Perception: vision

Perception - Vision (self-report)

LASA031 / LASA231
LASA604 / LASA704

Constructs: self-reported vision ability, self-reported vision ability with and without glasses/contact lenses, use of glasses/contact lenses, vision ability with and without glasses/contact lenses according to proxy, use of glasses/contact lenses according to proxy

Contact: Marieke Pronk and Ruth van Nispen

Background

Vision impairment in older adults
In general, four eye conditions or pathologies primarily cause vision impairment in older adults: cataract, diabetic retinopathy, glaucoma and age-related macular degeneration1. Cataract is a progressive retinal disorder causing blurred vision and impaired contrast sensitivity. Studies generally agree that cataract is the major cause of blindness, although surgical removal of the lens and the use of intraocular inserts can successfully eliminate cataract as the most prevalent cause of vision loss in Western countries.2 Diabetic retinopathy is the consequence of longstanding diabetes mellitus. It results in blurred, distorted vision of the central visual field and in some instances, causes detachment of the retina. Glaucoma is caused by malfunction of the eye’s drainage system and results in serious loss of the visual field. Age-related macular degeneration is the progressive loss of reading vision and sharp distance vision. It concerns a retinal disorder and affects the central part of the visual field whilst peripheral vision is usually unaffected. In most cases medical treatment can be performed to restore functional vision or slow down the progression of the eye condition. However, in many cases, the eye condition can still lead to low vision or blindness in late life.

Prevalence of vision impairment
Numerous studies investigated the prevalence of eye conditions causing low vision and blindness in older adults. The WHO defines low vision as a visual acuity of less than 6/18, but equal to or better than 3/60, or a corresponding visual field loss to less than 20 degrees in the better eye with the best possible correction. Blindness is defined as a visual acuity of less than 3/60, or a corresponding visual field loss to less than 10-degrees in the better eye with the best possible correction.3

 In developed countries, age and visual impairment (which includes both low vision and blindness) are strongly associated.4 Using the WHO definitions, Stevens et al. (2013)5 showed that the prevalence rates in older adults (aged 50 years and over) in Western Europe of visual impairment (moderate-to severe) and blindness are 3.7% (CI= 2.7-6.3) and 0.4% (CI=0.2-0.7) in men, respectively, and 5.2% (CI=3.6-8.6) and 0.8% (CI=0.5-1.1), respectively in women.

The LASA data show that of all older persons (60+), around 6% is moderately visually-impaired, and 2% is severely visually-impaired or blind.6

As a result of demographic aging, the number of (irreversible) visual impairments is expected to rise in the coming decades.

Dual sensory loss
A large number of older adults suffer from a combined impairment in hearing and vision, which is also known as dual sensory loss (DSL).7 The prevalence rate of DSL among older adults ranges from 4.7% to 9.7% in the general population. A higher prevalence rate (20% to 45%) was stated among adults in nursing homes, hospitals and low vision rehabilitation.8 Using LASA data, Vaal et al. reported relatively low DSL prevalence rates (weighted) of 1.4 (0.8-2.0) based on self-report and 0.6 (0.1-1.1) based on clinical measurements in older persons aged 65 years and over, and a prevalence rate of 0.1 (0-0.3) based on self-report (clinical measurement not available) in older persons aged 55-64 years old.9 Using data of 1396 visually-impaired patients (aged 50 years and over) of outpatient rehabilitation centers in the Netherlands and Belgium, Vreeken et al.10 found that 44,8% suffered from DSL. In addition, they found that hearing impairment (based on self-report) increased with age in a quadratic fashion, resulting in a DSL prevalence rate of around 77% in the aged over 90 years of age.

Vision impairment and impact on psychosocial and physical health
An acquired vision impairment can have a significant impact on the well-being of older adults.11 Visually impaired older adults participate less in society as compared to their peers,12 and a vision loss is associated with disabilities in activities of daily living, including bathing, dressing, eating, toileting and transferring, and with disabilities in instrumental activities of daily living, such as shopping, meal preparation, household maintenance and money management.13-15 Furthermore, the degree of loneliness is higher among visually impaired older adults, with a prevalence of 50% among these adults.16 Depression and anxiety symptoms are also common among visually impaired older adults.17 A successful psychosocial adjustment to a vision loss can be made by acceptance of the condition, a positive attitude, and social support.11

Measurement instruments in LASA

Self-reported vision ability (LASA*031)
A number of self-reported vision ability questions are administered in LASA. The questions originate from the OECD long-term disability indicator18. LASA also includes questions on hearing (see Documentation on Hearing), stuttering/lisping, and dyslexia. The OECD questions are also used in other large surveys focusing on public health problems (e.g.,19).

As an introduction to the Senses-section, the interviewer reads out loud the following instructions to the respondent:  ‘Now I would like to ask you something about hearing and vision. We would like to know how much difficulty you have with hearing and seeing. It concerns what you can normally do, with aids if necessary, such as glasses if you normally use these. It does not concern temporary/passing problems.’

Below are the questions about self-reported vision ability that the interviewer asks the respondent:

*sense02: Can you see well enough? (No I cannot; Yes, without difficulty; Yes, but with some difficulty; Yes, but with much difficulty)

*sense03 Can you read the normal, small print in the newspaper without glasses or contact lenses?

(see sense02 for response categories)

*sense04 Can you do this with glasses, contact lenses, or other reading aids, such as a reading magnifier? (No I cannot; Yes, without difficulty; Yes, but with some difficulty; Yes, but with much difficulty; Respondent does not have glasses/contact lenses)

*sense05 Can you recognize someone’s face from a distance of 4 meters without glasses or contact lenses? (see sense02 for response categories)

*sense06 Can you do this with glasses or contact lenses? (see sense04 for response categories)

Note: Waves B, C: For sense03 and sense05 applies that when the respondent answers with ‘No I cannot’,  only then questions sense04 and sense06 were administered.

Waves E,F,G,H, 2B, 3B: For sense03 and sense05 applies that when the respondent answers with ‘No I cannot’, ‘Yes, with some difficulty’, or ‘Yes, with much difficulty’, only then questions sense04 and sense06  were administered.

Scoring
The following scores are applied for the answer categories (so higher scores indicate worse vision):
Yes, without difficulty à 1 point; Yes, but with some difficulty à 2; Yes, but with much difficulty à 3; No I cannot à 4

Slight variations of the self-reported vision ability questions applied across LASA waves/cohorts
In the migrant (i.e., MB) cohort, questions sense03&04 and sense05&06 were merged into one question each:

* visus_kr Can you read the normal, small print in the newspaper, if necessary with glasses or contact lenses? (No I cannot; Yes, without difficulty; Yes, but with some difficulty; Yes, but with much difficulty)

*visus_gez Can you recognize someone’s face from a distance of 4 meters if necessary with glasses or contact lenses? (see visus_kr for answer categories)

In the 2B cohort, sense02 was not asked at all.

Use of glasses/contact lenses (LASA*031)
In all waves and cohorts (all but the Migrant cohort (MB)), use of glasses/contact lenses can be indirectly deduced from the two OECD questions mentioned above (sense03&04 and sense05&06).

In wave D to G, additionally, use of glasses/ lenses is asked directly in *sense01:

*sense01 Do you usually wear glasses/contact lenses? (yes/no)

The interpretation of ‘usually’  was left to the respondent. This may for instance be complicated in the situation when someone only uses glasses/lenses in particular situations (e.g., when they read).

In wave B and C, sense01 (Do you usually wear glasses/contact lenses?) was not asked. Instead, the interviewer was instructed to observe whether or not the respondent wore glasses at the moment of interviewing.

*sense07 Respondent wears glasses: observation (yes/no)

In the Migrant cohort (wave MB), no information about wearing glasses/contact lenses was asked at all.

Constructed variable: self-reported vision ability with and without glasses/contact lenses (LASA*231)
Two dichotomous variables are available of which one includes vision ability without glasses/lenses (sensev) and another includes vision ability while wearing glasses/lenses (sensevg). The sensev and sensevg variables concern vision ability in the two vision situations: vision ability to read small letters of the newspaper (sense03&04) and vision ability to recognize someone´s face at 4 meters (sense05&06). The score of sensevg only differs from sensev if the respondent indicated to have glasses/lenses in the follow-up question, AND the glasses/lenses caused less difficulty in this situation). In all other cases (i.e., when the respondent did not have glasses/lenses or the respondent vision was similar while wearing the glasses/lenses), the same score as in variable sensev was  adopted in sensevg. The following scores are possible in sensev and sensevg:

0: without or with some difficulty
1: > 1 item with some difficulty

The syntax according to which sensev and sensevg were constructed from the variables from LASA*031 is available here.

Constructed variable: self-reported vision ability; summed  vision score in 2 situations (LASA*031)
A score can be computed by summing the scores of questions on: vision to read small letters of the newspaper (sense03&04) and vision to recognize someone´s face at 4 meters (sense05&06). These two situations occur often in daily life and reflect near and more distant vision ability. They could be assumed to reflect daily life vision. Applying a summation yields scores ranging from 2-8 points (higher scores indicate more vision difficulty).

The summed score has been used as a confounder of the relationship between hearing and psychosocial health by Pronk et al.22. It has been used as a determinant of social network size in a study by Broese van Groenou et al.35. Two versions of the sum variable can be computed: one that accounts for use of glasses/contact lenses (incorporating sense04 and sense06), and one that does not.

The SPSS syntax for making this variable can be deduced from a syntax that is used to calculate this variable for self-reported hearing ability. This syntax can be accessed here.

Telephone interview with the Respondent or its Proxy (LASA*604 LASA*704)
Some of the respondents could not participate in the main / medical interview and thus could not provide data on their  vision. Additional data was asked via the telephone (i.e., as part of the more comprehensive telephone interview), to the respondent itself, or to his/her proxy.

The type of data differed across the waves:

B, 2B, 3B, and MB: No telephone interview administered.

Wave C: LASAC604: data from proxy AND respondent

ctrespt  Data from proxy or respondent? (Proxy/Respondent)

As an introduction to the Senses-section, the interviewer reads out loud the following instructions to the proxy/respondent: ‘I would like to ask you how … ‘s hearing and vision is. We would like to know how much difficulty … has. It concerns what he/she is normally able to, with aids if necessary, such as glasses.’

ctsight Did the vision of … change the last three years? (Much better, Better, The same, Worse, Much worse)

Wave D and E: LASA*604: data from Proxy, LASA*704: data from Respondent

*604: data from Proxy:

As an introduction to the Senses-section, the interviewer reads out loud the following instructions to the proxy/respondent:

‘I would like to ask you how … ‘s hearing and vision is. We would like to know how much difficulty … has. It concerns what he/she is normally able to, with aids if necessary, such as glasses.’

*tpsight Did the vision of … change the last 3 years? (Much better, Better, The same, Worse, Much worse)

*704: data from Respondent:

N.B. The questions below are exactly similar to *sense01, *sense03, and *sense04 from the main/medical interview.

Wave F, G, and H: LASA*604: data from Proxy LASA*704: data from Respondent

*604: data from Proxy

Instruction read out loud by the interviewer at the beginning of the senses section: ‘Now I would like to ask something about vision and hearing.'

*tpsen01 Does … usually wear glasses or does he/she have contact lenses? (yes/no)

*tpsens03 Can … read the normal, small print in the newspaper without glasses or contact lenses?

(No he/she cannot; Yes, without difficulty à skip next question; Yes, but with some difficulty; Yes, but with much difficulty; Respondent does not have glasses/contact lenses)

*trsen04 Can �do this with glasses, contact lenses, or other reading aids, such as a reading magnifier?

(No he/she cannot; Yes, without difficulty à skip next question; Yes, but with some difficulty; Yes, but with much difficulty; Respondent does not have glasses/contact lenses)

*704 data from Respondent:

N.B. The questions below are exactly similar to *sens(e)01, *sens(e)03, and *sens(e)04 from the main/medical interview.

Questionnaires
LASAB031 / LASAC031 / LASAD031 / LASAE031 / LAS2B031 / LASAF031 / LASAG031 / LASAH031 / LAS3B031 / LASMB031 / LASAI031
(B/C/D/E/2B/3B/MB: main interview, F/G/H/I: medical interview, in Dutch);

LASAC604 / LASAD604 / LASAE604 / LASAF604 / LASAG604 / LASAH604 / LASAI604 (telephone interview with PROXY, in Dutch)
LASAD704 / LASAE704 / LASAF704 / LASAG704 / LASAH704 / LASAI704 (telephone interview with RESP, in Dutch)

 in C also with respondent

Variable information
LASAB031 / LASAC031 / LASAD031 / LASAE031 / LAS2B031 / LASAF031 / LASAG031 / LASAH031 / LAS3B031 / LASMB031 / LASAI031;
LASAB231 / LASAC231 / LASAD231 / LASAE231 / LAS2B231 / LASAF231 / LASAG231 / LASAH231 / LAS3B231 / LASMB231 (in processing) / LASAI231
(pdf)

LASAC604 / LASAD604 / LASAE604 / LASAF604 / LASAG604 / LASAH604 / LASAI604
(pdf);
LASAD704 / LASAE704 / LASAF704 / LASAG704 / LASAH704 / LASAI704
(pdf)

Availability of information per wave 1

 

B

C

D

E


2B*

F

G

H



3B*
MB* I

Self-reported vision ability

Ma

Ma

Tel_r
Tel_p

Ma

Tel_r
Tel_p

Ma

Tel_r
Tel_p

Ma

Me

Tel_r
Tel_p

Me

Tel_r
Tel_p

Me

Tel_r
Tel_p

Ma

Ma

Me

Tel_r
Tel_p

Self-reported vision ability with and without glasses/ contact lenses

Ma

Ma

Ma

Ma

Ma

Me

Me

Me

Ma

Ma

Me

Use glasses/contact lenses

Ma

Ma

Tel_r
Tel_p

Ma

Tel_r
Tel_p

Ma

Tel_r
Tel_p

Ma

Me

Tel_r
Tel_p

Me

Tel_r Tel_p

Me

Tel_r
Tel_p

Ma

-

Me

Tel_r
Tel_p

1 More information about the LASA data collection waves is available here.

* 2B=baseline second cohort;
   3B=baseline third cohort;
   MB=migrants: baseline first cohort

Ma=data was collected in main interview;
Me=data was collected in medical interview;
Tel_r=data was collected in telephone interview with respondent;
Tel_p=data was collected in telephone interview with proxy

Previous use in LASA
The dichotomized scores (no difficulty or little difficulty versus much difficulty or cannot see) of questions whether respondents could “read the small print in a newspaper” or could “recognize someone’s face at a distance of 4 m”, were used to assess the association with falls and fractures in a study by de Boer et al. (2004).
The summed score of self-reported vision ability has been used as a confounder of the relationship between hearing loss and psychosocial health by Pronk et al. (2011 and 2014). Self-reported vision ability (average score of items on being able to read the small print in a newspaper and being able to recognize someone’s face at a distance of four meters (wearing glasses or contact lenses if needed) was used as a determinant of social network size in a study by Broese van Groenou et al. The questions being able to “read small print” (with or without glasses/contact lenses) were used to assess if vision is an important predictor of falls in a study by Tromp et al. (2001).

  • De Boer MR, Pluijm SMF, Lips P, Moll AC, Völker-Dieben HJ, Deeg DJH, van Rens GHMB. Different aspects of visual impairment as risk factors for falls and fractures in older men and women. Journal of bone and mineral research.2001;19(9):1539-1547.
  • Broese van Groenou, M., Hoogendijk, E. O., & Van Tilburg, T. G. (2013). Continued and new personal relationships in later life: differential effects of health. J Aging Health, 25, 274-295.
  • Pronk, M., Deeg, D. J. H., Smits, C., Van Tilburg, T. G., Kuik, D. J., Festen, J.M., & Kramer, S.E. (2011). Prospective effects of hearing status on loneliness and depression in older adults - Identification of subgroups. Int J Audiol, 50, 887-896. doi:10.3109/14992027.2011.599871.
  • Pronk, M., Deeg, D. J. H., Smits, C., Twisk, J.W., Van Tilburg, T. G., Festen, J. M., & Kramer, S. E. (2014). Hearing loss in older persons: Does the rate of decline affect psychosocial health? J Aging Health, 26, 703-723. DOI: 10.1177/0898264314529329.
  • Tromp AM, Pluijm SMF, Smit JH, Deeg DJH, Bouter LM, Lips P. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol. 2001; 54: 837-44.

References

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