Reducing avoidable visual impairment in elderly home healthcare patients by basic ophthalmologic screening

Nispen, Ruth M. A. van; Aa, Hilde P. A. van der; Timmermans, Frank; Meijer, Nikki; Koster, Nicole; Blok, Jos de; Keunen, Jan E.E.; Rens, Ger H. M. B. van

doi:10.1111/aos.13956

Cited by 13 publications

(11 citation statements)

References 32 publications

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“…Therefore, new care concepts have to be considered for this difficult-to-reach population group. Among the solutions considered were screening examinations ranging from eye tests to more specialised procedures by trained medical staff or nursing staff for the detection and, where necessary, treatment of vision disorders [22,35]. The care provided by ophthalmologists within an inhouse ophthalmological examination unit likewise offers the possibility of adequate patient care despite reduced mobility and multimorbidity of the residents.…”

Section: Resultsmentioning

confidence: 99%

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge

Wagner

Stifter

Engesser

et al. 2020

Klin Monbl Augenheilkd

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Background The demographic change in Germany will lead to an increase in irreversible age-related eye diseases. This will increase the need for specialised care facilities for visually impaired people. Due to reduced mobility, residents in such facilities often do not receive adequate ophthalmological care. New concepts must therefore be considered for this group of patients. One approach is to set up an ophthalmological examination unit within the facility combined with regular visits by an ophthalmologist. We now present the experience with such a model in a home for the blind. Patients and Methods The project was initiated in 2009. Since then there have been visits by medical staff of the Eye Center at Medical Center, University of Freiburg, every two weeks. All patient records (2010 – 2017) were reviewed systematically. The following data were extracted in a structured and anonymous way: Age at first presentation, gender, ophthalmological diagnoses and if a therapy was initiated. This data set was finally analysed descriptively. Results Out of 130 residents aged between 48 and 100 years, half were between 78 and 90 years old. The youngest resident was 48, the oldest 100 years old. The median visual acuity was 0.2. Sixty percent of the residents had at least mild visual impairment according to the WHO (visual acuity < 0.5; category 1 – 6). In one of 6 – 7 residents, visual acuity could not be determined using Snellen charts. The most frequent ophthalmological diagnoses included cataract (44%), age-related macular degeneration (36%) and glaucoma (29%). In 67 residents (52%), the ophthalmological examination lead to treatment, such as application of local therapy or planning an operation. Conclusion In every second resident, the ophthalmologistʼs visit lead to treatment during the observation period. This underlines the difficulty of providing ophthalmological care even in specialised institutions for the blind and visually impaired, which is possibly due to the residentsʼ mobility problems. The concept presented here has established a low-threshold, sustainable and high-quality ophthalmological service on site. These positive experiences indicate that corresponding measures may also be useful for other locations. However, in order to implement such a project on a larger scale, suitable financing and accounting modalities for the construction measures, the nursing staff and the ophthalmological procedure still need to be developed.

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Section: Resultsmentioning

confidence: 99%

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge

Wagner

Stifter

Engesser

et al. 2020

Klin Monbl Augenheilkd

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“…This study suggests that screening for glaucoma and other age-related sight threatening conditions could be worthwhile in (subgroups of) the 65-74 years old age group, since all interventions took place in this age group of asymptomatic participants who are likely to have several more decades of living independently and in reasonably good health ahead of them. However, if screening for glaucoma and possibly other age-related ocular diseases such as cataract, AMD and DRP would be cost-effective, a clear strategy regarding referral, follow-up and treatment needs to be de ned, since low referral uptake has also been demonstrated in elderly (13,51).…”

Section: Clinical Resultsmentioning

confidence: 99%

The prevalence of undiagnosed age-related sight threatening diseases in self-proclaimed healthy individuals

Lemmens

Breda²,

Keer

et al. 2019

Preprint

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Background Age-related conditions such as glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DRP) and cataract have become the major cause of visual impairment and blindness in high-income countries and carry a major socio-economic burden. The aim of the current study is to investigate the prevalence of age-related eye diseases such as glaucoma, age-related macular degeneration, diabetic retinopathy and cataract in a cohort of self-proclaimed healthy elderly, and thus get a rough estimation of the prevalence of undiagnosed age-related eye conditions in the Belgian population.Methods Individuals aged 55 and older without ophthalmological complaints were asked to fill in a general medical questionnaire and underwent an ophthalmological examination, which included a biomicroscopic examination, intraocular pressure measurement, axial length measurement, and acquisition of fundus pictures and Optical Coherence Tomography scans. Information regarding follow-up was collected in the subset of participants who received the advice of referral to an ophthalmologist or the advice to have more frequent follow-up visits, based on the ophthalmological changes detected in their evaluation.Results The cohort included 102 people and comprised 46% men (median age 70 years, range 57-85 years). Referral for additional examinations based on clinical findings, was made in 26 participants (25%). The advice to have more regular follow-up ophthalmologist visits was given to nine additional participants (9%). No significant correlations between baseline characteristics, including eye care consumption, and the need for referral could be identified. Follow-up information was available for 25 out of 26 referred volunteers (96%). Out of these, four (16%) underwent a therapeutical intervention based on study referral, up until 18 months after study participation. All four interventions took place in the age group 65 - 74 years.Conclusions This study shows that even in an elderly population with self-proclaimed healthy eyes and good general health, a significant proportion of subjects showed ocular findings that need regular follow up and/or intervention. Moreover, the frequency of prior ophthalmological examinations does not seem to be relevant to this proportion, meaning that everyone above 55 years old needs a routine ophthalmological evaluation.

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“…This study suggests that screening for glaucoma and other age-related sight-threatening conditions could be worthwhile in (subgroups of) the 65–74 years old age group since all interventions took place in this age group of asymptomatic participants who are likely to have several more decades of living independently and in reasonably good health ahead of them. However, if screening for glaucoma and possibly other age-related ocular diseases such as cataracts, AMD, and DRP would be cost-effective, a clear strategy regarding referral, follow-up, and treatment needs to be defined since low referral uptake has also been demonstrated in the elderly [ 13 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Undiagnosed Age-Related Sight-Threatening Diseases in Self-Proclaimed Healthy Individuals

Lemmens

Breda

Keer

et al. 2020

Journal of Ophthalmology

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Background. Age-related conditions such as glaucoma, age-related macular degeneration, diabetic retinopathy, and cataract have become the major cause of visual impairment and blindness in high-income countries. The aim of the current study is to investigate the prevalence of these eye diseases in a cohort of self-proclaimed healthy elderly and thus get a rough estimation of the prevalence of undiagnosed age-related eye conditions in the Belgian population. Methods. Individuals aged 55 and older without ophthalmological complaints were asked to fill in a general medical questionnaire and underwent an ophthalmological examination, which included a biomicroscopic examination, intraocular pressure measurement, axial length measurement, and acquisition of fundus pictures and optical coherence tomography scans. Information regarding follow-up was collected in those who received the advice of referral to an ophthalmologist or the advice to have more frequent follow-up visits, based on their study evaluation. Results. The cohort included 102 people and comprised 46% men (median age 70 years, range 57–85 years). Referral for additional examinations was made in 26 participants (25%). The advice to have more regular follow-up ophthalmologist visits was given to nine additional participants (9%). No significant correlations between baseline characteristics and the need for referral could be identified. Follow-up information was available for 25 out of 26 referred volunteers. Out of these, four underwent a therapeutic intervention based on study referral, up until 18 months after study participation. All four interventions took place in the age group 65–74 years. Conclusions. This study shows that, even in an elderly population with self-proclaimed healthy eyes and good general health, a significant proportion of subjects showed ocular findings that need regular follow-up and/or intervention. The frequency of prior ophthalmological examinations does not seem to be relevant to this proportion, meaning that everyone above 55 years old needs a routine ophthalmological evaluation.

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Reducing avoidable visual impairment in elderly home healthcare patients by basic ophthalmologic screening

Cited by 13 publications

References 32 publications

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge

Ophthalmic Care in Nursing Homes for the Blind: A Growing Challenge

The prevalence of undiagnosed age-related sight threatening diseases in self-proclaimed healthy individuals

The Prevalence of Undiagnosed Age-Related Sight-Threatening Diseases in Self-Proclaimed Healthy Individuals

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