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Food insecurity has gained attention as a potential risk factor for vision impairment. However, research on this topic is limited. This objective of this study was to investigate the relationship between food insecurity and visual impairment among adults aged 50 years or older using data from six low-and middle-income countries (LMIC). Data from the longitudinal Study on global AGEing and adult health (SAGE) were analyzed in a community-based, cross-sectional, and nationally representative sample. Adults aged 50 years or older from six low- and middle-income countries (LMICs) including China, India, Mexico, Russia, South Africa, and Ghana. Food insecurity was evaluated using a questionnaire comprised of two questions that addressed the frequency of eating inadequately and hunger due to a lack of food in last 12 months. Distance and/or near vision impairment was considered as a visual acuity score of less than 6/18 in the eye with better vision. The analytical sample consisted of 29,804 adults (mean (SD) for age: 63.2 (9.54) years; 54.3% female). The prevalence of food insecurity, near vision and distance vision impairment in the sample was 16.4%, 36.7%, and 13.9%, respectively. Adjusted pooled analyses across countries revealed a significant association between food insecurity and distance (OR: 1.16; 95% CI: 1.01, 1.33; P=0.04, significant individually in India and South Africa) and near (OR: 1.12; 95% CI: 1.02, 1.22; P=0.01, significant individually in South Africa) vision impairment, and a between-country heterogeneity of 46.30% and 25.99%, respectively. Food insecurity was associated with both distance and near vision impairment in adults aged 50 years or older across six LMIC. Food policies and intervention programs targeted at decreasing food insecurity in vulnerable households are essential.

Purpose: Undetected vision impairment (VI) could negatively affect the overall development in children. School vision screening program is a viable and cost-effective approach for the early identification and management of VI. Aim: This study aims to estimate the prevalence of VI, its risk factors, and ocular morbidity among school children in Telangana, South India. Methods: Children aged 4-15 years attending schools in the study area were screened in this study. The vision screenings were performed in schools by trained community eye health workers using 6/12 tumbling E optotypes. Children who failed the test and/or presented with other eye conditions were referred to vision centers or secondary and tertiary eye care centers. A comprehensive eye examination was conducted in these centers, including cycloplegic refraction and fundus examination. Results: A total of 774,184 children, with a mean age of 9.4 ± 3.27 years, were screened. Overall, 51.49% (N = 398,596) were male. In total, 4.33% [N = 33,528; 95% confidence interval (CI): 4.29-4.38] required referral services, while 1.16% (N = 9,002) had a presenting visual acuity of < 6/12. Multivariate analysis showed a high risk of VI among older children [Adj. odds ratio (OR): 5.75; 95% CI: 5.18-6.38], those with disabilities (Adj. OR: 5.12; 95% CI: 4.14-6.33), female gender (Adj. OR: 1.29; 95% CI: 1.24 - 1.35), and those residing in the urban areas (Adj. OR: 2.87; 95% CI: 2.42-3.39). The main cause of VI was uncorrected refractive errors (74.14%). Conclusion: The prevalence of VI among school children was 1.16% in Telangana, South India, and refractive error was the leading cause of VI among this population. Increasing age, urban location, female gender and other disabilities increase the risk of VI among children.

Purpose To compare the results from a simulated computerized adaptive test (CAT) for the 28-item Impact of Vision Impairment (IVI) questionnaire and the original paper–pencil version in terms of efficiency (main outcome), defined as percentage item reduction. Methods Using paper–pencil IVI data from 832 participants across the spectrum of vision impairment, item calibrations of the 28-item IVI instrument and its associated 20-item vision-specific functioning (VSF) and 8-item emotional well-being (EWB) subscales were generated with Rasch analysis. Based on these calibrations, CAT simulations were conducted on 1000 cases, with ‘high’ and ‘moderate’ precision stopping rules (standard error of measurement [SEM] 0.387 and 0.521, respectively). We examined the average number of items needed to satisfy the stopping rules and the corresponding percentage item reduction, level of agreement between person measures estimated from the full IVI item bank and from the CAT simulations, and item exposure rates (IER). Results For the overall IVI-CAT, 5 or 9.7 items were required, on average, to obtain moderate or high precision estimates of vision-related quality of life, corresponding to 82.1 and 65.4% item reductions compared to the paper–pencil IVI. Agreement was high between the person measures generated from the full IVI item bank and the IVI-CAT for both the high precision simulation (mean bias, − 0.004 logits; 95% LOA − 0.594 to 0.587) and moderate precision simulation (mean bias, 0.014 logits; 95% LOA − 0.828 to 0.855). The IER for the IVI-CAT in the moderate precision simulation was skewed, with six EWB items used > 40% of the time. Conclusion Compared to the paper–pencil IVI instrument, the IVI-CATs required fewer items without loss of measurement precision, making them potentially attractive outcome instruments for implementation into clinical trials, healthcare, and research. Final versions of the IVI-CATs are available.

BackgroundVision impairment (VI) services aim to mitigate the effect of VI and provide opportunities for visually impaired individuals to actively participate in their daily activities.ObjectivesTo determine optometrists’ perceptions regarding VI services in public hospitals within Limpopo province, South Africa.MethodA descriptive, quantitative, cross-sectional study was conducted between January and August 2023 across 37 public hospitals, using a structured questionnaire. Data obtained from the participants’ responses were analysed to describe the level of VI services.ResultsThe study sample included 65 optometrists with 71% female, yielding a response rate of 83%. Over 90% of the participants were aware of the World Health Organization definition of VI. The majority of participants (54%) reported referring patients with VI to a hospital multidisciplinary team, while less than 50% provided optimal spectacle correction. The main barriers to providing VI services were: the lack of assistive devices (97%), and equipment (95%), poor access (80%), insufficient space (66%), and the lack of training (66%). The primary barriers to the uptake of VI services were the lack of awareness (86%) and the cost of VI services (80%).ConclusionThe provision of VI services in Limpopo province is currently limited. The factors contributing to the limited VI services are avoidable; therefore, efforts to enhance the availability of equipment, access and provision of comprehensive VI services are crucial to improving the quality of life for affected individuals utilising public hospitals in Limpopo province.ContributionThe study describes the optometrists’ perceptions of VI services in public hospitals.

Falls are the leading cause of injury among older adults, with vision impairment recognized as a significant risk factor. However, many existing studies have been limited by small sample sizes, retrospective designs, or insufficient adjustment for confounding factors. To overcome these limitations, we used data from the University of Michigan's Health and Retirement Study (HRS) to analyze the association between self-reported vision and fall risk among older adults in a large, nationally representative sample. The objective of this study was to investigate the association between vision impairment and falls and assess whether subjective vision impairment predicts future falls in older adults. This cross-sectional and longitudinal analysis used data from the HRS (1996-2020) to assess the relationship between self-reported vision, glaucoma history, and falls among US adults aged 65 years and older. HRS uses a biennial, multistage area probability sample survey design, collecting data with community-dwelling individuals followed up every 2 years until death, tracking health, economic, and social outcomes. Multivariate logistic regression was used to analyze associations between self-reported vision and self-reported falls in the past 2 years. A total of 38,835 respondents contributed 117,834 observations. The weighted proportion of participants reporting falls was 37.9% (95% CI 37.7%-40.1%). Significant risk factors for falls included overall eyesight impairment (adjusted odds ratio [aOR] 1.36, 95% CI 1.20-1.56), distance vision impairment (aOR 1.37, 95% CI 1.32-1.42), near vision impairment (aOR 1.33, 95% CI 1.27-1.37), and glaucoma (aOR 1.15, 95% CI 1.07-1.24). A similar association was observed for serious falls, where overall eyesight impairment (aOR 1.20, 95% CI 1.03-1.44), distance vision impairment (aOR 1.14, 95% CI 1.07-1.22), near vision impairment (aOR 1.12, 95% CI 1.05-1.18), and glaucoma (aOR 1.15, 95% CI 1.05-1.26) were significant. In longitudinal analyses, overall vision impairment (aOR 1.23, 95% CI 1.16-1.29), distance vision impairment (aOR 1.27, 95% CI 1.20-1.38), near vision impairment (aOR 1.23, 95% CI 1.19-1.32), and glaucoma (aOR 1.25, 95% CI 1.13-1.37) increased the risk of future falls. Reported overall vision was significantly associated with the number of falls in both the same (P<.001) and subsequent (P<.001) survey cycles. Both distance and near vision impairment, as well as glaucoma, are associated with a higher risk of falls in older adults and present possible areas for intervention and prevention.

Aims: To describe the impact of age related macular degeneration (AMD) on quality of life and explore the association with vision, health, and demographic variables. Methods: Adult participants diagnosed with AMD and with impaired vision (visual acuity <6/12) were assessed with the Impact of Vision Impairment (IVI) questionnaire. Participants rated the extent that vision restricted participation in activities affecting quality of life and completed the Short Form General Health Survey (SF-12) and a sociodemographic questionnaire. Results: The mean age of the 106 participants (66% female) was 83.6 years (range 64–98). One quarter had mild vision impairment, (VA<6/12–6/18) and 75% had moderate or severely impaired vision. Participants reported from at least “a little” concern on 23 of the 32 IVI items including reading, emotional health, mobility, and participation in relevant activities. Those with mild and moderate vision impairment were similarly affected but significantly different from those with severe vision loss (p<0.05). Distance vision was associated with IVI scores but not age, sex, or duration of vision loss. Conclusion: AMD affects many quality of life related activities and not just those related to reading. Referral to low vision care services should be considered for people with mild vision loss and worse.

Purpose We investigated whether the Chinese impact of vision impairment (IVI) questionnaire is valid to generate reliable person estimates in a population-based sample. Methods VRQoL was measured using the 32-item Chinese version of the IVI questionnaire in the Singapore Chinese Eye Study (2009-2011), a population-based study of the prevalence and risk factors for VI and eye diseases in Chinese Singaporeans. Rasch analysis was used to assess the Chinese IVI's response category functioning, precision, unidimensionality, targeting and differential item functioning. The ability of the Chinese IVI to discriminate participants along the spectrum of VI demonstrated criterion validity. Results Of the 3353 participants, 27.2 % (n = 912) had VI (presenting visual acuity <6/12, better eye). Response categories were collapsed from six to four to resolve disordered thresholds. The Chinese IVI initially demonstrated multidimensionality and was split into three scales: 'Reading and Accessing Information'; 'Mobility and Independence'; and 'Emotional Well-being'. All three scales were unidimensional and demonstrated excellent range-based precision (all reliability coefficients 0.97), following removal of three misfitting items. Mean person measures decreased with worsening VI (e.g. Reading: none (7.50 logits); mild (6.99 logits); moderate (6.44 logits); and severe (3.01 logits) VI; p < 0.001). Conclusions A three-dimensional 29-item Chinese IVI is a valid tool to assess the impact of VI on VRQoL in a large population-based sample, comprising over a quarter of participants with VI. The 28-item English IVI is also likely to be valid for use in population-based studies; however, this must be demonstrated empirically in future studies.

Childhood blindness is an issue of global health impact, affecting approximately 2 million children worldwide. Vision 2020 and the United Nations Sustainable Development Goals previously identified childhood blindness as a key issue in the twentieth century, and while public health measures are underway, the precise etiologies and management require ongoing investigation and care, particularly within resource-limited settings such as sub-Saharan Africa. We systematically reviewed the literature on childhood blindness in West Africa to identify the anatomic classification and etiologies, particularly those causes of childhood blindness with systemic health implications. Treatable causes included cataract, refractive error, and corneal disease. Systemic etiologies identified included measles, rubella, vitamin A deficiency, and Ebola virus disease. While prior public health measures including vitamin A supplementation and vaccination programs have been deployed in most countries with reported data, multiple studies reported preventable or reversible etiologies of blindness and vision impairment. Ongoing research is necessary to standardize reporting for anatomies and/or etiologies of childhood blindness to determine the necessity of further development and implementation of public health measures that would ameliorate childhood blindness and vision impairment.

Background The characteristics of the target group and the design of an epidemiologic study, in particular the recruiting methods, can influence participation. People with vision impairment have unique characteristics because those invited are often elderly and totally or partially dependent on help to complete daily activities such as travelling to study sites. Therefore, participation of people with impaired vision in studies is less predictable than predicting participation for the general population. Methods Participants were recruited in the context of a study of prevalence and costs of visual impairment in Portugal (PCVIP-study). Participants were recruited from 4 Portuguese public hospitals. Inclusion criteria were: acuity in the better eye from 0.5 decimal (0.30logMAR) or worse and/or visual field of less than 20 degrees. Recruitment involved sending invitation letters and follow-up phone calls. A multiple logistic regression model was used to assess determinants of participation. The J48 classifier, chi-square and Fisher’s exact tests were applied to investigate the possible differences between subjects in our sample. Results Individual cases were divided into 3 groups: immediate, late and non-participants. A participation rate of 20% was obtained (15% immediate, 5% late). Factors positively associated with participation included years of education, annual hospital attendance, and intermediate visual acuity. Females and greater distance to the hospital were inversely associated with participation. Conclusion In our study, a letter followed by a phone call was efficient to recruit a significant number of participants from a larger group of people with impaired vision. However, the improvement in participation observed after the phone call might not be cost-effective. People with low levels of education and women were more difficult to recruit. These findings need to be considered to avoid studies whose results are biased by gender or socio-economic inequalities of their participants. Young subjects and those at intermediate stages of vision impairment, or equivalent conditions, may need more persuasion than other profiles.

BackgroundTo assess prevalence and causes of vision loss in Central and South Asia.MethodsA systematic review of medical literature assessed the prevalence of blindness (presenting visual acuity<3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting visual acuity <6/12 and ≥6/18) in Central and South Asia for 1990, 2010, 2015 and 2020.ResultsIn Central and South Asia combined, age-standardised prevalences of blindness, MSVI and MVI in 2015 were for men and women aged 50+years, 3.72% (80% uncertainty interval (UI): 1.39–6.75) and 4.00% (80% UI: 1.41–7.39), 16.33% (80% UI: 8.55–25.47) and 17.65% (80% UI: 9.00–27.62), 11.70% (80% UI: 4.70–20.32) and 12.25% (80% UI:4.86–21.30), respectively, with a significant decrease in the study period for both gender. In South Asia in 2015, 11.76 million individuals (32.65% of the global blindness figure) were blind and 61.19 million individuals (28.3% of the global total) had MSVI. From 1990 to 2015, cataract (accounting for 36.58% of all cases with blindness in 2015) was the most common cause of blindness, followed by undercorrected refractive error (36.43%), glaucoma (5.81%), age-related macular degeneration (2.44%), corneal diseases (2.43%), diabetic retinopathy (0.16%) and trachoma (0.04%). For MSVI in South Asia 2015, most common causes were undercorrected refractive error (accounting for 66.39% of all cases with MSVI), followed by cataract (23.62%), age-related macular degeneration (1.31%) and glaucoma (1.09%).ConclusionsOne-third of the global blind resided in South Asia in 2015, although the age-standardised prevalence of blindness and MSVI decreased significantly between 1990 and 2015.