Week in Review: Home Lighting for Patients With Glaucoma, nAMD and Activities of Daily Living, HZO Reactivation After Shingles Vaccination

A weekly roundup of ophthalmic news from around the web.

Better lighting encourages older patients with glaucoma to move around the house. Poor indoor lighting has been found to increase the risk of falls. As people with glaucoma often have mobility issues, poor lighting may be an additional impediment to physical activity. To test this hypothesis, investigators used accelerometers and GPS trackers to measure the home physical activity of 153 older adults with glaucoma or glaucoma suspect enrolled in the Falls in Glaucoma Study who completed a home environment assessment of lighting levels. Better lighting levels were associated with more steps at home and faster average peak cadence. While home lighting was not associated with other metrics (such as activity fragmentation), better lighting may lead to more home physical activity for patients with glaucoma, which in turn could increase their likelihood of maintaining independence. JAMA Ophthalmology

Patients with nAMD who require treatment often have trouble with activities of daily living. An Australian study found that among 437 patients with neovascular age-related macular degeneration (nAMD) presenting for anti-VEGF therapy, two-thirds reported impaired instrumental activities of daily living (ADLs), such as cooking and cleaning, and more than one-third reported impaired basic ADLs, such as dressing and eating. Risk factors for impaired ADLs included visual impairment, poorer vision- and health-related quality of life scores, depressive symptoms, never driving, and the presence of any disability. The authors conclude that “these findings contribute to existing clinical practice by better enabling ophthalmologists to identify patients at risk of ADL impairment. . . . [and] may inform the development of interventions that aim to preserve function and/or rehabilitate nAMD patients presenting for anti-VEGF therapy.” Eye (London)

Shingles vaccination could lead to herpes zoster ophthalmicus reactivation, according to a retrospective cohort claims database study of 16,408 patients with a confirmed herpes zoster ophthalmicus (HZO) diagnosis, 22% of whom received at least 1 recombinant zoster vaccine (RZV) for shingles prevention between October 2017 and March 2022. Within the risk period of 56 days after the index date, vaccinated patients (i.e., those with RZV exposure) had nearly double the risk of HZO recurrence compared with unvaccinated/unexposed patients (hazard ratio 1.93). The outcome event (HZO exacerbation) rate was 37.7–39.7 per 1000 person-years in the vaccinated group and 26.2–28.4 per 1000 person-years in the unvaccinated group. The authors recommend that clinicians monitor their patients with a history of HZO who receive the RZV to ensure that any cases of HZO recurrence are diagnosed and treated early. JAMA Ophthalmology