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document
Differences in vision between clinic and home and the effect of lighting in older adults with and without glaucoma . IMPORTANCE Patients often report greater visual difficulties at home than expected from vision testing in the clinic . Such discordance may be owing to worse vision in the home than measured in clinic . OBJECTIVE To compare vision measured between the clinic and home and evaluate factors , including lighting , associated with these differences . DESIGN , SETTING , AND PARTICIPANTS This cross-sectional study conducted from 2005-2009 involved 126 patients with glaucoma and 49 without glaucoma recruited from the Glaucoma and Comprehensive Eye Clinics at Washington University , St Louis , Missouri . Patients underwent clinic and home visits , were aged 55 to 90 years , were consecutively recruited , and met inclusion criteria for this study . A total of 166 eligible patients refused participation . EXPOSURE Participants underwent clinic and home visits randomized to order of completion . At each visit , masked and certified examiners measured binocular distance visual acuity ( DVA ) with a nonbacklit chart , near visual acuity ( NVA ) , contrast sensitivity ( CS ) , CS with glare , and lighting . MAIN OUTCOMES AND MEASURES Differences in vision between the clinic and home . RESULTS The mean scores for all vision tests were significantly better in the clinic than home for participants with and without glaucoma ( P < .05 , matched-pair t tests ) . For DVA , 29 % of participants with glaucoma read 2 or more lines better in the clinic than home and 39 % with advanced glaucoma read 3 or more lines better . For the entire sample , 21 % of participants read 2 or more lines better in the clinic than home for NVA and 49 % read 2 or more triplets better in the clinic for CS with glare . Lighting was the most significant factor associated with differences in vision between the clinic and home for DVA , NVA , and CS with glare testing ( P < .05 , multiple regression model ) . Median home lighting was 4.3 times and 2.8 times lower than clinic lighting in areas tested for DVA and NVA , respectively . Home lighting was below that recommended in 85 % or greater of participants . CONCLUSIONS AND RELEVANCE Vision measured in the clinic is generally better than vision measured at home , with differences mainly owing to poor home lighting . Knowledge that vision discrepancies between patient report and clinical testing may be owing to home lighting may initiate clinician-patient discussions to optimize home lighting and improve the vision of older adults in their homes .
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Intervention_Educational
Participants underwent clinic and home visits
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Intervention_Physical
At each visit , masked and certified examiners measured binocular distance visual acuity ( DVA ) with a nonbacklit chart , near visual acuity ( NVA ) , contrast sensitivity ( CS ) , CS with glare , and lighting
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Participant_Age
older adults
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Participant_Condition
without
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Participant_Sample-size
126
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Participant_Condition
glaucoma
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Participant_Sample-size
49
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Participant_Condition
without glaucoma
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Participant_Age
55 to 90 years
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Participant_Sample-size
166
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Participant_Age
older adults