functioning: Protocol for a Nonrandomized Pre-Post Intervention Study

10.2196/19931 ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. e19931
Author(s):  
Walter Wittich ◽  
M Kathleen Pichora-Fuller ◽  
Aaron Johnson ◽  
Sven Joubert ◽  
Eva Kehayia ◽  
...  
Keyword(s):  
Older Adults ◽  
Beneficial Effect ◽  
Cognitive Functioning ◽  
Macular Degeneration ◽  
Low Vision ◽  
Age Related Macular Degeneration ◽  
Post Intervention ◽  
Age Related ◽  
Vision Rehabilitation ◽  
Reading Activity

Background Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer’s disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health. Objective The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation. Methods We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision & hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health). Results The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again. Conclusions Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration. Trial Registration ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610 International Registered Report Identifier (IRRID) DERR1-10.2196/19931

scholarly journals Impact of living with a bilateral central vision loss due to geographic atrophy—qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047861
Author(s):  
Gopinath Madheswaran ◽  
S Ve Ramesh ◽  
Shahina Pardhan ◽  
Raju Sapkota ◽  
Rajiv Raman
Keyword(s):  
Qualitative Study ◽  
Thematic Analysis ◽  
Vision Loss ◽  
Negative Impact ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Central Vision ◽  
Central Vision Loss ◽  
Age Related ◽  
The Impact

ObjectiveGeographic atrophy (GA), a type of dry age-related macular degeneration, affects vision as central vision loss (CVL). The challenges faced due to bilateral CVL in activities of daily living and strategies taken to overcome those challenges are not very well understood in the Indian population. This qualitative study aims to understand the impact on everyday life activities and related adaptive and coping strategies in people with long-standing bilateral CVL due to GA in India.Design, participants, setting and methodsA qualitative study using a semistructured face-to-face interview was conducted on 10 people with bilateral CVL after obtaining written informed consent. The interviews were audio-recorded, and were transcribed verbatim. Thematic analysis was carried out to understand the challenges faced and adaptive methods due to the impact of CVL.ResultsTen participants (50% male) with a median age (IQR) of 72 (70, 74) years were interviewed. All the participants had best-corrected visual acuity of ≤6/60 in the better eye and reported an absolute central scotoma with the home Amsler chart. Qualitative thematic analysis identified four main themes: challenges in everyday living (difficulty in face identification, reading), challenges with lifestyle and socialisation (driving, cooking, reading for a longer duration, watching TV, socially inactive), psychological implications (depression, poor self-esteem, fear due to poor vision) and strategies to overcome the challenges (voice identification, technology support).ConclusionGA has a severe negative impact on the quality of life in people with CVL. Inability to recognise faces was the main reason for dependency on others and being socially disconnected. The findings will help clinicians in providing improved rehabilitative care.

The Difference that Age Makes: Cultural Factors that Shape Older Adults’ Responses to Age-Related Macular Degeneration

2008 ◽  
Vol 102 (10) ◽  
pp. 581-590 ◽  
Author(s):  
Marja Mogk
Keyword(s):  
Older Adults ◽  
Macular Degeneration ◽  
Vision Loss ◽  
Cultural Factors ◽  
Age Related Macular Degeneration ◽  
Sociocultural Perspective ◽  
Visual Rehabilitation ◽  
Age Related ◽  
Perceptions Of Aging ◽  
The Difference

This article suggests that approaching vision loss from age-related macular degeneration from a sociocultural perspective, specifically considering perceptions of aging, blindness, disability, and generational viewpoints and norms, may be critical to understanding older adults’ responses to vision loss and visual rehabilitation.

A population study of correlates of social participation in older adults with age-related vision loss

2016 ◽  
Vol 31 (1) ◽  
pp. 115-125 ◽  
Author(s):  
Verena R Cimarolli ◽  
Kathrin Boerner ◽  
Joann P Reinhardt ◽  
Amy Horowitz ◽  
Hans-Werner Wahl ◽  
...  
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Environmental Factors ◽  
Social Participation ◽  
Vision Loss ◽  
Age Related Macular Degeneration ◽  
Social Contacts ◽  
Income Adequacy ◽  
Age Related ◽  
Social Leisure

Objective: To examine personal characteristics, disease-related impairment variables, activity limitations, and environmental factors as correlates of social participation in older adults with vision loss guided by the World Health Organization’s International Classification of Functioning, Disability and Health Model. Design: Baseline data of a larger longitudinal study. Setting: Community-based vision rehabilitation agency. Subjects: A total of 364 older adults with significant vision impairment due to age-related macular degeneration. Main Measures: In-person interviews assessing social participation (i.e. frequency of social support contacts, social/leisure challenges faced due to vision loss, and of social support provided to others) and hypothesized correlates (e.g. visual acuity test, Functional Vision Screening Questionnaire, ratings of attachment to house and neighborhood, environmental modifications in home). Results: Regression analyses showed that indicators of physical, social, and mental functioning (e.g. better visual function, fewer difficulties with instrumental activities of daily living, fewer depressive symptoms) were positively related to social participation indicators (greater social contacts, less challenges in social/leisure domains, and providing more support to others). Environmental factors also emerged as independent correlates of social participation indicators when functional variables were controlled. That is, participants reporting higher attachment to their neighborhood and better income adequacy reported having more social contacts; and those implementing more environmental strategies were more likely to report greater challenges in social and leisure domains. Better income adequacy and living with more people were related to providing more social support to others. Conclusion: Environmental variables may play a role in the social participation of older adults with age-related macular degeneration.

scholarly journals Role of amyloid β-peptide in the pathogenesis of age-related macular degeneration

2021 ◽  
Vol 6 (1) ◽  
pp. e000774
Author(s):  
Minwei Wang ◽  
Shiqi Su ◽  
Shaoyun Jiang ◽  
Xinghuai Sun ◽  
Jiantao Wang
Keyword(s):  
Mitochondrial Dysfunction ◽  
Macular Degeneration ◽  
Vision Loss ◽  
Cell Structure ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Amyloid Β ◽  
Age Related Macular Degeneration ◽  
Amyloid Β Peptide ◽  
Age Related

Age-related macular degeneration (AMD) is the most common eye disease in elderly patients, which could lead to irreversible vision loss and blindness. Increasing evidence indicates that amyloid β-peptide (Aβ) might be associated with the pathogenesis of AMD. In this review, we would like to summarise the current findings in this field. The literature search was done from 1995 to Feb, 2021 with following keywords, ‘Amyloid β-peptide and age-related macular degeneration’, ‘Inflammation and age-related macular degeneration’, ‘Angiogenesis and age-related macular degeneration’, ‘Actin cytoskeleton and amyloid β-peptide’, ‘Mitochondrial dysfunction and amyloid β-peptide’, ‘Ribosomal dysregulation and amyloid β-peptide’ using search engines Pubmed, Google Scholar and Web of Science. Aβ congregates in subretinal drusen of patients with AMD and participates in the pathogenesis of AMD through enhancing inflammatory activity, inducing mitochondrial dysfunction, altering ribosomal function, regulating the lysosomal pathway, affecting RNA splicing, modulating angiogenesis and modifying cell structure in AMD. The methods targeting Aβ are shown to inhibit inflammatory signalling pathway and restore the function of retinal pigment epithelium cells and photoreceptor cells in the subretinal region. Targeting Aβ may provide a novel therapeutic strategy for AMD.

scholarly journals Mingjing granule, a traditional Chinese medicine in the treatment of neovascular age-related macular degeneration: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yamin Li ◽  
Lina Liang ◽  
Torkel Snellingen ◽  
Kai Xu ◽  
Yun Gao ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Macular Degeneration ◽  
Vision Loss ◽  
Age Related Macular Degeneration ◽  
Case Report Form ◽  
Link Type ◽  
Anti Vegf ◽  
Age Related ◽  
Function Test

Abstract Background Neovascular age-related macular degeneration (nAMD) is the most common cause of irreversible vision loss and blindness among the older people aged 50 and over. Although anti-vascular endothelial growth factor (anti-VEGF) therapies have resulted in improving patient outcomes, there are limitations associated with these treatments. In China, traditional Chinese medicine (TCM) has been used to treat eye diseases for more than 2000 years. Previous studies have shown that TCM may be beneficial for nAMD patients. However, explicit evidence has not been obtained. The purpose of the present trial is to examine the efficacy and safety of the Mingjing granule, a compound Chinese herbal medicine, for nAMD patients. Methods/design This is a double-blind, placebo-controlled, randomized trial of Mingjing granule as an add-on to intravitreous ranibizumab for nAMD. One hundred eighty nAMD patients from six hospitals in China will be enrolled according to the inclusion and exclusion criteria and randomly allocated into two groups, 90 in each. All participants will receive a 24-week treatment and then be followed up for another 24 weeks. The primary outcome is the mean change of best-corrected visual acuity at week 24 and 48 as compared to the baseline. The secondary outcomes include mean change in central retinal thickness, area of retinal hemorrhage and exudation, and TCM syndrome score, mean number of intravitreal ranibizumab injection, and total cost of the treatment. Indexes of safety include blood regular test, urine regular test, liver function test, renal function test, and electrocardiogram from baseline to weeks 24 and 48. Qualitative control and some standard operating processes will be formed throughout the trial. Any ocular or systemic adverse events will be treated suitably, and related data will be recorded accurately and completely in the case report form. Discussion Based on previous empirical and animal laboratory studies, this study will address the question of whether Mingjing granule could contribute to improving efficacy, safety, and efficiency with need for fewer intravitreal injections of anti-VEGF, improving compliance and visual outcomes in the management of persons with nAMD. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2000035990. Registered on 21 August 2020.

scholarly journals One-year outcomes of fixed-dosing Aflibercept therapy for pre treated and naive polypoidal choroidal vasculopathy patient

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hun Gu Choo ◽  
Jin Hae Lee ◽  
Hyun Sub Oh ◽  
Soon Hyun Kim ◽  
Yong Sung You ◽  
...  
Keyword(s):  
Polypoidal Choroidal Vasculopathy ◽  
Vision Loss ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Research Information ◽  
Age Related ◽  
Case Series Study ◽  
Treatment Naïve ◽  
One Year ◽  
Choroidal Vasculopathy

Abstract Background Polypoidal choroidal vasculopathy (PCV) is a type of age-related macular degeneration that can cause permanent vision loss. The purpose of this paper was to report the one-year outcomes of fixed-dosing aflibercept therapy for the treatment of PCV. Methods This was a prospective, single-arm, interventional case series study of 25 PCV patients; 12 pre-treated and 13 treatment-naïve patients. The patients were treated and monitored for 12 months. Each patient was administered with an aflibercept (2.0 mg) injection every month for the first 3 months (the loading phase), and thereafter, once every 2 months. At every follow-up visit, best-corrected visual acuity (BCVA) test, fundus examination, and optical coherence tomography for measuring the central subfield macular thickness (CSMT) were performed. Fluorescein and indocyanine green angiography were conducted at baseline and at 4 and 12 months. Results After 12 months of aflibercept therapy, the mean BCVA of the patients significantly improved from 65.48 letters at baseline to 69.91 letters (p=0.001), and the CSMT significantly decreased from 406.92 um at baseline to 276.12 um (p< 0.001). Additionally, ten patients (40%) showed complete polyp regression. The treatment-naïve patients showed a statistically significant improvement in BCVA from 66.58 letters at baseline to 76.36 letters at 12 months, and a significant decrease in CSMT, from 462 to 243 um. In the pre-treated group, there was no change in BCVA (64.46 letters), and the decrease in CSMT from 356.08 to 303.69 um was not statistically significant. Conclusions The fixed-dosing aflibercept regimen is effective for treating patients with PCV and is more effective in treatment-naïve patients than in pre-treated patients. Trial registration Clinical Research Information Service (CRiS), Republic of Korea. Identifer: KCT0005798, Registered: Jan 20, 2021. Retrospectively registered, URL: https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=18546

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