Background: Cognitive impairment (CI) may be overdiagnosed in individuals with vision impairment (VI) due to the vision-dependent design of current cognitive assessment tools. This cross-sectional study evaluated the acceptability and diagnostic accuracy (pilot) of the Visually Independent Test Battery of Neurocognition (VISION-Cog) protocol, against gold-standard neurologist diagnosis. Methods: Community-dwelling older adults with near binocular presenting VI (near visual acuity [NVA] ≥ 0.2 logarithm of the minimum angle of resolution [LogMAR] units) were recruited from the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study. Participants underwent VISION-Cog and the Singapore-validated Montreal Cognitive Assessment (MoCA-SG) testing and were referred for neurologist evaluation based on standardized referral protocols. The acceptability of the VISION-Cog was assessed through study completion rates, test duration, and the qualitative feedback. Vision-Cog’s diagnostic accuracy (pilot) against neurologist evaluation was analyzed using binary logistic regression and C-statistics to estimate area under the receiver operating curve (AUC) with corresponding sensitivity and specificity. Results: Out of forty-five participants (mean age [SD]: 73.8 [6.1 years]; mean NVA [SD]: 0.47 [0.14] LogMAR; and 54.1% female), 37 (82.2%) completed the protocol. The mean VISION-Cog completion time [SD] was 59 m 57 s (7 m 18 s). Qualitatively, participants found the testing time acceptable. The VISION-Cog achieved an AUC of 0.930 against neurologist diagnosis, with 100.0% sensitivity and 78.0% specificity. Conclusions:The VISION-Cog demonstrated satisfactory preliminary diagnostic accuracy and good acceptability indices in older Asian adults, supporting the need of larger studies to confirm its diagnostic accuracy of CI and clinical utility in those with VI.

Age-related macular degeneration (AMD) is a progressive retinal disease and a major cause of visual impairment in older adults. Non-neovascular AMD (non-nAMD), the more common phenotype, can substantially impair vision-related quality of life (QoL) even when visual acuity remains relatively preserved. The 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) is the most widely used instrument for assessing vision-related QoL in AMD. However, QoL in non-nAMD has not been systematically synthesised across disease stages and settings. This review aims to summarise vision-related QoL in treatment-naive patients with non-nAMD, examine how QoL varies by disease stage and measurement instrument and identify study-level factors associated with QoL differences. We will search MEDLINE, Embase, EBM Reviews and APA PsycINFO from inception for original studies reporting mean values or mean differences, with corresponding variability, for overall or subscale scores from the NEI-VFQ-25 or other validated vision-related QoL instruments. Two reviewers will independently screen studies, extract data and assess risk of bias using the appropriate Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Random-effects meta-analyses will be conducted to pool NEI-VFQ-25 composite and subscale scores by non-nAMD stage and, where available, to estimate differences between stages or versus controls. Instrument-specific meta-analyses will be performed for other QoL measures when feasible and standardised metrics will be used to combine instruments assessing similar constructs but using different scales. Meta-regression will explore whether QoL varies with study-level characteristics. The findings will clarify the functional burden of non-nAMD and support future clinical research and trial design.

Importance:While population-based surveys have identified a high prevalence of undiagnosed eye diseases among Asian adults, these studies were conducted more than a decade ago, and there is a paucity of contemporary data. Objectives:To determine the contemporary prevalence of undiagnosed age-related macular degeneration (AMD), diabetic retinopathy (DR), cataracts, and glaucoma and their shared risk determinants and to evaluate these conditions' patient-centered and economic burden in a large multiethnic cohort of older Asian adults. Design, Setting, and Participants:This cross-sectional cohort study was conducted among individuals from the Population Health and Eye Disease Profile in Elderly Singaporeans study (PIONEER-1, conducted from December 2017 to November 2022), a population-based cohort of community-dwelling individuals of Chinese, Malay, and Indian ethnicity aged 60 years or older living in Singapore. Data analysis was performed from April 2024 to December 2024. Exposures:The 4 eye diseases were diagnosed clinically by a study ophthalmologist; participants were considered undiagnosed if no prior physician diagnosis or related interventions were reported. Main Outcomes and Measures:One primary outcome, visual impairment (VI), was assessed clinically using the logMAR chart at 4 m by certified optometrists, while key patient-centered and economic outcomes were assessed using validated questionnaires. Results:This study was conducted among 1878 individuals from the PIONEER-1 study, among whom mean (SD) age was 72.7 (8.3) years and 1013 participants (53.9%) were female. A total of 742 participants (weighted prevalence: 35.8%) had at least 1 type of undiagnosed eye disease, with 650 participants (87.6%), 87 participants (11.7%), and 5 participants (0.7%) having 1, 2, and 3 conditions, respectively. Among individuals with AMD, DR, cataracts, or glaucoma, the weighted prevalences of undiagnosed disease were 89.8%, 89.8%, 40.8%, and 48.1%, respectively. Younger age (odds ratio [OR], 1.08 per year decrease; 95% CI, 1.06-1.10; P < .001), wearing multifocal glasses (OR, 1.75; 95% CI, 1.19-2.59; P = .005), and Malay (OR, 1.71; 95% CI, 1.21-2.43; P = .003) and Indian (OR, 1.43; 95% CI, 1.00-2.04; P = .05) ethnicities compared with Chinese individuals were associated with greater odds of having undiagnosed eye disease. Individuals with undiagnosed eye diseases reported -1.97% to -4.57% lower scores in health- and vision-related quality of life, as well as a greater likelihood of having VI (OR, 2.46; 95% CI, 1.68-3.61; P < .001). Additionally, undiagnosed individuals incurred 1.73-fold higher health care expenditures compared with those who were diagnosed (diagnosed: reference; undiagnosed: OR, 1.73; 95% CI, 1.06-2.84; P = .03). Conclusions and Relevance:In this cross-sectional cohort study, the rates of undiagnosed age-related eye diseases were relatively high, and these conditions were associated with poorer patient-centered outcomes and greater health care expenditure. These results support the use of community eye screening services and health awareness campaigns targeted toward individuals at the lower end of the older than 60 years spectrum and those of Malay and Indian ethnicities to mitigate the detrimental effects of undiagnosed eye diseases in these individuals.

Background: Age-related sensory impairments (SIs), including visual (VI), hearing (HI), and olfactory impairment (OI), may contribute to sarcopenia and functional decline, but their individual and cumulative effects remain unclear. Using the updated 2025 Asian Working Group for Sarcopenia (AWGS) criteria, we examined these associations in older adults. Methods: In this cross-sectional analysis of 2,267 adults aged ≥60 years from the population-based Population HEalth and Eye Disease PRofilE (PIONEER) cohort study in Singapore, visual acuity, hearing thresholds, and olfactory function were assessed using standardized protocols. VI was defined as better-eye logMAR >0.3, HI as better-ear pure-tone average >25 dB, and OI as Sniffin’ Sticks Identification Test score <11. Sarcopenia (AWGS 2025) was defined as the presence of low muscle mass and low muscle strength; gait speed was analysed as a functional outcome. Multivariable logistic regression models were used to assess associations of continuous and categorical SIs (single, dual, and multiple) with outcomes, adjusting for covariates. Findings: VI, HI, and OI prevalence were 20.3%, 73.0%, and 33.8%, respectively; sarcopenia prevalence was 48.8%. Poorer visual acuity (per 0.1 logMAR increase) was associated with higher odds of sarcopenia (odds ratio [OR] 1.11, 95% CI 1.04–1.18; p=0.002), low grip strength (1.10, 1.04–1.18; p=0.003), and slow gait speed (1.19, 1.08–1.33; p<0.001). Higher hearing thresholds (per 10 dB increase) were associated with sarcopenia (1.13, 1.01–1.27; p=0.03) and low grip strength (1.18, 1.05–1.32; p=0.005) but not gait speed. Olfactory function was not associated with outcomes. Multiple sensory impairment (MSI) showed the strongest associations with sarcopenia (2.26, 1.34–3.86) and low grip strength (2.12, 1.25–3.64), whereas only MSI was associated with slow gait speed (3.08, 1.15–10.71). No associations were observed for low muscle mass. Interpretation: VI and HI are independent correlates of sarcopenia and functional decline, whereas OI is not. Multisensory loss, particularly MSI, confers the greatest risk. Multisensory screening may improve identification of older adults at risk of sarcopenia.

Background: Minimally invasive glaucoma surgery, often performed with phacoemulsification (PHACO-MIGS), for the management of primary open angle glaucoma (POAG), has good clinical outcomes and safety profiles. However, few studies have comprehensively evaluated the impact of PHACO-MIGS on patients' quality of life (QoL). We determined the post-operative effectiveness of PHACO-MIGS on glaucoma-specific QoL domains in mild-moderate POAG patients. Methods: In this prospective study, adults aged ≥ 21 years with mild-moderate POAG in one eye scheduled for PHACO-MIGS at the Singapore National Eye Centre were administered a digital patient-reported outcome measure (PROM) that utilizes computerized adaptive testing (CAT) to precisely estimate glaucoma-specific QoL across 12 different domains (GlauCATTM), pre-surgery and at 6 months post-surgery. The 12 domains included the following: Visual Symptoms (VSs), Ocular Comfort Symptoms (OSs), Emotional (EM), Activity Limitation (AL), Driving (DV), Lighting (LT), Mobility (MB), Treatment Convenience (TCV), Concerns (CNs), Social (SC), General Convenience (GCV), and Economic (EC). Clinical variables collected included intraocular pressure (IOP), better eye visual acuity (VA), visual field deficit (VFD) and number of glaucoma drops prescribed. Linear mixed models were utilized to determine the within-group changes in each domain, adjusted for relevant clinical, treatment and sociodemographic variables. Results: Of the 83 patients (mean age ± SD: 70.84 ± 6.70 years; 65.1% male; 90.4% Chinese), 61 (73.5%) underwent PHACO-MIGS with Hydrus® Microstent, and 22 (26.5%) with iStent®inject. Mean (SD) improvements in VA and IOP were observed post-surgery (0.11 [0.15] LogMAR units and 1.35 [4.20] mmHg, respectively), while VFD and the average number of anti-glaucoma medications prescribed decreased by 0.90 (2.97) dB and 1.30 (0.11) drops (all p < 0.05). Compared to pre-operative scores, four GlauCATTM domains [VSs (13.04%, p < 0.001; ES: 0.84), OSs (6.42%, p < 0.001; ES: 0.52), CNs (7.53%, p = 0.002; ES: 0.51), and GCV (6.34%, p = 0.004; ES: 0.45)] showed significant improvements post-surgery. The improvements across these four domains were driven primarily by a reduction in IOP and improvements in VA. Conclusions: Using a novel and AI-driven QoL PROM, we found significant post-operative improvements in Visual and Ocular Comfort Symptoms, Convenience, and Concerns in patients with POAG undergoing combined PHACO-MIGS, driven by improvements in IOP and VA post-surgery.

We aimed to determine the prevalence, risk factors, patient-centered impact and health-related costs of three types of dual sensory impairment (DSI) in a multi-ethnic older Asian population. In this population-based, cross-sectional study (2017-2022) of 2048 Asian adults aged ≥ 60 years, vision, hearing and olfactory impairments (VI, HI and OI) were assessed using validated clinical tests. DSI types included: VI + HI, VI + OI, and HI + OI. Age-, sex-, and ethnicity-adjusted prevalence rates (2020 Singapore Census) were calculated. Regression analyses identified associated risk factors, impacts and healthcare costs. Of the 2048 participants (mean age ± standard deviation 75.7 ± 7; 49.5% female), prevalence rates of VI + OI, VI + HI, OI + HI were 1.0%, 7.3% and 21.7%, respectively. Older age (odds ratio[OR]1.22) and multimorbidity (OR3.74) were significantly associated with VI + HI, while older age (OR1.23), males (OR3.62), living alone (OR2.37) and current smoking (OR2.51) were associated with higher odds of OI + HI. VI + HI was associated with lower HRQoL-scores (β:- 0.026), while VI + HI (OR2.39) and OI + HI (OR2.10) were associated with lower IADL status. The OI + HI group showed a trend toward higher healthcare costs compared to those without. DSI, particularly OI + HI, is relatively prevalent in older Singaporean adults. Early identification and targeted screening of at-risk groups may mitigate adverse outcomes and healthcare cost, given the global ageing population.

To determine the associations between deficits in the visual function system, comprising visual acuity (VAI), contrast sensitivity (CSI), colour vision (CVI), depth perception (DPI) and visual field (VFI) impairments, as well as poor muscle health in an older Asian population. We used data from the baseline assessment of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER; 2017–2022) study. Visual function deficits included near visual acuity impairment (NVAI) (> N8), distance visual acuity impairment–DVAI (< 20/40 or > 0.3 logMAR), CSI (< 1.55 logCS), CVI (1 or more major crossings on Farnsworth D-15), DPI (≥ 150 arc sec) and VFI (Hodapp, Parish and Anderson criteria). Poor muscle health was defined as the presence of either low muscle mass (appendicular-lean-mass/height 2 of < 7 kg/m 2 for males and < 5.4 kg/m 2 for females), or low muscle strength (handgrip strength < 28 kg and < 18 kg, in men and women, respectively) or low physical performance (gait speed of < 1.0 m/s). Regression models were utilized to evaluate the associations between visual deficits and poor muscle health after adjusting for sociodemographic, clinical and lifestyle factors. Of the 2199 included participants (1105 Chinese, 580 Malays and 514 Indians; mean age ± SD: 72.9 ± 8.3 years; 54.3% female), 91.7% had poor muscle health. In multivariable analyses, DVAI (odds ratio [OR]: 2.01; 95%CI: 1.19, 3.40), NVAI (OR: 2.48; 95%CI: 1.31, 4.71), CSI (OR: 1.77; 95%CI: 1.18, 2.64) and CVI (OR: 1.95; 95%CI: 1.07, 3.59) were significantly associated with approximately twice the odds of poor muscle health. Moreover, the likelihood of poor muscle health significantly increased with the severity of visual function deficits (all p trend < 0.05). Participants with moderate–severe DVAI, NVAI, CSI and DPI had much higher odds (OR range: 2.24–5.78) of poor muscle health compared to those without these impairments. No associations were found between VFI and poor muscle health. The leading cause of VAI (near or distance) or CSI in those with poor muscle health was cataract (50.5%). Older adults with visual function deficits, especially moderate–severe impairment in DVAI, NVAI and CSI, have a much higher likelihood of poor muscle health. Importantly, most cases of VAI or CSI were treatable. These findings support targeted clinic-based assessment of visual function deficits and interventions (e.g., cataract surgery) as potential strategies for early prevention and management of poor muscle health.

There is rising public health concern surrounding dual sensory impairment (DSI), or comorbid hearing and vision impairments. Its global prevalence and the magnitude of its association with cognitive decline (CD) is unclear. Three databases were searched for epidemiological studies examining DSI prevalence or its association with CD. Independent reviewers selected studies, extracted data, and evaluated bias. Random-effects meta-analyses were performed. Projections were estimated using United Nations data. The population attributable fraction of DSI-associated CD was calculated. Among 43 studies with 5,246,796 participants, clinically assessed DSI prevalence was 5.50% (95% confidence interval [CI] = 2.88%-10.26%), with regional/ethnic/age variations. DSI prevalence is projected to increase by 27.2% from 2025 to 2050. Approximately 59.83% (95%CI = 41.03-76.12) of DSI patients had cognitive impairment. Baseline DSI was associated with incident CD (odds ratio [OR] = 1.72, 95%CI = 1.37-2.15). Globally, 3.81% (95%CI = 1.05-10.55) of incident CD may be attributed to DSI. DSI is globally prevalent, growing, and associated with CD, highlighting the need for better health policy and resource allocation. HIGHLIGHTS: The global prevalence of DSI is 5.50%, with geographical, ethnical and age variations. The prevalence of DSI rises with age and is projected to increase by 27.2% by 2050. Approximately 60% of individuals with DSI may have measurable cognitive impairment. DSI was associated with a 72% greater longitudinal risk of incident CD. Globally, 3.81% of CD cases may be attributable to DSI.

AIMS:We determined the rates, predictors, and barriers/facilitators of non-adherence to annual follow-up screenings for Diabetic Retinopathy (DR), nephropathy (DN) and foot complications (DFC) screening in primary care patients with type 2 diabetes. METHODS:This prospective, mixed-method, clinical study, included 934 patients (mean ± SD age 60.4 ± 9.4 years, 46.9 % women) who underwent DR/DN/DFC screenings (N = 2012 appointments). Logistic regression analysis determined the baseline predictors of non-adherence to follow-up screening (failure to attend annual follow-up screening within ± 4 months). Qualitative interviews on barriers/facilitators of screening adherence were conducted with 36/24 non-adherent/adherent patients and 9 healthcare professionals (HCPs). RESULTS:Non-adherence rates to DR, DFC and DN follow-up screening were 27.6 % (n = 186), 29.8 % (n = 225) and 12.7 % (n = 74), respectively. Predictors included higher total cholesterol (DR); poor self-rated Diabetes Control (DN); and higher satisfaction with diabetes support (DFC and DN). Better self-efficacy was protective (DFC). Poor HCP-patient communication and long waiting times were patient-reported barriers to adherence, while knowledge about benefits of diabetes complications screening was a facilitator. Time constraints prevented HCPs from reinforcing the importance of screening to patients. CONCLUSIONS:Non-adherence to diabetic microvascular complications follow-up screening was suboptimal in Singapore and driven by multi-faceted predictors and barriers. Targeted interventions are needed to improve follow-up screening adherence.

Purpose:To determine the prevalence, factors, temporal trends, and projections of glaucoma over 15 years among multiethnic older Asian adults aged 60 to 100 years. Methods:We included 2380 participants (mean [SD] age, 73.6 [8.5] years; 55.2% female) from the baseline phase of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER; 2017-2022) study. Comprehensive eye examinations and standardized questionnaires assessed sociodemographic, clinical, and lifestyle factors. Glaucoma and subtypes were defined using International Society of Geographical and Epidemiological Ophthalmology guidelines, with age-standardized prevalence rates based on the 2020 Singapore census. Logistic regression using generalized estimating equations identified risk factors, temporal trends were analyzed using population-based data, and projections utilized United Nations population data. Results:The census-adjusted glaucoma prevalence was 5.1%, comprising 3.4% primary open-angle glaucoma, 0.7% primary angle-closure glaucoma, and 1% secondary glaucoma. Prevalence was higher among Malays (6.5%) and Indians (6.2%) compared to Chinese (4.9%). Significant factors included older age (odds ratio [OR], 1.07), Malay ethnicity (OR, 2.07), higher intraocular pressure (OR, 1.14), longer axial length (OR, 1.20), cataract surgery (OR, 1.81), and polypharmacy (OR, 2.04). Over two decades, age-adjusted glaucoma prevalence in Singapore remained stable (5%-7%) but increased among Indians (3.65% in 2013 to 6.70% in 2022), likely due to the high rates of systemic diseases. Currently, ∼57,800 Singaporeans aged ≥60 years have glaucoma, projected to rise by 43%, reaching 85,800 by 2040. Conclusions:Glaucoma is common among older Singaporeans, with notable sociodemographic and modifiable clinical factors. Rising prevalence among Indians and the projected increase in cases underscore the need for targeted screening and early interventions.

PURPOSE:To optimize the psychometric properties of age-related macular degeneration (AMD) quality of life (QoL) item banks (IBs), and evaluate their performance using computerized adaptive testing (CAT) simulations. DESIGN:Cross-sectional, clinical study. METHODS:261 AMD patients answered 219 items within seven IBs: Activity Limitation (AL); Lighting (LT); Mobility (MB); Emotional (EM); Concerns (CN); AMD Management (AM); and Work (WK), referred to collectively as "MacCAT". The psychometric properties of each IB (e.g. measurement precision; item "fit"; differential item functioning (DIF)) were assessed using Rasch analysis. The mean number of items required for "high" and "moderate" measurement precision was determined using CAT simulations. RESULTS:Of the 261 participants (mean age 70.5 ± 7.6 years), 69 (26.4 %), 35 (13.4 %), 80 (30.7 %) and 77 (29.5 %) had no, early, intermediate and late AMD (better eye), respectively. AL, EM, CN and AM displayed good psychometric properties overall after collapsing response categories and deleting items for misfit and/or DIF. Despite similar reengineering efforts, LT and MB had suboptimal measurement precision but were retained due to otherwise good psychometric performances. Owing to unresolvable psychometric issues, WK was not considered further. Targeting for all IBs was suboptimal. In CAT simulations on the six remaining IBs, the mean number of items required per IB ranged from 8 (AL) to 13 (MB) for moderate, and 13 (AL) to19 (MB) for high measurement precision. CONCLUSIONS:Six IBs demonstrated acceptable psychometric properties and potential CAT efficiency, suggesting MacCAT provides a comprehensive measurement of the QoL impact of AMD and associated treatments. Further testing in larger clinical cohorts is needed.

Purpose:To optimize the psychometric properties of myopia refractive intervention quality of life (QoL) item banks (IBs), and evaluate their performance using computerized adaptive testing (CAT) simulations. Methods:In this clinical study, adults utilizing myopic refractive intervention modalities answered 204 items within seven IBs: Activity Limitation (AL); Comfort (CM); Concerns (CN); Convenience (CV); Emotional (EM); Mobility (MB); and Work (WK), referred to collectively as "MyoRICAT". The psychometric properties of each IB were assessed with Rasch analysis, and CAT simulations with 1000 respondents determined the average number of items needed to achieve moderate (standard error of measurement [SEM] = 0.387) and high (SEM = 0.30) precision levels. Results:Of the 291 participants (mean age 34.02 ± 11.04 years; 65.64% female), 61 (20.96%) wore spectacles only, 123 (42.27%) used both spectacles and contact lenses, and 107 (36.76%) underwent laser refractive surgery. AL, CM, CN, CV, and EM showed satisfactory psychometric properties after minor amendments. WK lacked measurement precision owing to certain items being applicable only to specific subsets of refractive modalities. This IB was therefore retained as a fixed length rather than a CAT operationalized scale. Conversely, MB demonstrated such poor targeting that it was not considered further. In CAT simulations, the mean number of items required per IB ranged from 10 (CV) to 12 (AL) for moderate, and 15 (CV) to 19 (AL) for high measurement precision. Conclusions:Five IBs demonstrated strong psychometric properties and potential CAT efficiency. Translational Relevance:MyoRICAT can provide a comprehensive measurement of the QoL impact of myopic refractive intervention modalities.

PurposeA psychometric evaluation of the Chinese Impact of Vision Impairment (C-IVI) questionnaire in an adult cohort with high myopia using Rasch Analysis and determination of the relationship between vision-related quality-of-life (VRQoL) and myopia macular degeneration (MMD).MethodsWe used the baseline visit data of the AIER-Singapore Eye Research Institute (SERI) High Myopia Adult Cohort Study. VRQoL was assessed using the 28-item C-IVI. Rasch analysis was conducted to evaluate the overall C-IVI and domain scores ('Mobility and independence'-MB, 'Reading and accessing information'-RD, and 'Emotional well-being'-EWB), including response category functioning, precision, unidimensionality, targeting, and differential item functioning (DIF). The criterion validity, C-IVI's ability to distinguish participants based on severity of vision impairment (VI), spherical equivalent (SER), and the presence of MMD were analyzed using ANOVA and pairwise t-tests.ResultsThere were 431 participants, with mean (SD) age of 42.2 (7.1) years, SER of -8.3 (3.8) D, and visual acuity of 0.1 (0.2) LogMAR. Of these, 15.8% presented MMD, 79.4%, 13.5%, 7.0%, and 0.2% had no, mild, moderate, and severe VI, respectively. Response thresholds were ordered for the overall and three domains. The overall range-based precision was 0.94, and 0.80 for each domain. The three domains demonstrated unidimensionality. DIF was uniform in overall and EWB, but not the MB and RD domains. Person estimates decreased with increasing VI severity, worsening SER, and presenting MMD (all p < 0.05) for the overall and domain scores.ConclusionsThe C-IVI questionnaire is a valid and reliable tool for assessing VRQoL in adults with high myopia in China.

BACKGROUND:We evaluated the prevalence of age-related macular degeneration (AMD) and its interplay with age in influencing vision-related quality of life (VRQoL) in older Asians. METHODS:We included 2361 participants aged 60-101 years from the Population Health and Eye Disease Profile in Elderly Singaporeans cross-sectional study (2017-2022). Early and late AMD were graded using the modified Wisconsin grading system. VRQoL was assessed using Rasch-transformed overall, visual functioning and emotional well-being scores of the Brief Impact of Visual Impairment questionnaire. We calculated the prevalence of AMD and used multivariable regression models to assess the associations between AMD and age on VRQoL. VRQoL reduction was deemed clinically meaningful if ≥0.5 SD of the cohort's baseline VRQoL scores. RESULTS:The overall prevalence of any, early and late AMD was 6.2%, 4.4% and 1.8%, respectively. The age-specific prevalence increased progressively with age; that is, any AMD (4.1%, 7.2%, 12.9%), early AMD (3.0%, 4.7%, 9.3%) and late AMD (1.1%, 2.5%, 3.5%) across the three age groups (60-79, 70-79 and 80+), respectively. Participants aged ≥80 with late AMD experienced 30.1%, 21.0% and 29.7% poorer overall, visual functioning and emotional well-being, respectively (all p≤0.001), compared with those aged 60-79 without AMD. Importantly, only those aged ≥80 with late AMD demonstrated both statistically and clinically meaningful VRQoL reductions. CONCLUSIONS:AMD is prevalent in ageing Asians and has a substantial impact on visual functioning and emotional well-being. Our findings support early detection of declining visual functioning and mental health and strategies to prevent progression to late-stage AMD in older patients.

Purpose:To determine the prevalence of under-corrected refractive error (UCRE) and its associated risk factors and patient-reported, health-related, and economic impact in a multiethnic cohort of older adults. Methods:This study included 2592 older participants from a population-based cohort study. UCRE was defined as an improvement of at least 0.2 logMAR in best-corrected distance visual acuity from presenting distance visual acuity (PDVA) in the better-eye with PDVA worse than 20/40 (>0.3 logMAR). Patient-reported and economic outcomes, including visual functioning and healthcare expenditures, were assessed using validated questionnaires. Prevalence was weighted according to Singapore's 2020 population census, and multivariable regression models were used to analyze the risk factors of UCRE and its association with patient-reported and economic outcomes. Results:The weighted prevalence of UCRE was 8%. Lower socioeconomic status (odds ratio [OR] = 2.98; P < 0.001) and greater spherical equivalent (per 0.50-D increase, OR = 1.07; P = 0.018) were associated with increased odds of UCRE, contributing 39.2% and 23.2%, respectively, of the total variance. UCRE was significantly associated with lower visual functioning scores (-5.7%; β = -0.22; P = 0.046), higher likelihood of loneliness (OR = 2.96; P = 0.015), slower gait speed (OR = 2.03; P = 0.02), and presence of sarcopenia (OR = 2.41; P < 0.001). Individuals with UCRE incurred 2.33-times higher healthcare costs (P = 0.05) compared to those without. Conclusions:One in 12 older Singaporeans had UCRE. Given the substantial adverse patient-centered and health-related impact and economic burden associated with UCRE, targeted vision screening, treatment for visual impairment, and public health education on the importance of regular eye examinations and wearing appropriate glasses are recommended to mitigate these challenges and reduce associated costs.

Purpose:Determine the prevalence and vision-related quality of life (VRQoL) effects of single and multiple visual function impairments (VFIs) in multi-ethnic older Asians. Methods:A total of 2380 participants from a population-based cohort study were included. Visual function comprised presenting visual acuity (VA), contrast sensitivity (CS), depth perception (DP), and color vision (CV). Rasch-transformed VRQoL was obtained using the Brief Impact of Visual Impairment questionnaire. Multiple linear regression explored the independent (mutually adjusting for each VFI) impact of bilateral single (VAI, CSI, CVI and DPI) and multiple (i.e., the co-occurrence of any two, three, or four bilateral VFI) VFIs on VRQoL. Dominance analysis estimated the relative contribution for each of the single VFI on VRQoL. Results:The prevalence of bilateral VAI, CSI, CVI, or DPI alone was 15.3%, 20.7%, 8.1%, and 23.5%, respectively, whereas for concurrent two, three and four bilateral VFIs was 11%, 4.1% and 1.6%, respectively. Participants with single bilateral VFI (except CVI) experienced poorer overall VRQoL (β -0.25 to -0.34; all p < 0.05) compared to those without. CSI had the largest contribution (25%), to the decline in overall VRQoL. As the number of concurrent bilateral VFIs increased, VRQoL progressively worsened (% decrements -12.26% to -25.61%; all P < 0.001) compared to no VFI. Conclusions:Bilateral single and multiple VFIs are prevalent in older Asians. CSI had the largest contribution to VRQoL decrements. There was a systematic worsening in VRQoL scores with an increase in concurrent bilateral VFI. Comprehensive visual function testing may be warranted to prevent the debilitating consequences of VFIs on healthy aging.

Yearly screening for microvascular complications of diabetes mellitus (DM), namely retinopathy (DR), nephropathy (DN), and foot complications (DFC), is recommended to reduce their incidence, and delay or prevent their progression. However, poor adherence to screening is common, but prospective data on the magnitude and predictors of non-adherence to DR, DN and DFC screening in Singapore are unavailable. The Understanding Non-Adherence to Diabetes Complications Screening (UNADS) study aims to determine the rates, predictors, clinical and economic impact of non-adherence to diabetic complications screening in patients with type 2 diabetes (T2DM) in Singapore. We describe the study methodology and participants’ baseline characteristics that may be associated with non-adherence to DM complications screening. In this prospective, mixed-methods, clinic-based study, patients who underwent DR, DN, and/or DFC screening and were offered an annual rescreening appointment, were recruited from six primary care centres. Patients’ sociodemographic, medical, clinical, and patient-reported characteristics were recorded at baseline. Non-adherence to DR/DN/DFC screening is defined as not attending the annual rescreening appointment within 4 months of the scheduled rescreening date. Adherence and clinical data will be recorded at 16-months post-enrolment. Additionally, selected participants and healthcare professionals will undergo qualitative interviews to elicit barriers/facilitators of adherence to rescreening. 974 eligible patients (2,123 screenings, median [IQR] age 61.0 [55.0-67.0] years, 52.9% male, 64.1% Chinese) consented and completed the baseline assessment. Of these, 75.4%, 61.9%, and 80.7% attended DR, DN and DFC screening, respectively. Most (81.4%) attended >1 complication screening on the same day; had received secondary or lower education (71.9%); had hypertension (73.4%) and dyslipidemia (85.1%); and 43.1% were obese (BMI>27.5 kg/m2). Median DM duration and HbA1c levels were 6.3 years and 6.9%, respectively. Over half (55.1%) had not received prior DM education. Furthermore, participants reported low levels of diabetes-related self-efficacy (1.4 [IQR 1.0-3.9] out of 5). At baseline, we have successfully enrolled almost 1000 patients with T2DM scheduled for annual DR/DN/DFC rescreening, and potential predictors of non-adherence to rescreening were systematically collected. Ongoing follow-up phases will focus on establishing the rates and associated modifiable predictors of non-adherence to DR/DN/DFC rescreening, which may inform programme initiatives.

Introduction: The concomitant impact of visual impairment (VI) and cognitive impairment (CI) on health-related quality of life (HRQoL) in older adults is unclear. We aimed to determine the synergistic effect of baseline VI and CI on HRQoL decline at 6 years in multiethnic Asians. Methods: We included Chinese, Malay, and Indian adults aged ≥60 years who participated in baseline (2004–2011) and 6-year (2011–2017) follow-up visits of the Singapore Epidemiology of Eye Diseases Study, a population-based cohort study in Singapore. Visual acuity (VA) was objectively measured at both visits, with VI defined as presenting VA >0.3 LogMAR in the better eye. CI was defined as Abbreviated Mental Test scores of ≤6 and ≤8 for individuals with ≤6 and >6 years of formal education, respectively. HRQoL was measured using the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. HRQoL decline was defined as the difference in the composite EQ-5D scores at baseline and 6-year follow-up and deemed clinically meaningful if the reduction was equal to or larger than the minimal clinically important difference. Multivariable linear regression assessed the independent associations and synergism (β interaction) between baseline VI and CI on EQ-5D decline. Results: Of the 2,433 participants (mean [SD] age: 67.6 [5.5]) at baseline, 559, 120, and 151 had VI only, CI only, and both impairments, respectively. HRQoL decline in individuals with baseline comorbid VI-CI was clinically meaningful and was 2.0 times (β = −0.044, 95% confidence interval: −0.077 to −0.010) and 3.7 times (β = −0.065, 95% confidence interval: −0.11 to −0.022) larger than those with VI only and CI only, respectively. Importantly, there was a significant synergism (β interaction = −0.048, 95% confidence interval: −0.095 to −0.001) between baseline VI and CI as predictors of HRQoL decline, suggesting that individuals having both conditions concurrently had a greater HRQoL reduction than the sum in those with VI alone and CI alone. The affected HRQoL domains included mobility and usual activities. Conclusions: Concomitant VI-CI potentiated HRQoL decline to a greater extent than the sum of individual contributions of VI and CI, suggesting synergism. Our results suggest that rehabilitative interventions such as the use of mobility aids and occupational therapy are needed to maintain HRQoL in older adults with concomitant VI-CI. Moreover, preventive interventions targeting at early detection and management of both VI and CI may also be beneficial.

AbstractBackgroundWe aim to determine the multiethnic patterns of the prevalence and associated factors of poor muscle health and its associated components in older Chinese, Malays, and Indian Asian adults.MethodsWe included 2199 participants (mean age ± SD: 72.9 ± 8.3 years; 54.3% female) from the baseline assessment of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER; 2017–2022) cohort study. Poor muscle health was defined as the presence of either low muscle mass (DEXA), or low muscle strength (handgrip strength), or low physical performance (gait speed). Its components include poor muscle function (low muscle strength and/or low physical performance without low muscle mass), pre‐sarcopenia (low muscle mass only), and any sarcopenia (low muscle mass with low muscle strength and/or low physical performance). Sociodemographic, clinical, and lifestyle factors were assessed using biochemistry, clinical tests, and validated questionnaires. Regression models were utilized to evaluate the independent risk factors of poor muscle health and its components.ResultsThe national census‐adjusted prevalence of poor muscle health (88%) was similar across the three ethnic groups. However, Chinese individuals had higher prevalence of pre‐sarcopenia and any sarcopenia, and a lower prevalence of poor muscle function compared with Indians or Malays. We observed ethnic differences in modifiable risk factors (low physical activity, diabetes, osteoporosis, and obesity) of poor muscle health and its components. Although obesity was protective of pre‐sarcopenia (RRR = 0.19, 95% CI: 0.11, 0.36) and any sarcopenia (RRR = 0.29, 95% CI: 0.18, 0.47) in the overall population and across ethnic groups, it was associated with 1.7 times (95% CI: 1.07, 2.67) the likelihood of poor muscle function in the entire population.ConclusionsAlmost 90% of community dwelling Singaporean aged ≥60 years have poor muscle health across the three ethnic groups with ethnic disparities in modifiable risk factors, highlighting an urgent need for community‐wide targeted interventions to promote muscle health.

Background and Objectives There is a paucity of data on the prevalence, risk factors, and impact of olfactory impairment (OI) on key health indicators and economic outcomes in Asian populations. We aimed to address these gaps in a population of community-dwelling older adults. Research Design and Methods We included 2 101 participants (mean age +/- standard deviation [SD]: 72.9 +/- 8.1 years; 55.1% women) from the baseline assessment of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study (2017-2022). Any OI was based on a score of <11 on the 16-item identification segment of the Sniffin' Sticks test battery; subcategorized into hyposmia (score 9-10) and anosmia (score <= 8). Sociodemographic, clinical, and lifestyle risk determinants, health indicators (health-related quality of life, depressive symptoms, daily caloric intake, frailty, and cognitive impairment), and economic outcomes (healthcare expenditure, productivity loss) were assessed via standardized clinical testing and validated questionnaires. Multivariable logistic and linear regression models were utilized to explore the risk factor profile of OI across its severity spectrum and its impact on health indicators and economic outcomes. Results The census-adjusted prevalence of any OI, hyposmia, and anosmia were 34.0%, 20.5%, and 13.5%, respectively. Older age and male gender were associated with increased likelihood of hyposmia and anosmia, while the presence of diabetes and >4 days/week alcohol consumption were associated with increased odds of having anosmia only (all p < .05). Both hyposmia and anosmia were also associated with more than twofold increased odds of having CI. Discussion and Implications Over a third of our community-dwelling older Singaporean population had OI, with 1-in-10 experiencing total olfaction loss. Those with OI had more than double the odds of having CI, regardless of its severity. Our results suggest the importance of community-based programs aimed at detecting and delaying the progression of OI in high-risk individuals.