Hyderabad Ocular Morbidity in Elderly Study (HOMES) – Rationale, Study Design and Methodology

Purpose: To describe the study design, interobserver variability of the questionnaires and clinical procedures of Hyderabad Ocular Morbidity in Elderly Study (HOMES) designed to, (a) to investigate the prevalence, causes and risk factors for visual impairment, and (b) to assess the impact of dispensing spectacles and cataract surgery on visual functions, fear of falls (FOF) and depression among the elderly in India. Methods: Individuals aged ≥60 years are considered elderly. The non-clinical protocol was administered by two trained investigators and included collection of personal, sociodemographic information, ocular and systemic history, Indian Visual Function Questionnaire (IND-VFQ33), Patient Health Questionnaire (PHQ9), Mini-Mental State Examination (MMSE) questionnaire, Hearing Handicap Inventory for the Elderly Screening (HHIE), Short Falls Efficacy Scale (SFES) questionnaire. The eye examination was conducted by a trained optometrist and vision technicians in clinics set-up in the homes and included visual acuity (VA) assessment for distance and near, anterior segment examination and fundus examination, and imaging. The reliability assessments were carried out among 138 participants. Result: The intraclass correlation (ICC) coefficients for MMSE, PHQ9, HHIE, SFES was 0.73 (95% CI: 0.62–0.81), 0.67 (95% CI: 0.54–0.77), 0.63 (95% CI: 0.48–0.74) and 0.70 (95% CI: 0.58–0.79) respectively. The ICC for INDVFQ domains ranged from 0.66 (95% CI: 0.55–0.74) for Psychosocial Impact to 0.88 (95% CI: 0.84–0.91) for activity limitation. The ICC for VA was 0.94 (95% CI: 0.92–0.96). Conclusion: All questionnaires demonstrated acceptable reliability and can be applied in the main study. HOMES is expected to provide data that will help plan strategies to contribute towards ‘healthy aging’ in India.