Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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Query Trace: Saaddine JB[original query] |
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Prevalence of diagnosed diabetes among U.S. Adults aged ≥18 years with disabilities, 2021-2022
Bardenheier BH , Omura JD , Saaddine JB , Hora I , McKeever Bullard K . Diabetes Care 2025 OBJECTIVE: To compare the prevalence of diagnosed diabetes among U.S. adults with and without disabilities, overall and by subgroups. RESEARCH DESIGN AND METHODS: We used data on adults aged ≥18 years from the cross-sectional 2021-2022 National Health Interview Survey to report the prevalence of diagnosed diabetes by functional disability status and for each disability type (hearing, seeing, mobility, cognition, self-care, and communication) separately. With use of the Washington Group Short Set on Functioning indicator, disability was defined according to the categories of milder (reporting some difficulty), moderate (reporting a lot of difficulty), and severe (cannot do at all) by disability type. Crude prevalence and age-standardized prevalence of diabetes were also calculated for adults with any difficulty with any disability by age, sex, race/ethnicity, education, insurance, and poverty-to-income ratio. RESULTS: Diabetes prevalence increased with number of disability types, was lower among adults with no disability (5.8%) than among those with milder (9.5%) or moderate to more severe (18.3%) disability, and was 4.0-10.3 percentage points higher among those with moderate to more severe disability than among those with milder disability for vision, hearing, mobility, and cognitive disabilities. Diabetes prevalence was similar for adults with milder and moderate to more severe self-care and communication disabilities. CONCLUSIONS: Prevalence of diabetes was higher among adults with any functional disability than without and increased with increasing number of disability types. Adults with multiple disability types, or those who have difficulty with self-care or communication or other moderate to more severe disabilities, may benefit from diabetes prevention programs. |
Health care access and use among adults with and without vision impairment: Behavioral Risk Factor Surveillance System, 2018
Cheng Q , Okoro CA , Mendez I , Lundeen EA , Saaddine JB , Stein R , Holbrook J . Prev Chronic Dis 2022 19 E70 INTRODUCTION: Adults with vision impairment may have unique needs when accessing health care to maintain good health. Our study examined the relationship between vision status and access to and use of health care. METHODS: We analyzed data on adults aged 18 years or older who participated in the 2018 Behavioral Risk Factor Surveillance System. Vision impairment was identified by a yes response to the question "Are you blind or do you have serious difficulty seeing, even when wearing glasses?" Survey questions assessed health care access over the past year (having health insurance coverage, a usual health care provider, or unmet health care needs because of cost) and use of health care during that period (routine checkup and dental visit). We estimated age-adjusted prevalence of our outcomes of interest and used bivariate analyses to compare estimates of the outcomes by vision impairment status. RESULTS: The prevalence of self-reported vision impairment was 5.3%. Compared with adults without impaired vision, adults with vision impairment had a lower prevalence of having health insurance coverage (80.6% vs 87.6%), a usual health care provider (71.9% vs 75.7%), or a dental visit in the past year (52.9% vs 67.2%) and a higher prevalence of having an unmet health care need in the past year because of cost (29.2% vs 12.6%). CONCLUSION: Adults with vision impairment reported lower access to and use of health care than those without. Further research can better identify and understand barriers to care to improve access to and use of health care among this population. |
Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Feasibility Results
Hark LA , Tan CS , Kresch YS , De Moraes CG , Horowitz JD , Park L , Auran JD , Gorroochurn P , Stempel S , Maruri SC , Besagar S , Saaddine JB , Lambert BC , Pizzi LT , Sapru S , Price S , Williams OA , Cioffi GA , Liebmann JM . Curr Eye Res 2021 46 (10) 1597-1604 PURPOSE/AIM: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care. MATERIALS AND METHODS: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers. RESULTS: Participants (n=42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n=33) failed vision screening. Of those who failed, 84.8% (n=28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses. CONCLUSION: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes. |
Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology.
Hark LA , Kresch YS , De Moraes CG , Horowitz JD , Park L , Auran JD , Gorroochurn P , Stempel S , Maruri SC , Stidham EM , Banks AZ , Saaddine JB , Lambert BC , Pizzi LT , Sapru S , Price S , Williams OA , Cioffi GA , Liebmann JM . J Glaucoma 2021 30 (5) 388-394 PRCIS: The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. PURPOSE: To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. METHODS: This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23-29 mmHg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. If IOP is ≥30 mmHg, participants are assigned as "fast-track" and referred to ophthalmology. Participants living in seven developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in three developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. CONCLUSION: This study targets vulnerable populations where they live to ensure improved access to and utilization of eye-care services in those who are least likely to seek eye care. |
Eye care among US adults at high risk for vision loss in the United States in 2002 and 2017
Saydah SH , Gerzoff RB , Saaddine JB , Zhang X , Cotch MF . JAMA Ophthalmol 2020 138 (5) 479-489 Importance: Timely eye care can prevent unnecessary vision loss. Objectives: To estimate the number of US adults 18 years or older at high risk for vision loss in 2017 and to evaluate use of eye care services in 2017 compared with 2002. Design, Setting, and Participants: This survey study used data from the 2002 (n = 30920) and 2017 (n = 32886) National Health Interview Survey, an annual, cross-sectional, nationally representative sample of US noninstitutionalized civilians. Analysis excluded respondents younger than 18 years and those who were blind or unable to see. Covariates included age, sex, race/ethnicity, marital status, educational level, income-to-poverty ratio, health insurance status, diabetes diagnosis, vision or eye problems, and US region of residence. Main Outcomes and Measures: Three self-reported measures were visiting an eye care professional in the past 12 months, receiving a dilated eye examination in the past 12 months, and needing but being unable to afford eyeglasses in the past 12 months. Adults at high risk for vision loss included those who were 65 years or older, self-reported a diabetes diagnosis, or had vision or eye problems. Multivariable logistic regression models incorporating sampling weights were used to investigate associations between measures and covariates. Temporal comparisons between 2002 and 2017 were derived from estimates standardized to the US 2010 census population. Results: Among 30 920 individuals in 2002, 16.0% were 65 years or older, and 52.0% were female; among 32 886 individuals in 2017, 20.0% were 65 years or older, and 51.8% were female. In 2017, more than 93 million US adults (37.9%; 95% CI, 37.0%-38.7%) were at high risk for vision loss compared with almost 65 million (31.5%; 95% CI, 30.7%-32.3%) in 2002, a difference of 6.4 (95% CI, 5.2-7.6) percentage points. Use of eye care services improved (56.9% [95% CI, 55.7%-58.7%] reported visiting an eye care professional annually, and 59.8% [95% CI, 58.6%-61.0%] reported receiving a dilated eye examination), but 8.7% (95% CI, 8.0%-9.5%) said they could not afford eyeglasses (compared with 51.1% [95% CI, 49.9%-52.3%], 52.4% [95% CI, 51.2%-53.6%], and 8.3% [95% CI, 7.7%-8.9%], respectively, in 2002). In 2017, individuals with lower income compared with high income were more likely to report eyeglasses as unaffordable (13.6% [95% CI, 11.6%-15.9%] compared with 5.7% [95% CI, 4.9%-6.6%]). Conclusions and Relevance: Compared with data from 2002, more US adults were at high risk for vision loss in 2017. Although more adults used eye care, a larger proportion reported eyeglasses as unaffordable. Focusing resources on populations at high risk for vision loss, increasing awareness of the importance of eye care, and making eyeglasses more affordable could promote eye health, preserve vision, and reduce disparities. |
Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Cataract classifications following eye screening
Hark LA , Adeghate J , Katz LJ , Ulas M , Waisbourd M , Maity A , Zhan T , Hegarty S , Leiby BE , Pasquale LR , Leite S , Saaddine JB , Haller JA , Myers JS . Telemed J E Health 2019 26 (8) 992-1000 Background: Cataracts are a major cause of visual impairment and blindness in the United States and worldwide. Introduction: Risk factors for cataracts include age over 40 years, smoking, diabetes, low socioeconomic status, female sex, steroid use, ocular trauma, genetic factors, and exposure to ultraviolet-B light. Community-based telemedicine vision screenings can be an efficient method for detecting cataracts in underserved populations. The Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study reports the prevalence and risk factors for cataracts in individuals screened and examined for glaucoma and other eye diseases. Materials and Methods: A total of 906 high-risk individuals were screened for glaucoma using telemedicine in seven primary care practices and four Federally Qualified Health Centers in Philadelphia. Participants with suspicious nerves or other abnormalities on fundus photographs, unreadable images, and ocular hypertension returned for an eye examination with an ophthalmologist at the same community location. Results: Of the participants screened through telemedicine, 347 (38.3%) completed a follow-up eye examination by an ophthalmologist. Of these, 267 (76.9%) were diagnosed with cataracts, of which 38 (14.2%) had visually significant cataracts. Participants who were diagnosed with visually significant cataract were more likely to be older (p < 0.001), have diabetes (p = 0.003), and worse visual acuity (p < 0.001). Discussion: Our study successfully detected and confirmed cataracts in a targeted, underserved urban population at high risk for eye disease. Conclusions: Telemedicine programs offer an opportunity to identify and refer individuals who would benefit from continuous follow-up eye care and treatment to improve visual function and quality of life. |
Self-reported oral health status among adults age 40+ years with and without vision impairment: National Health Interview Survey, 2008
Crews JE , Chou CF , Naavaal S , Griffin S , Saaddine JB . Am J Ophthalmol 2019 210 184-191 PURPOSE: To examine self-reported oral health among adults age 40 years and older with and without vision impairment. DESIGN: Cross-sectional with a nationally representative sample. METHODS: We used publicly available data from the Oral Health Module, last administered in 2008 of the National Health Interview Survey. Outcome variables included fair/poor oral health status, mouth condition compared to others the same age, mouth problems (mouth sores, difficulty eating, dry mouth, bad breath and/or jaw pain), teeth problems (toothache; broken/missing fillings or teeth; loose, crooked or stained teeth; and/or bleeding gums) and lack of social participation. Using descriptive statistics and multivariate logistic regression, we examined the association (p<0.05) between vision impairment and oral health outcomes by age-group, sociodemographic, and other explanatory variables. RESULTS: Our study sample included 12,090 adults; 12.8% of adults aged 40-64 years reported vision impairment, and among them, 44.5% reported fair/poor oral health status and 47.2% reported any mouth problems. Among adults aged >/=65 years, 17.3% reported vision impairment, of whom 36.3% reported fair/poor oral health status, and 57.3 reported any mouth problems. There is a strong association between vision impairment and poorer oral health of adults; adults aged 40-64 years with vision impairment reported 90% to 150% greater odds of oral health problems, including fair/poor oral health status, mouth problems, and teeth problems, compared to people without vision impairment. CONCLUSIONS: Oral health disparities exist between adults with and without vision impairment. Targeted interventions are required to improve oral health in this vulnerable population. |
Eye care utilization among insured people with diabetes, U.S. 2010-2014
Benoit SR , Swenor B , Geiss LS , Gregg EW , Saaddine JB . Diabetes Care 2019 42 (3) 427-433 OBJECTIVE: Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults, and although screening with eye exams is effective, screening rates are low. We evaluated eye exam visits over a 5-year period in a large population of insured patients 10-64 years of age with diabetes. RESEARCH DESIGN AND METHODS: We used claims data from IBM Watson Health to identify patients with diabetes and continuous insurance coverage from 2010 to 2014. Diabetes and DR were defined using ICD-9 Clinical Modification codes. We calculated eye exam visit frequency by diabetes type over a 5-year period and estimated period prevalence and cumulative incidence of DR among those receiving an eye exam. RESULTS: Among the 298,383 insured patients with type 2 and no diagnosed DR, almost half had no eye exam visits over the 5-year period and only 15.3% met the American Diabetes Association (ADA) recommendations for annual or biennial eye exams. For the 2,949 patients with type 1 diabetes, one-third had no eye exam visits and 26.3% met ADA recommendations. The 5-year period prevalence and cumulative incidence of DR was 24.4% and 15.8% for patients with type 2 diabetes, respectively, and 54.0% and 33.4% for patients with type 1 diabetes. CONCLUSIONS: The frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in health care may be needed to detect and prevent vision-threatening eye disease among people with diabetes. |
Trends in eye care use and eyeglasses affordability: The US National Health Interview Survey, 2008-2016
Varadaraj V , Frick KD , Saaddine JB , Friedman DS , Swenor BK . JAMA Ophthalmol 2019 137 (4) 391-398 Importance: Understanding eye care use over time is essential to estimate continued unmet health care needs and help guide future public health priorities. Objective: To update trends in using eye care and affording eyeglasses in the United States. Design, Setting, and Participants: This analysis of data from the US National Health Interview Survey included adults 18 years and older from 9 annual cross-sectional population-based samples ranging in size from 21781 to 36697 participants from 2008 to 2016. Data were analyzed from August 2017 to February 2018. Exposures: Visual impairment, defined as self-reported difficulty seeing despite wearing eyeglasses. Main Outcomes and Measures: Outcome measures included visits to an eye care professional and inability to afford eyeglasses when needed in the past year. Survey logistic regression, adjusted for age, sex, race/ethnicity, visual impairment status, education, employment, general health, poverty-income ratio, and vision insurance, was used to examine associations between survey year and eye care outcomes. Results: Analyses included 9 annual cross-sectional population-based samples pooled from 2008 to 2016, ranging in size from 21781 to 36697 participants aged 18 years or older. Compared with 2008, greater proportions of the US population were 65 years or older, Hispanic, or Asian in 2016. There was a significant trend for eye care use and difficulty affording eyeglasses from 2008 to 2016. In fully adjusted models, Americans were less likely to use eye care in 2014 compared with 2008 (odds ratio [OR], 0.90; 99.9% CI, 0.82-0.98; P < .001). Compared with 2008, Americans were also less likely to report difficulty affording eyeglasses from 2014 onwards (2014: OR, 0.82; 99.9% CI, 0.69-0.97; P < .001; 2015: OR, 0.81; 99.9% CI, 0.69-0.96; P < .001; 2016: OR, 0.70; 99.9% CI, 0.59-0.82; P < .001). After adjusting for all covariates, including survey year, those with visual impairment compared with those without were more likely to use eye care (OR, 1.54; 99.9% CI, 1.45-1.65; P < .001) but had greater difficulty affording eyeglasses (OR, 3.86; 99.9% CI, 0.58-0.72; P < .001). Women were also more likely to use eye care (OR, 1.42; 99.9% CI, 1.37-1.48; P < .001) and report difficulty affording eyeglasses (OR, 1.68; 99.9% CI, 1.56-1.81; P < .001) compared with men. Compared with non-Hispanic white individuals, black, Asian, and Hispanic individuals were less likely to use eye care, and Asian and black individuals were less likely to have difficulty affording eyeglasses. Conclusions and Relevance: These data indicate decreased difficulty affording eyeglasses among Americans from 2014 to 2016, possibly related to economic recovery and health care reform. However, the findings suggest women and racial/ethnic minorities are more likely to have lower use of eye care or inability to afford eyeglasses. |
Prevalence of diabetic retinopathy and associated mortality among diabetic adults with and without chronic kidney disease
Pavkov ME , Harding JL , Chou CF , Saaddine JB . Am J Ophthalmol 2019 198 200-208 Purpose: To estimate prevalence and severity of diabetic retinopathy (DR) among U.S. adults with diabetes and with or without chronic kidney disease (CKD), and assess associated risk of mortality. Design(s): Cross-sectional study with national survey data. Method(s): The cohort included adults >=40 years old with diabetes in the National Health and Nutrition Examination Surveys (NHANES) 2005-2008. Vital status was determined through December 31, 2011. We defined diabetes as hemoglobin A1c >=6.5% or self-report and CKD by urinary albumin/creatinine >=30 mg/g or glomerular filtration rate <60 mL/min/1.73 m2. The main outcomes were DR and mortality. Result(s): Prevalence of DR was 27.8% (95% CI 24.3-31.7), 36.2% (95%CI 30.1-42.7), and 23.4% (95% CI 19.2-28.1), overall, with and without CKD. Prevalence of vision-threatening DR was 4.2% (95% CI 3.2-5.5), 8.2% (95% CI 5.4-12.2), and 2.0% (95% CI 1.2-3.5), respectively. In a multivariable adjusted model, DR was positively but nonsignificantly associated with CKD (OR = 1.1, 95% CI 0.7-1.7), was 40% higher per 1% increase in hemoglobin A1c (OR = 1.4, 95% CI 1.1-1.6), was 30% higher per 5 years additional diabetes duration (OR = 1.3, 95% CI 1.1-1.5), was 30% higher per 10 mm Hg increase in systolic blood pressure (OR = 1.3, 95% CI 1.1-1.5), and was 6-fold higher with insulin treatment (OR = 6.2, 95% CI 2.6-14.8). Compared with diabetic participants with neither DR nor CKD, those with DR and CKD had a 3.6-fold (95% CI 1.5-9.1) increased adjusted risk for all-cause mortality. Conclusion(s): Over one third of persons with diabetes and CKD had DR. The risk of death was higher with than without CKD and DR. Many of the studied risk factors associated with DR are modifiable. |
Establishing a vision and eye health surveillance system for the nation: A status update on the Vision and Eye Health Surveillance System
Rein DB , Wittenborn JS , Phillips EA , Saaddine JB . Ophthalmology 2018 125 (4) 471-473 Vision loss and eye disorders cost the US health care system $65.1 billion in 2013, the fifth leading cause of medical expenditures.1 Americans fear losing vision as much as or more than memory, hearing, or speech, and consider blindness among the top 4 worst things that could happen to them.2 It is estimated that as much as 98% of visual impairment and blindness, much of it consisting of uncorrected refractive error and untreated cataracts, in the United States can be prevented through timely diagnosis and early treatment.3 |
Early age-related macular degeneration with cardiovascular and renal comorbidities: An analysis of the National Health and Nutrition Examination Survey, 2005-2008
Cheng Q , Saaddine JB , Klein R , Rothenberg R , Chou CF , Il'yasova D . Ophthalmic Epidemiol 2017 24 (6) 1-7 PURPOSE: A cross sectional study was designed to examine the relationship of early age-related macular degeneration (AMD) with comorbidities of cardiovascular and renal conditions in the representative population using National Health and Nutrition Examination Survey (NHANES), 2005-2008. METHODS: Participants (≥40 years) who underwent retinal photography were included. Early AMD was defined by the retinal digital images. The comorbidities were self-reported stroke and heart disease (HD), including angina pectoris (AP), coronary heart disease (CHD), congestive heart failure (CHF), and myocardial infarction (MI). Chronic kidney disease (CKD) was determined based on self-report, estimation of glomerular filtration rate (GFR), or the level of urine albumin. RESULTS: The age-adjusted odds ratio (OR) and 95% CI for having early AMD for persons with the selected conditions were: 2.6 (1.9, 3.6) for any type of HD. When the conditions were considered separately, ORs (95% CIs) were: 2.0 (1.2, 3.4) for AP; 2.5 (1.6, 3.8) for CHD; 2.4 (1.6, 3.6) for MI; 2.3 (1.3, 3.9) for CHF; 3.3 (2.2, 5.0) for stroke; and 2.4 (1.8, 3.2) for CKD. Covariable-adjusted ORs (AOR) were attenuated for all examined conditions, but remained statistically significant. Having any single condition (AOR [95%CI]: 2.7 [1.5, 4.8]) was significantly associated with early AMD, as was having ≥ 2 conditions (AOR [95%CI]: 5.2 [3.0, 9.0]). The strongest association was between early AMD and the combination of HD and stroke (AOR [95% CI]: 6.3 [2.9, 13.8]). CONCLUSION: Cardiovascular and renal comorbidities are associated with early AMD in a representative sample of the US general population. |
Philadelphia telemedicine glaucoma detection and follow-up study: Methods and screening results
Hark LA , Katz LJ , Myers JS , Waisbourd M , Johnson D , Pizzi LT , Leiby BE , Fudemberg SJ , Mantravadi AV , Henderer JD , Zhan T , Molineaux J , Doyle V , Divers M , Burns C , Murchison AP , Reber S , Resende A , Bui TDV , Lee J , Crews JE , Saaddine JB , Lee PP , Pasquale LR , Haller JA . Am J Ophthalmol 2017 181 114-124 PURPOSE: To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN: Screening program results for a prospective, randomized clinical trial. MATERIALS AND METHODS: Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; Caucasian individuals over age 65 years; any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a non-mydriatic, auto-focus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICarerebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS: From 4/1/15, to 2/6/17, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve; 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy; and 68 (7.5%) had other retinal abnormalities. CONCLUSION: An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology. |
The prevalence of chronic conditions and poor health among people with and without vision impairment, aged ≥ 65 years, 2010-2014
Crews JE , Chou CF , Sekar S , Saaddine JB . Am J Ophthalmol 2017 182 18-30 PURPOSE: To examine the prevalence of 13 chronic conditions and fair/poor health among people aged ≥65 years in the U.S. with and without vision impairment. DESIGN: Cross-sectional study from the 2010-2014 National Health Interview Survey METHODS: We examined hypertension, heart disease, high cholesterol, stroke, arthritis, asthma, chronic obstructive pulmonary disease, cancer, weak/failing kidneys, diabetes, hepatitis, depression, and hearing impairment. We used logistic regression to show the association between vision impairment and chronic conditions and the association between vision impairment and poor health for those with chronic conditions. RESULTS: People aged ≥65 years with vision impairment reported greater prevalence of chronic conditions compared to people without vision impairment. After controlling for covariates (age, sex, education, race, smoking, physical activity, and obesity), people with vision impairment were more likely than those without to report chronic conditions (hypertension: OR [odds ratio] 1.43; heart disease: OR 1.68; high cholesterol: OR 1.26; stroke: OR 1.99; arthritis; OR 1.71; asthma: OR 1.56; COPD: OR 1.65; cancer: OR 1.23; weak/failing kidneys: OR 2.29; diabetes: OR 1.56; hepatitis: OR 1.30; depression: OR 1.47; hearing impairment: OR 1.91) (all P<0.05). Among older people with chronic conditions, those with vision impairment and chronic conditions compared to people without vision impairment and chronic conditions were 1.66 to 2.98 times more likely to have fair/poor health than those without vision impairment (all p<0.05). CONCLUSION: Higher prevalence of chronic conditions is strongly associated with vision impairment among the older people and poor health is strongly associated with vision impairment and chronic conditions. |
Applying RE-AIM to evaluate two community-based programs designed to improve access to eye care for those at high-risk for glaucoma
Sapru S , Berktold J , Crews JE , Katz LJ , Hark L , Girkin CA , Owsley C , Francis B , Saaddine JB . Eval Program Plann 2017 65 40-46 INTRODUCTION: Glaucoma is a leading cause of vision loss and blindness in the U.S. Risk factors include African American race, older age, family history of glaucoma, and diabetes. This paper describes the evaluation of a mobile eye health and a telemedicine program designed to improve access to eye care among people at high-risk for glaucoma. METHODS: The RE-AIM (reach, efficacy, adoption, implementation, and maintenance) evaluation framework was used to harmonize indicators. Both programs provided community-based eye health education and eye services related to glaucoma detection and care. Each program reported data on participants and community partners. An external evaluator conducted site visit interviews with program staff and community partners. Quantitative and qualitative data were integrated and analyzed using the RE-AIM dimensions. DISCUSSION: By targeting high-risk populations and providing comprehensive eye exams, both programs detected a large proportion of new glaucoma-related cases (17-19%) - a much larger proportion than that found in the general population (<2%). The educational intervention increased glaucoma knowledge; evidence that it led people to seek eye care was inconclusive. CONCLUSIONS: Evaluation findings from the mobile eye health program and the telemedicine program may provide useful information for wider implementation in public health clinics and in optometrist clinics located in retail outlets. |
Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project
Pizzi LT , Waisbourd M , Hark L , Sembhi H , Lee P , Crews JE , Saaddine JB , Steele D , Katz LJ . Br J Ophthalmol 2017 102 (2) 225-232 BACKGROUND: Glaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres. METHODS: The analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded. RESULTS: 1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273. CONCLUSION: Glaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes. |
Association between county-level characteristics and eye care use by us adults in 22 states after accounting for individual-level characteristics using a conceptual framework
Chou CF , Beckles GL , Cheng YJ , Saaddine JB . JAMA Ophthalmol 2016 134 (10) 1158-1167 Importance: Individual-level characteristics are associated with eye care use. The influence of contextual factors on vision and eye health, as well as health behavior, is unknown. Objective: To examine the association between county-level characteristics and eye care use after accounting for individual-level characteristics using a conceptual framework. Design, Setting, and Participants: This investigation was a cross-sectional study of respondents 40 years and older participating in the Behavioral Risk Factor Surveillance System surveys between 2006 and 2010 from 22 states that used the Visual Impairment and Access to Eye Care module. Multilevel regressions were used to examine the association between county-level characteristics and eye care use after adjusting for individual-level characteristics (age, sex, race/ethnicity, educational attainment, annual household income, employment status, health care insurance coverage, eye care insurance coverage, personal established physician, poor vision or eye health, and diabetes status). Data analysis was performed from March 23, 2014, to June 7, 2016. Main Outcomes and Measures: Eye care visit and receipt of a dilated eye examination in the past year. Results: Among 117295 respondents who resided in 828 counties, individual-level data were obtained from the Behavioral Risk Factor Surveillance System surveys. All county-level variables were aggregated at the county level from the Behavioral Risk Factor Surveillance System surveys except for a high geographic density of eye care professionals, which was obtained from the 2010 Area Health Resource File. After controlling for individual-level characteristics, the odds of reporting an eye care visit in the past year were significantly higher among people living in counties with high percentages of black individuals (adjusted odds ratio [aOR], 1.12; 95% CI, 1.01-1.24; P = .04) or low-income households (aOR, 1.12; 95% CI, 1.00-1.25; P = .045) or with a high density of eye care professionals (aOR, 1.18; 95% CI, 1.07-1.29; P < .001) than among those living in counties with the lowest tertile of each county-level characteristic. The odds of reporting receipt of a dilated eye examination in the past year were also higher among people living in counties with the highest percentages of black individuals (aOR, 1.20; 95% CI, 1.07-1.34; P = .002) or low-income households (aOR, 1.17; 95% CI, 1.04-1.32; P = .01). However, the odds of reported receipt of a dilated eye examination in the past year were lower in counties with the highest percentages of people with poor vision and eye health compared with counties with lower percentages (aOR, 0.85; 95% CI, 0.77-0.94; P = .002). Conclusions and Relevance: Contextual factors, measured at the county level, were associated with eye care use independent of individual-level characteristics. The findings suggest that, while individual characteristics influence health care use, it is also important to address contextual factors to improve eye care use and ultimately vision health. |
The Philadelphia Glaucoma Detection and Treatment Project: Detection rates and initial management
Waisbourd M , Pruzan NL , Johnson D , Ugorets A , Crews JE , Saaddine JB , Henderer JD , Hark LA , Katz LJ . Ophthalmology 2016 123 (8) 1667-1674 PURPOSE: To evaluate the detection rates of glaucoma-related diagnoses and the initial treatments received in the Philadelphia Glaucoma Detection and Treatment Project, a community-based initiative aimed at improving the detection, treatment, and follow-up care of individuals at risk for glaucoma. DESIGN: Retrospective analysis. PARTICIPANTS: A total of 1649 individuals at risk for glaucoma who were examined and treated in 43 community centers located in underserved communities of Philadelphia. METHODS: Individuals were enrolled if they were African American aged ≥50 years, were any other adult aged ≥60 years, or had a family history of glaucoma. After attending an informational glaucoma workshop, participants underwent a targeted glaucoma examination including an ocular, medical, and family history; visual acuity testing, intraocular pressure (IOP) measurement, and corneal pachymetry; slit-lamp and optic nerve examination; automated visual field testing; and fundus color photography. If indicated, treatments included selective laser trabeculoplasty (SLT), laser peripheral iridotomy (LPI), or IOP-lowering medications. Follow-up examinations were scheduled at the community sites after 4 to 6 weeks or 4 to 6 months, depending on the clinical scenario. MAIN OUTCOME MEASURES: Detection rates of glaucoma-related diagnoses and types of treatments administered. RESULTS: Of the 1649 individuals enrolled, 645 (39.1%) received a glaucoma-related diagnosis; 20.0% (n = 330) were identified as open-angle glaucoma (OAG) suspects, 9.2% (n = 151) were identified as having narrow angles (or as a primary angle closure/suspect), and 10.0% (n = 164) were diagnosed with glaucoma, including 9.0% (n = 148) with OAG and 1.0% (n = 16) with angle-closure glaucoma. Overall, 39.0% (n = 64 of 164) of those diagnosed with glaucoma were unaware of their diagnosis. A total of 196 patients (11.9%) received glaucoma-related treatment, including 84 (5.1%) who underwent LPI, 13 (0.8%) who underwent SLT, and 103 (6.2%) who were prescribed IOP-lowering medication. CONCLUSIONS: Targeting individuals at risk for glaucoma in underserved communities in Philadelphia yielded a high detection rate (39.1%) of glaucoma-related diagnoses. Providing examinations and offering treatment, including first-line laser procedures, at community-based sites providing services to older adults are effective to improve access to eye care by underserved populations. |
Falls among persons aged ≥65 years with and without severe vision impairment - United States, 2014
Crews JE , Chou CF , Stevens JA , Saaddine JB . MMWR Morb Mortal Wkly Rep 2016 65 (17) 433-7 In 2014, an estimated 2.8 million persons aged ≥65 years in the United States reported severe vision impairment defined as being blind or having severe difficulty seeing, even with eyeglasses. Good vision is important for maintaining balance as well as for identifying low-contrast hazards, estimating distances, and discerning spatial relationships. Conversely, having poor vision increases the risk for falls (1,2). Falls among older adults are common and can cause serious injuries, disabilities, and premature death (1,3). To date, no state-level investigations have examined the annual prevalence of falls among persons with and without severe vision impairment. CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the state-specific annual prevalence of falls among persons aged ≥65 years with and without self-reported severe vision impairment. Overall, 46.7% of persons with, and 27.7% of older adults without, self-reported severe vision impairment reported having fallen during the previous year. The state-specific annual prevalence of falls among persons aged ≥65 years with severe vision impairment ranged from 30.8% (Hawaii) to 59.1% (California). In contrast, the prevalence of falls among persons aged ≥65 years without severe vision impairment ranged from 20.4% (Hawaii) to 32.4% (Alaska). Developing fall-prevention interventions intended for persons with severe vision impairment will help states manage the impact of vision impairment and falls on health care resources, and can inform state-specific fall prevention initiatives. |
The association of health-related quality of life with severity of visual impairment among people aged 40-64 years: Findings from the 2006-2010 Behavioral Risk Factor Surveillance System
Crews JE , Chou CF , Zack MM , Zhang X , Bullard KM , Morse AR , Saaddine JB . Ophthalmic Epidemiol 2016 23 (3) 145-53 PURPOSE: To examine the association of health-related quality of life (HRQoL) with severity of visual impairment among people aged 40-64 years. METHODS: We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six measures of HRQoL: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, or moderate/severe. We examined the association between visual impairment and HRQoL using logistic regression accounting for the survey's complex design. RESULTS: Overall, 23.0% of the participants reported a little difficult seeing, while 16.8% reported moderate/severe difficulty seeing. People aged 40-64 years with moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days, as well as greater life dissatisfaction, greater disability, and poorer health compared to people reporting no or a little visual impairment. After controlling for covariates (age, sex, marital status, race/ethnicity, education, income, state, year, health insurance, heart disease, stroke, heart attack, body mass index, leisure-time activity, smoking, and medical care costs), and compared to people with no visual impairment, those with moderate/severe visual impairment were more likely to have fair/poor health (odds ratio, OR, 2.01, 95% confidence interval, CI, 1.82-2.23), life dissatisfaction (OR 2.06, 95% CI 1.80-2.35), disability (OR 1.95, 95% CI 1.80-2.13), and frequent physically unhealthy days (OR 1.69, 95% CI 1.52-1.88), mentally unhealthy days (OR 1.84, 95% CI 1.66-2.05), and activity limitation days (OR 1.94, 95% CI 1.71-2.20; all p < 0.0001). CONCLUSION: Poor HRQoL was strongly associated with moderate/severe visual impairment among people aged 40-64 years. |
Improving access to eye care among persons at high-risk of glaucoma in Philadelphia - design and methodology: The Philadelphia Glaucoma Detection and Treatment Project
Hark L , Waisbourd M , Myers JS , Henderer J , Crews JE , Saaddine JB , Molineaux J , Johnson D , Sembhi H , Stratford S , Suleiman A , Pizzi L , Spaeth GL , Katz LJ . Ophthalmic Epidemiol 2016 23 (2) 1-9 PURPOSE: The Wills Eye Glaucoma Research Center initiated a 2-year demonstration project to develop and implement a community-based intervention to improve detection and management of glaucoma in Philadelphia. METHODS: The glaucoma detection examination consisted of: ocular, medical, and family history; visual acuity testing; corneal pachymetry; biomicroscopy of the anterior segment; intraocular pressure (IOP) measurement; gonioscopy; funduscopy; automated visual field testing; and fundus-color photography. Treatment included laser surgery and/or IOP-lowering medication. A cost analysis was conducted to understand resource requirements. Outcome measures included; prevalence of glaucoma-related pathology and other eye diseases among high-risk populations; the impact of educational workshops on level of knowledge about glaucoma (assessed by pre- and post-test evaluation); and patient satisfaction of the glaucoma detection examinations in the community (assessed by satisfaction survey). Treatment outcome measures were change in IOP at 4-6 weeks and 4-6 months following selective laser trabeculoplasty treatment, deepening of the anterior chamber angle following laser-peripheral iridotomy treatment, and rate of adherence to recommended follow-up examinations. Cost outcomes included total program costs, cost per case of glaucoma detected, and cost per case of ocular disease detected. RESULTS: This project enrolled 1649 participants (African Americans aged 50+ years, adults 60+ years and individuals with a family history of glaucoma). A total of 1074 individuals attended a glaucoma educational workshop and 1508 scheduled glaucoma detection examination appointments in the community setting. CONCLUSIONS: The Philadelphia Glaucoma Detection and Treatment Project aimed to improve access and use of eye care and to provide a model for a targeted community-based glaucoma program. |
Utilization of e-health services among U.S. adults with diabetes
Chou CF , Bullard KM , Saaddine JB , Devlin HM , Crews J , Imperatore G , McDivitt J , Albright A . Diabetes Care 2015 38 (12) e200-1 Electronic health (e-health) services have become increasingly important as a method to improve access to health care, including online renewal of prescription medications and making appointments. Healthy People 2020 includes objectives related to e-health to improve population health outcomes and to reduce health disparities, particularly to improve shared decision-making processes between patients and health care professionals (1). E-health services have been encouraged as part of the strategy to improve diabetes care and prevention (2,3). The adoption of these services among health care professionals has improved the quality and efficiency of care (4). However, e-health services may be underutilized among patients with diabetes. While research related to e-health services has been conducted in clinical and managed care settings (5), there are no national population estimates or trends for the utilization of e-health services among U.S. adults with diabetes. | We analyzed the 2009–2013 National Health Interview Survey (NHIS) (12,689 respondents aged ≥18 years with diabetes) self-reported data. NHIS is a cross-sectional household survey, using a multistage area probability design of the U.S. noninstitutionalized civilian population. NHIS is the first nationally representative household survey to include questions on the use of health information technology. Utilization of e-health services was defined as scheduling appointments, communicating with health care providers, and refilling prescription medications online. We calculated the predictive margins for the estimates of e-health utilization from multivariate logistic regression, controlling for age, sex, race/ethnicity, educational attainment, poverty-to-income ratio, health insurance coverage, having at least one visit to a doctor or health care professional in the past year, self-rated health status, history of other chronic diseases, diabetes duration, and diabetes medication. We used SAS-Callable SUDAAN 10.0.1 software to account for the complex sampling design of the NHIS. Differences were considered statistically significant at P values < 0.05. |
Geographic disparity of severe vision loss - United States, 2009-2013
Kirtland KA , Saaddine JB , Geiss LS , Thompson TJ , Cotch MF , Lee PP . MMWR Morb Mortal Wkly Rep 2015 64 (19) 513-7 Vision loss and blindness are among the top 10 disabilities in the United States, causing substantial social, economic, and psychological effects, including increased morbidity, increased mortality, and decreased quality of life. There are disparities in vision loss based on age, sex, race/ethnicity, socioeconomic status, and geographic location. Current surveillance activities using national and state surveys have characterized vision loss at national and state levels. However, there are limited data and research at local levels, where interventions and policy decisions to reduce the burden of vision loss and eliminate disparities are often developed and implemented. CDC analyzed data from the American Community Survey (ACS) to estimate county-level prevalence of severe vision loss (SVL) (being blind or having serious difficulty seeing even when wearing glasses) in the United States and to describe its geographic pattern and its association with poverty level. Distinct geographic patterns of SVL prevalence were found in the United States; 77.3% of counties in the top SVL prevalence quartile (≥4.2%) were located in the South. SVL was significantly correlated with poverty (r = 0.5); 437 counties were in the top quartiles for both SVL and poverty, and 83.1% of those counties were located in southern states. A better understanding of the underlying barriers and facilitators of access and use of eye care services at the local level is needed to enable the development of more effective interventions and policies, and to help planners and practitioners serve the growing population with and at risk for vision loss more efficiently. |
Association of socioeconomic position with sensory impairment among US working-aged adults
Chou CF , Beckles GL , Zhang X , Saaddine JB . Am J Public Health 2015 105 (6) e1-e7 OBJECTIVES: We examined the relationship between socioeconomic position (SEP) and sensory impairment. METHODS: We used data from the 2007 to 2010 National Health Interview Surveys (n = 69 845 adults). Multivariable logistic regressions estimated odds ratios (ORs) for associations of educational attainment, occupational class, and poverty-income ratio with impaired vision or hearing. RESULTS: Nearly 20% of respondents reported sensory impairment. Each SEP indicator was negatively associated with sensory impairment. Adjusted odds of vision impairment were significantly higher for farm workers (OR = 1.41; 95% confidence interval [CI] = 1.01, 2.02), people with some college (OR = 1.29; 95% CI = 1.16, 1.44) or less than a high school diploma (OR = 1.36; 95% CI = 1.19, 1.55), and people from poor (OR = 1.35; 95% CI = 1.20, 1.52), low-income (OR = 1.28; 95% CI = 1.14, 1.43), or middle-income (OR = 1.19; 95% CI = 1.07, 1.31) families than for the highest-SEP group. Odds of hearing impairment were significantly higher for people with some college or less education than for those with a college degree or more; for service groups, farmers, and blue-collar workers than for white-collar workers; and for people in poor families. CONCLUSIONS: More research is needed to understand the SEP-sensory impairment association. |
Vision screening among children aged 6 years - Medical Expenditure Panel Survey, United States, 2009-2010
Kemper AR , Crews JE , Strickland B , Saaddine JB . MMWR Suppl 2014 63 (2) 43-6 Amblyopia or lazy eye is an important cause of monocular blindness and is associated with a 2.6 fold increase in the risk for bilateral visual impairment in adults. However, amblyopia can usually be prevented through early detection and treatment. Treatment focuses on correcting the underlying cause of amblyopia (e.g., strabismus or unequal refractive error) and promoting the use of the amblyogenic eye (e.g., through patching of the other eye). Effectiveness of treatment decreases with age and is less successful after age 12 years. The overall prevalence of amblyopia among children aged 6 months to 6 years is 1% to 2%. In addition, the prevalence of amblyogenic risk factors among children in this age range is approximately 3%. Because amblyopia can usually be prevented with early intervention, preschool vision screening for the prevention of amblyopia is considered cost-effective. |
Health-related quality of life among people aged ≥65 years with self-reported visual impairment: findings from the 2006-2010 Behavioral Risk Factor Surveillance System
Crews JE , Chou CF , Zhang X , Zack MM , Saaddine JB . Ophthalmic Epidemiol 2014 21 (5) 1-10 PURPOSE: To examine the association between health-related quality of life (HRQoL) and visual impairment among people aged ≥65 years. METHODS: We used cross-sectional data from the 2006-2010 Behavioral Risk Factor Surveillance System to examine six HRQoL measures: self-reported health, physically unhealthy days, mentally unhealthy days, activity limitation days, life satisfaction, and disability. Visual impairment was categorized as no, a little, and moderate/severe. We examined the association between self-reported visual impairment and HRQoL using logistic regression accounting for the survey's complex design. RESULTS: People with self-reported moderate/severe visual impairment had more frequent (≥14) physically unhealthy days, mentally unhealthy days, and activity limitation days in the last 30 days compared to those reporting a little or no visual impairment. After controlling for all covariates (age, sex, marital status, race/ethnicity, education, income, diabetes, heart disease, stroke, heart attack, body mass index, leisure time activity, smoking, and medical care cost concerns) and comparing to those with no self-reported visual impairment, people reporting a little visual impairment were more likely to have fair/poor health (odds ratio, OR, 1.2, 95% confidence interval, CI, 1.1-1.3), life dissatisfaction (OR 1.6, 95% CI 1.3-2.0), and disability (OR 1.5, 95% CI 1.3-1.6), and those with self-reported moderate/severe visual impairment had more fair/poor health (OR 1.8, 95% CI 1.6-2.0), life dissatisfaction (OR 2.3, 95% CI 1.8-2.9), and disability (OR 2.0, 95% CI 1.8-2.2). They also had more frequent physically unhealthy days (OR 1.9, 95% CI 1.7-2.1), mentally unhealthy days (OR 1.8, 95% CI 1.5-2.1), and activity limitations days (OR 1.9, 95% CI 1.6-2.2). CONCLUSION: Poor HRQoL is strongly associated with the severity of self-reported visual impairment among people aged ≥65 years. |
Barriers to eye care among people aged 40 years and older with diagnosed diabetes, 2006-2010
Chou CF , Sherrod CE , Zhang X , Barker LE , Bullard KM , Crews JE , Saaddine JB . Diabetes Care 2014 37 (1) 180-8 OBJECTIVE: We examine barriers to receiving recommended eye care among people aged ≥40 years with diagnosed diabetes. RESEARCH DESIGN AND METHODS: We analyzed 2006-2010 Behavioral Risk Factor Surveillance System data from 22 states (n = 27,699). Respondents who had not sought eye care in the preceding 12 months were asked the main reason why. We categorized the reasons as cost/lack of insurance, no need, no eye doctor/travel/appointment, and other (meaning everything else). We used multinomial logistic regression to control for race/ethnicity, education, income, and other selected covariates. RESULTS: Among adults with diagnosed diabetes, nonadherence to the recommended annual eye examinations was 23.5%. The most commonly reported reasons for not receiving eye care in the preceding 12 months were "no need" and "cost or lack of insurance" (39.7 and 32.3%, respectively). Other reasons were "no eye doctor," "no transportation" or "could not get appointment" (6.4%), and "other" (21.5%). After controlling for covariates, adults aged 40-64 years were more likely than those aged ≥65 years (relative risk ratio [RRR] = 2.79; 95% CI 2.01-3.89) and women were more likely than men (RRR = 2.33; 95% CI 1.75-3.14) to report "cost or lack of insurance" as their main reason. However, people aged 40-64 years were less likely than those aged ≥65 years to report "no need" (RRR = 0.51; 95% CI 0.39-0.67) as their main reason. CONCLUSIONS: Addressing concerns about "cost or lack of insurance" for adults under 65 years and "no perceived need" among those 65 years and older could help improve eye care service utilization among people with diabetes. |
Age-related eye diseases and visual impairment among U.S. adults
Chou CF , Cotch MF , Vitale S , Zhang X , Klein R , Friedman DS , Klein BE , Saaddine JB . Am J Prev Med 2013 45 (1) 29-35 BACKGROUND: Visual impairment is a common health-related disability in the U.S. The association between clinical measurements of age-related eye diseases and visual impairment in data from a national survey has not been reported. PURPOSE: To examine common eye conditions and other correlates associated with visual impairment in the U.S. METHODS: Data from the 2005-2008 National Health and Nutrition Examination Survey of 5222 Americans aged ≥40 years were analyzed in 2012 for visual impairment (presenting distance visual acuity worse than 20/40 in the better-seeing eye), and visual impairment not due to refractive error (distance visual acuity worse than 20/40 after refraction). Diabetic retinopathy (DR) and age-related macular degeneration (AMD) were assessed from retinal fundus images; glaucoma was assessed from two successive frequency-doubling tests and a cup-to-disc ratio measurement. RESULTS: Prevalence of visual impairment and of visual impairment not due to refractive error was 7.5% (95% CI=6.9%, 8.1%) and 2.0% (1.7%, 2.3%), respectively. The prevalence of visual impairment not due to refractive error was significantly higher among people with AMD (2.2%) compared to those without AMD (0.8%), or with DR (3.5%) compared to those without DR (1.2%). Independent predictive factors of visual impairment not due to refractive error were AMD (OR=4.52, 95% CI=2.50, 8.17); increasing age (OR=1.09 per year, 95% CI=1.06, 1.13); and less than a high school education (OR=2.99, 95% CI=1.18, 7.55). CONCLUSIONS: Visual impairment is a public health problem in the U.S. Visual impairment in two thirds of adults could be eliminated with refractive correction. Screening of the older population may identify adults at increased risk of visual impairment due to eye diseases. |
Association between depression and functional vision loss in persons 20 years of age or older in the United States, NHANES 2005-2008
Zhang X , Bullard KM , Cotch MF , Wilson MR , Rovner BW , McGwin Jr G , Owsley C , Barker L , Crews JE , Saaddine JB . JAMA Ophthalmol 2013 131 (5) 573-581 IMPORTANCE: This study provides further evidence from a national sample to generalize the relationship between depression and vision loss to adults across the age spectrum. Better recognition of depression among people reporting reduced ability to perform routine activities of daily living due to vision loss is warranted. OBJECTIVES: To estimate, in a national survey of US adults 20 years of age or older, the prevalence of depression among adults reporting visual function loss and among those with visual acuity impairment. The relationship between depression and vision loss has not been reported in a nationally representative sample of US adults. Previous studies have been limited to specific cohorts and predominantly focused on the older population. DESIGN: The National Health and Nutrition Examination Survey (NHANES) 2005-2008. SETTING: Across-sectional, nationally representative sample of adults, with prevalence estimates weighted to represent the civilian, noninstitutionalized US population. PARTICIPANTS: A total of 10,480 US adults 20 years of age or older. MAIN OUTCOME MEASURES: Depression, as measured by the 9-item Patient Health Questionnaire depression scale, and vision loss, as measured by visual function using a questionnaire and by visual acuity at examination. RESULTS: In 2005-2008, the estimated crude prevalence of depression (9-item Patient Health Questionnaire score of >=10) was 11.3% (95% CI, 9.7%-13.2%) among adults with self-reported visual function loss and 4.8% (95% CI, 4.0%-5.7%) among adults without. The estimated prevalence of depression was 10.7% (95% CI, 8.0%-14.3%) among adults with presenting visual acuity impairment (visual acuity worse than 20/40 in the better-seeing eye) compared with 6.8% (95% CI, 5.8%-7.8%) among adults with normal visual acuity. After controlling for age, sex, race/ethnicity, marital status, living alone or not, education, income, employment status, health insurance, body mass index, smoking, binge drinking, general health status, eyesight worry, and major chronic conditions, selfreported visual function loss remained significantly associated with depression (overall odds ratio, 1.9 [95% CI, 1.6-2.3]), whereas the association between presenting visual acuity impairment and depression was no longer statistically significant. CONCLUSIONS AND RELEVANCE: Self-reported visual function loss, rather than loss of visual acuity, is significantly associated with depression. Health professionals should be aware of the risk of depression among persons reporting visual function loss. (2013 American Medical Association. All rights reserved.) |
Achievement of goals in U.S. diabetes care, 1999-2010
Ali MK , Bullard KM , Saaddine JB , Cowie CC , Imperatore G , Gregg EW . N Engl J Med 2013 368 (17) 1613-24 BACKGROUND: Tracking national progress in diabetes care may aid in the evaluation of past efforts and identify residual gaps in care. METHODS: We analyzed data for adults with self-reported diabetes from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to examine risk-factor control, preventive practices, and risk scores for coronary heart disease over the 1999-2010 period. RESULTS: From 1999 through 2010, the weighted proportion of survey participants who met recommended goals for diabetes care increased, by 7.9 percentage points (95% confidence interval [CI], 0.8 to 15.0) for glycemic control (glycated hemoglobin level <7.0%), 9.4 percentage points (95% CI, 3.0 to 15.8) for individualized glycemic targets, 11.7 percentage points (95% CI, 5.7 to 17.7) for blood pressure (target, <130/80 mm Hg), and 20.8 percentage points (95% CI, 11.6 to 30.0) for lipid levels (target level of low-density lipoprotein [LDL] cholesterol, <100 mg per deciliter [2.6 mmol per liter]). Tobacco use did not change significantly, but the 10-year probability of coronary heart disease decreased by 2.8 to 3.7 percentage points. However, 33.4 to 48.7% of persons with diabetes still did not meet the targets for glycemic control, blood pressure, or LDL cholesterol level. Only 14.3% met the targets for all three of these measures and for tobacco use. Adherence to the recommendations for annual eye and dental examinations was unchanged, but annual lipid-level measurement and foot examination increased by 5.5 percentage points (95% CI, 1.6 to 9.4) and 6.8 percentage points (95% CI, 4.8 to 8.8), respectively. Annual vaccination for influenza and receipt of pneumococcal vaccination for participants 65 years of age or older rose by 4.5 percentage points (95% CI, 0.8 to 8.2) and 6.9 percentage points (95% CI, 3.4 to 10.4), respectively, and daily glucose monitoring increased by 12.7 percentage points (95% CI, 10.3 to 15.1). CONCLUSIONS: Although there were improvements in risk-factor control and adherence to preventive practices from 1999 to 2010, tobacco use remained high, and almost half of U.S. adults with diabetes did not meet the recommended goals for diabetes care. |
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