The following population-based, cross-sectional study of 1179 participants aged 60 to 80 years from the Singapore Malay Eye study was conducted to describe the associations of visual impairment and major age-related eye diseases with cognitive function in an older Asian population.

Visual acuity was measured using the logMAR vision chart and cataract and age-related macular degeneration (AMD) were graded using the Wisconsin Cataract Grading System and the Wisconsin Age-Related Maculopathy Grading System, respectively. Additionally, glaucoma was diagnosed using the International Society Geographical and Epidemiological Ophthalmology criteria and diabetic retinopathy was graded using the modified Airlie House classification system. Cognitive dysfunction was defined as a locally validated Abbreviated Mental Test using education-based cutoff scores.

After adjusting for age, sex, education level, income, and type of housing, persons with visual impairment before refractive correction (odds ratio [OR] = 2.59; 95% CI, 1.89–3.56) or after refractive correction (OR = 1.96; 95% CI, 1.27–3.02) and those with visual impairment due to cataract (OR = 2.75; 95% CI, 1.35–5.63) were more likely to have cognitive dysfunction. Only moderate to severe diabetic retinopathy was independently associated with cognitive dysfunction (OR = 5.57; 95% CI, 1.56–19.91) after controlling for concurrent age-related eye diseases. Furthermore, no significant independent associations were observed between cataract, AMD or glaucoma and cognitive dysfunction.

It was determined that older persons with visual impairment, particularly those with visual impairment due to cataract, were more likely to have cognitive dysfunction. Among the major age-related eye diseases, only diabetic retinopathy was associated with cognitive dysfunction.

Researchers in London sought to assess the ability of patients to predict the need for retreatment with intravitreal ranibizumab in neovascular age-related macular degeneration (NVAMD) based on their perception of visual deterioration or distortion of objects in their everyday environment (environmental Amsler).

They gave a questionnaire to 89 patients undergoing optical coherence tomography (OCT)-guided retreatment with intravitreal ranibizumab for NVAMD following an initial loading regimen of three injections and with at least 12-month follow up. Then they recorded the patient's opinion on the need for an injection on the current visit, based on their perception of change in environmental Amsler. The researchers compared this subjective measure with the objective evaluation of retreatment, based on predefined retreatment criteria comprising of changes in visual acuity and morphological changes on OCT. They then instructed the patients on the technique of environmental Amsler, and this evaluation was repeated. At baseline and after the training, they analyzed the sensitivity and specificity of patient prediction.

According to the researchers, the ability of patients to predict disease activity at baseline showed a sensitivity of 61% and specificity of 96.6%. They noted that the area under the receiver operating characteristic curve was 0.8 and that the presence of macular fluid correlated well with the patient's perception of an abnormal environmental Amsler. After training, the sensitivity and specificity improved to 87.5% and 98.5%, respectively.

In real life, most patients are able to predict the reactivation of the disease in NVAMD, after 12-month follow-up, after training to monitor their symptoms using the environmental Amsler test.

The authors of the following Australian study followed 1,192 cataract surgical patients aged ≥65 for 12 months postoperatively to assess cataract surgery visual outcomes 12 months postoperatively in patients with diabetes, with or without diabetic retinopathy (DR), compared to patients without diabetes.

They took standardized pre- and postoperative pinhole LogMAR visual acuity (VA) measurements and determined VA improvement by comparing VA after 12 months to preoperative VA.

They reported that of 1,192 surgical patients, 324 (27.2%) had diabetes, of whom, 136 (42.0%) had DR. After adjusting for age, gender, diabetes duration and preoperative pinhole VA, the average VA gained 12 months after surgery was 10.8 letters among 868 patients without diabetes, 10.6 letters among 188 patients with diabetes but no DR, 10.0 letters among 95 patients with DR but no past laser treatment, and no letters among 41 patients with DR plus past laser treatment (p<0.0001, compared to the other three groups). The study authors associated diabetes duration ≥20 years with mean VA gain of 3 fewer letters than duration <10 years (7 versus 10 letters, p=0.023), after adjusting for age, gender, DR and preoperative pinhole VA.

To conclude, cataract surgery improved VA by an average two lines for patients both with and without diabetes, or with DR but no past laser treatment. No significant VA improvement was evident for patients who had preoperative DR and laser therapy.

In London, investigators aimed to obtain prevalence estimates of age-related macular degeneration (AMD; late, geographic atrophy, neovascular) by age and gender among populations of European ancestry taking into account study design and time trends.

They conducted a systematic review of population-based studies published by September 2010 with quantitative estimates of geographic atrophy (GA), neovascular (NV) and late AMD prevalence. They identified studies by a literature search of MEDLINE (from 1950), EMBASE (from 1980) and Web of Science (from 1980) databases. For their participants, they used data from 25 published studies (57,173 subjects: 455 with GA, 464 with NVAMD, and 1,571 with late AMD). The method used was Bayesian meta-regression of the log odds of AMD with age, gender and year of study allowing for differences in study design characteristics to estimate prevalences of AMD (late, GA, NVAMD) along with 95% credible intervals (CrI). Main outcome measures were log odds and prevalence of AMD.

The investigators reported that there was considerable heterogeneity in prevalence rates between studies; for late AMD, 20% of the variability in prevalence rates was explained by differences in age and 50% by study characteristics. They also noted that prevalence of AMD increased exponentially with age (odds ratio [OR], 4.2 per decade; 95% CrI, 3.8–4.6), which did not differ by gender. There was some evidence to suggest higher risk of NVAMD in women compared with men (OR, 1.2; 95% CrI, 1.0–1.5). The study investigators also found that compared with studies using fundus imaging and international classification systems, studies using fundus imaging with alternative classifications were more likely (OR, 2.7; 95% CrI, 1.1–2.8), and studies using alternative classifications without fundus imaging most likely to diagnose late AMD (OR, 2.9; 95% CrI, 1.3–7.8). There was no good evidence of trends in AMD prevalence over time. Estimated prevalence of late AMD is 1.4% (95% CrI, 1.0% –2.0%) at 70 years of age, rising to 5.6% (95% CrI, 3.9% –7.7%) at age 80 and 20% (95% CrI, 14% –27%) at age 90.

In conclusion, studies using recognized classifications systems with fundus photography reported the lowest prevalences of AMD taking account of age and gender, and were stable over time, with a potentially higher risk of NVAMD for women. These prevalence estimates can be used to guide health service provision in populations of European ancestry.