The Relationship Between Visual Impairment and Mortality
Studies dating as far back as the 1930’s have reported associations between visual impairment, age-related ocular conditions and increased mortality. More recent meta-analyses of these accumulating studies have documented that persons living with visual impairment, cataract, and late AMD are at a small but significantly increased risk of mortality (pooled hazard ratio [HR] range: 1.20-1.55). Adults living with Type 1 or Type 2 diabetes and a diagnosis of diabetic retinopathy versus those without are at a larger increased risk of mortality (pooled HR: 2.57). The Ocular Epidemiology Research Group is presently working to summarize research findings and is developing a conceptual model that incorporates a life course perspective on the role of proximal and distal risk factor influences on the ocular system as a marker of aging processes which are in turn associated with increased mortality risk.Health Disparities in Visually Impaired Adults with Multimorbidity
This grant, lead by Ms. D. Diane Zheng, aims to identify chronic disease patterns and their relationship to visual impairment (1F31EY025936). It also seeks to estimate the associated mortality risk in nationally representative chronic disease population subgroups. It uses data from the National Health Interview Survey and the Medical Expenditure Panel Survey and employs latent class analyses and Cox hazard modeling. A recent related publication in JAMA Ophthalmology demonstrated that visual impairment is associated with poorer cognitive function both cross-sectionally and longitudinally. This paper received widespread media attention, being covered by 47 international news outlets.
University of Miami Vision Loss Prevention Translational Research Center
The University of Miami Vision Loss Prevention Translational Research Center was operated by the Ocular Epidemiology Research Group from 2010-2014 and funded by a contract from the Centers for Disease Control and Prevention. This center was part of a multi-site study and included multiple local projects:
- A comprehensive analysis of Bascom Palmer Eye Institute (BPEI) medical and billing records to determine treatment patterns for patients 40 years of age and older with the following disabling ocular conditions: age-related macular degeneration (AMD), cataract, diabetic retinopathy, and open-angle glaucoma, as a function of insurance status, insurance type, ocular diagnosis, and patient sociodemographic characteristics.
Dilated eye examination screening guideline compliance among patients with diabetes without a diabetic retinopathy diagnosis: the role of geographic access. BMJ Open Diabetes Res Care 2014, 2(1).
- An ancillary study to the Hispanic Community Health Survey/Study of Latinos in which we surveyed a sub-sample of Hispanics aged 40 years and older on healthcare utilization and barriers to care, knowledge of ocular healthcare visit recommendations and risk factors, and prevalence of reported ocular conditions and risk factors.
Factors Associated with Ocular Healthcare Utilization among Hispanics/Latinos: The Ocular SOL Ancillary to the Hispanic Community Health Study/Study of Latinos. JAMA Ophthal 2016, 134(3):320-9.
Ocular Screening Adherence Across Hispanic/Latino Heritage Groups with Diabetes: Results from the Ocular SOL Ancillary to The Miami Site of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). BMJ Open Diabetes Res & Care 2016, 10;4(1):e000236.
Eye Health Knowledge and Eye Health Information Exposure Among Hispanic/Latino Individuals: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). JAMA Ophthal 2017, 135(8): 878-882.
- As part of a network study with the other study sites, we conducted screenings for diabetic retinopathy at a local community clinic in order to determine the impact of opportunistic screening in a novel setting on referral and compliance with recommended eye examinations and to evaluate the cost-effectiveness of this screening modality.
Cost of a community-based diabetic retinopathy screening program. Diabetes Care 2014, 37(11): e236-7.
A multi-center diabetes eye screening study in community settings: study design and methodology. Ophthalmic Epidemiology 2016, 23(2):109-15.
- Expanding on the above network study we left the screening camera at the community clinic, letting clinic staff take over operation. We compared outcomes with the original project in terms of number screened per month, percent of photos with quality control issues, percent of those who screen positive, etc., the effectiveness of this type of screening at a Federally-Qualified Health Center.
- Provide an educational intervention to ocular healthcare physicians to better help their patients quit smoking. Additionally, we evaluated the effectiveness of this educational intervention and disseminate this training tool through key stakeholder groups. As part of this effort we also published a paper advocating for increased involvement in ocular healthcare providers in the reduction of smoking in their patients.
Evaluation of a Web-Based Training in Smoking Cessation Counseling Targeting U.S. Eye-Care Professionals. Health Educ Behav. 2018 Apr;45(2):181-189.
Smoking causes blindness: time for eye care professionals to join the fight against tobacco. IOVS 2015, 56(2): 1120-1.
- Conduct structural equation modeling to examine the influence of direct and indirect effects of visual impairment on mortality risk through novel pathways including allostatic load and activities of daily living. Data for this study came from the National Health and Nutrition Examination Survey.
Visual acuity and increased mortality: the role of allostatic load and functional status. IOVS 2014, 55(8): 5144-40.
- The Welcome to Medicare Pilot project, which assessed the interest and participation in a routine eye exam among patients at the University of Miami Hospital who have recently become eligible for Medicare and/or who completed their Welcome to Medicare visit. The primary objectives of this project were to:
Determine uptake of a complimentary comprehensive eye exam for individuals who are or will soon be eligible for Medicare, as indicated by attendance at the eye exam.
Obtain a preliminary estimate of the level of undiagnosed eye disease in this sample.
To assess patient experience/satisfaction with their comprehensive eye examination.