The burden of visual impairment among older persons is considerable, with especially high rates reported among nursing home residents. Causes of visual impairment are largely remediable with refraction and cataract surgery, or the functional impact lessened with appropriate low vision aids. Yet, no intervention trial to determine methods to improve visual status in nursing home residents has ever been carried out. Moreover, the impact of improving visual status on socialization and functional status in nursing homes is unknown. In this project the investigators propose to measure the impact on socialization, and a variety of other measures of function, of a visual impairment intervention program. Nursing homes will be randomized into a group receiving standard care and a group receiving a visual impairment intervention program, and outcomes compared at 6 and 12 months after the intervention. The intervention program consists of 3 tracks depending on the cause of vision loss: free refraction and subsidized spectacles; transportation in connection with cataract surgery; and free training and subsidized low vision aids. From 28 nursing homes on the Lower Eastern Shore of Maryland, the investigators will assess visual impairment and the causes of visual loss in the residents. They expect to identify 578 persons with presenting acuity worse than 20/40 in the better eye, and an equal sample of 578 persons with no visual loss. Baseline comparisons of difference between those with visual impairment and those with no visual loss will determine the impact of visual loss on functional status. Those with visual loss will be randomized, by nursing home, into treatment arms for prospective determination of the impact of impairment in visual status on function. The primary outcome measure is improved socialization scores, using a scale of observed resident behavior with nursing home staff respondents. Secondary outcomes include utilization of appropriate eye care services in both treatment arms, change in physical function and mobility, changes in depressive symptomatology, and changes in psychoactive drug use. Prospective change will be measured among intervention and control groups, including both visually impaired and non-impaired. The cost-effectiveness of the intervention strategy will be determined. Optimizing eye care services for nursing home residents will become increasingly important as the size of this population increases. This trial will answer timely questions of the impact on the functional status of the most frail elderly of modest, potentially sustainable inputs into improving the appropriate utilization of eye care services.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Human Development and Aging Subcommittee 3 (HUD)
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Johns Hopkins University
Schools of Medicine
United States
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Friedman, David S; Munoz, Beatriz; Roche, Karen Bandeen et al. (2005) Poor uptake of cataract surgery in nursing home residents: the Salisbury Eye Evaluation in Nursing Home Groups study. Arch Ophthalmol 123:1581-7
Friedman, David S; West, Sheila K; Munoz, Beatriz et al. (2004) Racial variations in causes of vision loss in nursing homes: The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) Study. Arch Ophthalmol 122:1019-24
West, Sheila K; Friedman, David; Munoz, Beatriz et al. (2003) A randomized trial of visual impairment interventions for nursing home residents: study design, baseline characteristics and visual loss. Ophthalmic Epidemiol 10:193-209
Friedman, David S; Munoz, Beatriz; Massof, Robert W et al. (2002) Grating visual acuity using the preferential-looking method in elderly nursing home residents. Invest Ophthalmol Vis Sci 43:2572-8
West, S K (2000) Looking forward to 20/20: a focus on the epidemiology of eye diseases. Epidemiol Rev 22:64-70