Joshua R. Ehrlich

Introduction: Global ageing is expected to influence an increase of people with vision problems, especially women. The risk factors that shape gender disparities in older adult visual difficulty are subject to vary in different environments. Thus, we ask: do risk factors that influence the gender disparity in older adult visual difficulty vary by country? Methods: Using cross-sectional data for 2018–19 from the Health and Retirement Study international family of studies, we investigated gender disparities in self-reported visual difficulty with country-specific linear regression models among respondents aged 55–89 in the United States (n = 14,586), England (n = 7,297), Mexico (n = 12,214) and Korea (n = 6,767), while progressively adjusting for demographic, socioeconomic and health characteristics. Results: Age-adjusted visual difficulty for women varied by country: US ( b = 0.07; p = 0.000), England ( b = 0.09; p = 0.000), Mexico ( b = 0.02; p = 0.196), and Korea ( b = 0.10; p = 0.000). In the United States, women’s greater reports of visual difficulty were accounted for by marital status. In England, women’s greater reports of visual difficulty were partially accounted for by education, while high-education women had greater visual difficulty than high-education men. In Mexico, there was no gender difference in reports of visual difficulty. In Korea, women’s greater reports of visual difficulty were partially accounted for by morbidity, and low- and moderate-education women had greater visual difficulty than low- and moderate-education men, respectively. Conclusion: Our results highlight the different risk factors that shape gender disparities in visual difficulty around the world. We suggest that education and healthcare provisions can help address gender disparities in visual difficulty later in life.

Despite calls for equitable global eye-health research partnerships, there are limited data on authorship trends in research from Sub-Saharan Africa (SSA). Our aims were to determine the magnitude, trends, associated factors, and gender disparities related to inequitable authorship in eye-health research conducted in SSA. This was a cross-sectional analysis of SSA eye-health publications between 2003 and 2022. A systematic literature search was conducted. Data were manually extracted from the 1777 publications that met eligibility screening criteria. Namsor V.2 was used to classify author gender. Outcomes included no locally-affiliated authors and SSA-affiliated female authors. Overall, 1777 publications were included. The percentage of publications with no locally-affiliated authors was 6% overall, 33% in the first author position, and 45% in the last author position. There were no significant trends in the exclusion of locally-affiliated authors between 2003 and 2022 (no authors: p = 0.899; no first authors: p = 0.515; no last authors: p = 0.574). Factors with a higher odds of no locally-affiliated authors at all or in prominent positions included high-income-country-affiliated co-authors, low-income study countries, randomised trials, high-impact research, US/UK journal publishers and funders, and trachoma publications. SSA-affiliated female authors were underrepresented in prominent authorship positions (first authors: p < 0.001; last authors: p < 0.001) and had lower odds of representation with US/UK journal publishers, low-income study countries, and randomised trials. Inequitable authorship practices persist in eye-health research in SSA. Greater commitment towards partnership equity by ophthalmic researchers, journals, and funding organisations is needed.

Purpose of Review: This narrative review synthesizes current evidence on the relationship between visual impairment and driving safety in older adults, with a focus on the visual functions required for safe driving, the impact of common visual deficits, and current approaches to clinical evaluation and management. Recent Findings: Recent studies have strengthened evidence that visual functions beyond high contrast visual acuity--particularly visual field sensitivity, contrast sensitivity, and visual processing speed--are associated with driving performance and crash risk. Emerging studies also highlight the role of higher-order visuospatial processing and the integration of visual input with cognitive, multisensory, and motor systems. Advances in functional assessment tools and in-vehicle technologies, such as advanced driver-assistance systems, may further enhance evaluation and support driving safety. Summary: Driving safety in older adults with visual impairment is multifactorial and cannot be adequately assessed by a single visual measure. A multidomain approach incorporating visual, cognitive, and functional assessment is essential for clinical decision-making. Management should emphasize treatment of reversible conditions, patient-centered counseling, and referral for functional driving evaluation when appropriate. Future research should focus on developing functionally relevant, real-world measures to better guide clinical practice and policy. Opinion Statement: Driving is a visually intensive activity that plays a central role in maintaining independence, mobility, and social participation for older adults. As global populations age, the number of older drivers is increasing, making safe mobility an important public health concern. Visual impairment is common in later life and may arise from both ocular disease and neurologic conditions affecting the visual pathways or higher-order visual processing. Although driver licensing systems worldwide rely heavily on visual acuity thresholds to determine visual fitness to drive, growing evidence indicates that visual acuity alone provides an incomplete assessment of driving safety. Safe driving depends on the coordinated function of multiple visual domains, including central vision, peripheral vision, contrast sensitivity, motion and depth perception, visual processing speed, and higher-order visuospatial processing. Impairments in these domains may compromise hazard detection, situational awareness, and timely responses to changing traffic conditions, even when central visual acuity remains relatively preserved. In addition, driving performance requires integration of visual input with cognitive, multisensory, and motor systems, which may be affected by neurologic disease and age-related changes in sensory processing. Clinical evaluation of older drivers with visual impairment should therefore extend beyond visual acuity to incorporate multidomain assessment of visual and neurologic function when concerns arise. Management strategies should prioritize treatment of reversible visual conditions, patient counseling regarding adaptive driving behaviors, and referral for functional driving evaluation when appropriate. Ultimately, decisions regarding driving must balance preservation of independence with public safety. Continued research is needed to develop evidence-based screening strategies and policies that better reflect the complex visual demands of real-world driving.

Objectives: This cross-sectional study examined differences in the prevalence of sensory difficulties (vision/hearing) and concurrent social isolation among older adults from Mexico and the United States. Methods: Using data from the Mexican Health and Aging Study (age 50+) and the Health and Retirement Study (ages 51+), we explored how sensory difficulties are related to social isolation among Mexican, U.S. Hispanic, and U.S. non-Hispanic older adults. Social isolation was measured by assessing whether participants lived alone, had weekly contact with children and friends/relatives, and participated in weekly social activities. Results: An ANOVA analysis identified that Mexican Health and Aging Study and U.S. Hispanic individuals had higher rates of vision and hearing difficulties than U.S. non-Hispanics, yet social isolation was lower. Regression models with hearing and vision difficulties predicting social isolation by country/ethnicity indicated that sensory difficulties are more strongly related to social isolation for U.S. non-Hispanic individuals compared to U.S. Hispanic and Mexican individuals. Discussion: Sensory difficulties, including vision and hearing difficulties, are prevalent among older adults, disproportionately affecting Mexican and U.S. Hispanic individuals. Social determinants of health are potential drivers of these disparities. Mexican and U.S. Hispanic older adults experience lower levels of social isolation, potentially because of culturally motivated familismo.

Sensory impairments (e.g., decreased function in hearing, vision, olfaction, and other senses) may be risk factors for or early markers of Alzheimer's disease (AD) and related dementias (ADRD). Sensory impairments are common and have a large impact on wellbeing. Furthermore, they are clinically detectable and, often, treatable, and could be leveraged to identify and prevent AD/ADRD. This Supplement Issue brings together original research articles, reviews, and thought papers regarding the links between sensory impairments and cognitive health. Together, this work highlights the significant opportunities to use sensory information and remediation for earlier diagnosis, treatment, and prevention of dementia.

Importance: Older adults with poor vision are more likely to fall. However, there has been little research to understand whether this association is concentrated among individuals with specific exposures, such as home environmental hazards. Objective: To assess the association between differences in visual function, home environmental hazards, and falls. Design, Setting, and Participants: This population-based cross-sectional study used data from the National Health and Aging Trends Study, which gathers nationally representative data on Medicare beneficiaries aged 65 years and older in the US. A total of 4648 community-dwelling older adults who completed visual function tests and the home environment instrument in 2022 were included. Data were analyzed from September 2024 to March 2025. Exposure: Objective measured visual function was assessed using binocular presenting distance visual acuity (DVA; logMAR) and contrast sensitivity (CS: logCS). Home hazards included absence of grab bars in the bathroom, tripping hazards, and broken flooring, as well as an ordinal variable representing cumulative hazards (0, 1, ≥2). Main Outcomes and Measures: Falls were defined as any self-reported fall in the past month. Survey-weighted multivariable logistic regression assessed the associations of visual function, home hazards, and falls. Results: The survey-weighted prevalence of home hazards among 4648 participants (53.6% female) was 47.0% (no grab bars), 9.5% (tripping hazards), 4.5% (broken flooring), and 7.3% (≥2 hazards). Mean (SD) DVA was 0.10 (0.18) logMAR and mean (SD) CS was 1.72 (0.23) logCS. Worse DVA and CS were associated with falling in homes with hazards, including no grab bars (DVA: OR, 1.14; 95% CI, 1.02-1.27; CS: OR, 0.91; 95% CI, 0.84-1.00), tripping hazards (DVA: OR, 1.29; 95% CI, 1.11-1.49; CS: OR, 0.87; 95% CI, 0.78-0.98), and broken flooring (DVA: OR, 1.47; 95% CI, 1.26-1.70; CS: OR, 0.79; 95% CI, 0.68-0.93). The presence of multiple hazards further strengthened this association (DVA: OR, 1.31; 95% CI, 1.12-1.53; CS: OR, 0.93; 95% CI, 0.86-1.00). Conclusions and Relevance: The association between differences in visual function and falls among older adults in this study was shaped by the home environment. These findings underscore the potential importance of considering both intrinsic and extrinsic risk factors in fall prevention and highlight the potential for targeted strategies that include home safety interventions for individuals with poor visual function.