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| ID | Type | Description | Link |
|---|---|---|---|
| REC reference: 24/SS/0021/AM01 | Other Identifier | South East Scotland Research Ethics Committee 01 | |
| IRAS project ID: 338463 | Other Identifier | Integrated Research Application System (IRAS) |
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| Name | Class |
|---|---|
| NHS Lothian | OTHER_GOV |
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The goal of this observational study is to define visual frailty and refine monitoring for an ageing population. It involves piloting a visual frailty assessment tool in a cohort of patients aged 60 and above with a known diagnosis of Age-related Macular Degeneration (AMD) in Princess Alexandra Eye Pavilion (PAEP), Anne Rowling Clinic which is hosting the NHS Low Visual Aid Clinic, or any other NHS Lothian facility treating patients with Age-related Macular Degeneration (AMD). The main questions it aims to answer are:
Participants will have the following data collected from them from either Princess Alexandra Eye Pavilion, Anne Rowling Clinic which is hosting the NHS Low Visual Aid Clinic, or any other NHS Lothian facility treating patients with Age-related Macular Degeneration (AMD):
Data will also be collected remotely (by phone call) from both the participants and their carers/relatives about their perceptions of visual frailty.
Expert opinion will be sought from optometrists and ophthalmologists about the concept of visual frailty using an online survey.
This is a mixed methods observational cross-sectional study that will consist of designing a tool to measure visual frailty and piloting it in a cohort of participants in the ageing population. The study will be implemented over a period of three years: literature review to define visual frailty and designing of the tool in the first year, recruitment of participants and performing a pilot and a validation study in the second year and thesis write-up in the final year.
Participants aged 60 and above with a known diagnosis of advanced Age-related Macular Degeneration (AMD) will be recruited from Princess Alexandra Eye Pavilion (PAEP) macular clinic, Anne Rowling Clinic which is hosting the NHS Low Visual Aid Clinic, or any other NHS Lothian facility treating patients with Age-related Macular Degeneration (AMD).
The visual frailty index will consist of results from visual acuity, reading performance, functional status, mental health and co-morbidities. This tool will be piloted in a cohort of 20 patients with advanced AMD. The internal consistency of the tool will be determined at this phase of the project.
In addition to visual frailty, physical frailty will also be assessed in this cohort to enable analysis and establishment of the relationship between the two.
The patients with AMD and their relatives/carers will be invited to participate in remote data collection about their perspectives on visual frailty.
Best corrected distance and near visual acuity will be assessed and recorded. Reading performance will consist of reading speed and reading acuity which will be automatically measured using Digital Radner that will be acquired and installed before the implementation of the study.
Functional status will be assessed using Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale.
Mental health will consist of depression, anxiety, and cognitive impairment that will be assessed using General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Six-item Cognitive Impairment Test (6-CIT) respectively. All these are validated tools.
Physical frailty will be assessed using the FRAIL scale which relies on functions of fatigue, resistance, ambulation, illnesses and loss of weight.
Information about co-morbidities will be retrieved from the patients' health record through National Health Service (NHS) Lothian.
The data to be collected remotely from both the patients and their relatives/carers will be done through a phone call which will be scheduled during the hospital appointment. These calls will be recorded for analysis. They will then be transcribed verbatim, coded, and themes will be generated during the analysis.
In addition to defining and designing a tool to measure visual frailty, expert input will be sought from optometrists and ophthalmologists about this topic using an online survey.
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| Measure | Description | Time Frame |
|---|---|---|
| Visual frailty | This will be assessed in units of visual frailty index. This is a pilot study and the visual frailty index will be derived from the results from the outcomes measures described below. These outcome measures include visual acuity, reading performance, functional status, mental health, and co-morbidities. | Within the first day of enrollment into the study. |
| Measure | Description | Time Frame |
|---|---|---|
| Visual acuity | Visual acuity will be assessed using logMAR charts and will be recorded in logMAR units. | Within the first day of enrollment into the study. |
| Reading performance | To be assessed using Digital Radner. The results will be recorded in terms of reading speed (measured in words per minute) and reading acuity (measured in logRAD) |
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Inclusion Criteria:
Exclusion Criteria:
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Participants aged 60 and above with a known diagnosis of advanced Age-related Macular Degeneration (AMD) will be recruited from Princess Alexandra Eye Pavilion (PAEP) macular clinic.
Their relatives or carers will also participate in the study but their data will be collected remotely. The term relatives/carers will be restricted to spouses/partners or children of the patients with advanced AMD.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Godfrey Wanok, BSc (Hons) Optom; MSc PCO | Contact | +447442374789 | W.Godfrey@sms.ed.ac.uk | |
| Baljean Dhillon | Contact | Baljean.Dhillon@ed.ac.uk |
| Name | Affiliation | Role |
|---|---|---|
| Peter Cackett | Princess Alexandra Eye Pavilion | Principal Investigator |
| Ian Underwood | School of Engineering, University of Edinburgh | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Princess Alexandra Eye Pavilion | Not yet recruiting | Edinburgh | Scotland | EH3 9HA | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19091416 | Background | Rahi JS, Cumberland PM, Peckham CS. Visual impairment and vision-related quality of life in working-age adults: findings in the 1958 British birth cohort. Ophthalmology. 2009 Feb;116(2):270-4. doi: 10.1016/j.ophtha.2008.09.018. Epub 2008 Dec 16. | |
| 18653592 | Background | Polack S, Kuper H, Wadud Z, Fletcher A, Foster A. Quality of life and visual impairment from cataract in Satkhira district, Bangladesh. Br J Ophthalmol. 2008 Aug;92(8):1026-30. doi: 10.1136/bjo.2007.134791. |
| Label | URL |
|---|---|
| Ageing published by The United Nations | View source |
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The anonymised data from the results section will be made available.
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| ID | Term |
|---|---|
| D000073496 | Frailty |
| D008268 | Macular Degeneration |
| D000092862 | Psychological Well-Being |
| D003863 | Depression |
| D001008 | Anxiety Disorders |
| D060825 | Cognitive Dysfunction |
| D014786 | Vision Disorders |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012162 | Retinal Degeneration |
| D012164 | Retinal Diseases |
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| Within the first day of enrollment into the study. |
| Functional status | To be assessed using Lawton and Brody Instrumental Activities of Daily Living scale. The score on this scale ranges from 0 to 8 for women and 0 to 5 for men. The lower value (0) corresponds to low function or being dependent while the highest values (8 or 5) correspond to high function or being independent. | Within the first day of enrollment into the study. |
| Mental health (Depression) | This will be assessed using Patient Health Questionnaire -9 tool. The scores are classified as: 1-4: Minimal depression; 5-9: Mild depression; 10-14: Moderate depression; 15-19: Moderately severe depression; and 20-27: Severe depression | Within the first day of enrollment into the study. |
| Mental health (Anxiety) | This will be assessed using the Generalized Anxiety Disorder - 7 tool. The scores are classified as: 0-4: Minimal anxiety; 5-9: Mild anxiety; 10-14: Moderate anxiety; and 15-21: Severe anxiety | Within the first day of enrollment into the study. |
| Mental health (Cognitive Impairment) | This will be assessed using the 6-item Cognitive Impairment Test. The score ranges from 0 to 28 in which 0-7 are considered normal and 8 or more are considered to be more significant. | Within the first day of enrollment into the study. |
| Co-morbidities | These will be collected from the medical records of participants and a simple count of the conditions will be used. | Within the first day of enrollment into the study. |
| Physical frailty | This will be assessed using the frail scale which relies on functions of fatigue, resistance, ambulation, illnesses and loss of weight. The scores range from 0 to 5. A score of 0 represents robust health status; 1-2 means participant is pre-frail; and 3-5 means the participant is Frail. | Within the first day of enrollment into the study. |
| Correlation between visual frailty and physical frailty | Results of visual frailty and physical frailty will be analysed to establish the correlation between the two. | This will be done immediately after assessment of both visual frailty and physical on the first day. |
| Correlation between Age-related macular degeneration and frailty | Age-related macular degeneration stage will be retrieved from the medical records and frailty will be assessed using the FRAIL scale which relies on functions of fatigue, resistance, ambulation, illnesses and loss of weight. | This will be done immediately after assessment of physical frailty on the first day. |
| Perception about visual frailty | This qualitative data will be remotely collected through a phone call from both the patients with AMD and their relatives/carers | Within 4 weeks from the assessment date of visual frailty. |
| Expert opinion about visual frailty | This will be collected via an online survey from optometrists and ophthalmologists. | From enrolment to the end of the study, an average of approximately 3 months. |
| Anne Rowling Clinic | Recruiting | Edinburgh | United Kingdom |
|
| 26382936 | Background | Peters D, Heijl A, Brenner L, Bengtsson B. Visual impairment and vision-related quality of life in the Early Manifest Glaucoma Trial after 20 years of follow-up. Acta Ophthalmol. 2015 Dec;93(8):745-52. doi: 10.1111/aos.12839. Epub 2015 Sep 18. |
| Background | Dzenana RA, Smaila H. Quality of life of elderly people with visual impairment in relation to the degree of visual impairment. Human Research in Rehabilitation. 2022, DOI: 10.21554/hrr.042207 |
| 32056745 | Background | Rahman MS, Rahman MA, Ali M, Rahman MS, Maniruzzaman M, Yeasmin MA, Ahmed NAMF, Abedin MM, Islam SMS. Determinants of depressive symptoms among older people in Bangladesh. J Affect Disord. 2020 Mar 1;264:157-162. doi: 10.1016/j.jad.2019.12.025. Epub 2019 Dec 16. |
| 33002726 | Background | Dong X, Ng N. Contribution of multiple pathways to the relationship between visual impairment and depression: Explaining mental health inequalities among older Chinese adults. J Affect Disord. 2021 Jan 1;278:350-356. doi: 10.1016/j.jad.2020.09.068. Epub 2020 Sep 14. |
| 33299297 | Background | Demmin DL, Silverstein SM. Visual Impairment and Mental Health: Unmet Needs and Treatment Options. Clin Ophthalmol. 2020 Dec 3;14:4229-4251. doi: 10.2147/OPTH.S258783. eCollection 2020. |
| 25603915 | Background | Court H, McLean G, Guthrie B, Mercer SW, Smith DJ. Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study. BMC Med. 2014 Oct 17;12:181. doi: 10.1186/s12916-014-0181-7. |
| 36293591 | Background | Itokazu M, Ishizaka M, Uchikawa Y, Takahashi Y, Niida T, Hirose T, Ito A, Yakabi A, Endo Y, Sawaya Y, Igawa T, Kobayashi K, Hara T, Watanabe M, Kubo A, Urano T. Relationship between Eye Frailty and Physical, Social, and Psychological/Cognitive Weaknesses among Community-Dwelling Older Adults in Japan. Int J Environ Res Public Health. 2022 Oct 11;19(20):13011. doi: 10.3390/ijerph192013011. |
| 14971577 | Background | Klein BE, Klein R, Knudtson MD, Lee KE. Relationship of measures of frailty to visual function: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2003;101:191-6; discussion 196-9. |
| 9596502 | Background | Klaver CC, Wolfs RC, Vingerling JR, Hofman A, de Jong PT. Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol. 1998 May;116(5):653-8. doi: 10.1001/archopht.116.5.653. |
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| 31465753 | Background | Varadaraj V, Lee MJ, Tian J, Ramulu PY, Bandeen-Roche K, Swenor BK. Near Vision Impairment and Frailty: Evidence of an Association. Am J Ophthalmol. 2019 Dec;208:234-241. doi: 10.1016/j.ajo.2019.08.009. Epub 2019 Aug 26. |
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| WHO- Blindness and vision impairment | View source |
| Eye frailty Awareness by the Japan Ophthalmology Society | View source |
| D005128 | Eye Diseases |
| D010549 | Personal Satisfaction |
| D001519 | Behavior |
| D001526 | Behavioral Symptoms |
| D001523 | Mental Disorders |
| D003072 | Cognition Disorders |
| D019965 | Neurocognitive Disorders |
| D012678 | Sensation Disorders |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |