OSLI Retina

May 2020

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262 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C L I N I C A L S C I E N C E ■ Assessment of Eye Disease and Visual Impairment in the Nursing Home Population Using Mobile Health Technology Krystal Y. Lai, BS; Mythili P. Pathipati, MD; Mark S. Blumenkranz, MD; Loh-Shan Leung, MD; Darius M. Moshfeghi, MD; Brian C. Toy, MD; David Myung, MD, PhD BACKGROUND AND OBJECTIVE: To characterize the burden of eye disease and the utility of teleoph- thalmology in nursing home patients, a population with ophthalmic needs not commensurate with care received. PATIENTS AND METHODS: Informed consent was ob- tained from 78 California Bay Area skilled nursing facility patients. Near visual acuity (VA) and ante- rior/posterior segment photographs were taken with a smartphone-based VA app and ophthalmic camera system. The Nursing Home Vision-Targeted Health- Related Quality of Life questionnaire was also ad- ministered. Risk factors for visual impairment were assessed. Institutional review board approval was ob- tained from Stanford University. RESULTS: Cataracts (51%), diabetic retinopathy (DR) (12%), optic neuropathy (12%), and age-relat- ed macular degeneration (AMD) (10%) were com- mon findings; 11.7% had other referral-warranted findings. AMD and DR correlated with a higher risk of poor VA, with adjusted odds ratios of 22 (P = .01) and 43 (P = .004). CONCLUSIONS: This study demonstrated a high prevalence of poor VA and ophthalmic disease in the nursing home population impacting quality of life. Smartphone-based teleophthalmology plat- forms have the potential to increase access to eye care for nursing home patients. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:262-270.] INTRODUCTION According to the World Health Organization, adults older than 50 years of age are at higher risk for vision impairment. 1 Prevalence of vision impairment is even higher in nursing homes, where a significant number of these adults reside. Compared to their noninstitution- alized peers, nursing home residents have a three- to 15-fold increase in incidence of visual impairment, depending on the geographical population and study setting. 2-6 Rates of ophthalmic disease are also high in this population, with one study finding incidences in nursing home residents of cataract, macular degenera- tion, and glaucoma to be 37% to 54%, 7% to 29%, and 4% to 10%, respectively. 7,8 Decreased visual function has been found to di- minish quality of life through decreased functional ability as measured by the Barthel index, decreased From Byers Eye Institute, Stanford University, Palo Alto, California (KYL, MPP, MSB, LSL, DMM, DM); VA Palo Alto Health Care System, Palo Alto, California (LSL, DM); and Roski Eye Institute, Department of Ophthalmology, University of Southern California, Los Angeles, California (BCT). Originally submitted February 27, 2020. Revision received February 27, 2020. Accepted for publication March 26, 2020. Presented in part at the 2016 American Academy of Ophthalmology Conference in Chicago, October 15-18, 2016. Supported by unrestricted grants to the Departments of Ophthalmology at both Stanford and USC from Research to Prevent Blindness (RPB), New York, New York, and a departmental P30-EY026877 core grant to Stanford from the National Eye Institute. Dr. Blumenkranz is a member of the board of directors of Verana Health. Dr. Moshfeghi reports the following disclosures: Akebia (SAB), Bayer (steering committee), Congruence Medical (consultant), dSENTZ (founder, director, equity), Genentech (research), Grand Legend Technologies (equity), Iconic Therapeutics (steering committee, consultant), Linc (founder, equity), Novartis (DMC, consultant), Pr3vent (founder, equity), Promisight (SAB, equity), Pykus (SAB, equity), Regeneron (consultant, steering committee), Versl (founder, equity), Visunex (consultant, equity). Dr. Toy has received non-financial sup- port from Verana Health (formerly Digisight Technologies) during the conduct of the study, as well as personal fees from Eleusis Ltd., Mallinckrodt Inc., and Advanced Clinical outside the submitted work. Dr. Myung has a patent on the ophthalmic camera technology used in this study, but no active commercial relationship with the company (Verana Health) that commercialized the technology. Dr. Moshfeghi did not participate in the editorial review of this manuscript. Address correspondence to David Myung, MD, PhD, Byers Eye Institute, Stanford University, 2452 Watson Court, 9 Palo Alto, CA 94303; email: dj- myung@stanford.edu; and Brian Toy, MD, Roski Eye Institute, USC School of Medicine, 1450 San Pablo St., 4th Floor, Los Angeles, CA 90033; email: brian. toy@med.usc.edu. doi: 10.3928/23258160-20200501-03

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