Visual acuity and correctable visual impairment among Norwegian 65-year olds
Keywords:Correctable visual impairment, Undercorrected refractive error, Eye examination, optical correction, visual acuity
AbstractPrevalence of ocular disease and visual impairment increases with increased age. Population studies have shown that uncorrected refractive error is the main cause of visual impairment in the general population. The aim of this study was to examine visual acuity (VA) and the prevalence of correctable visual impairment among Norwegian 65-year-olds. The study had a crosssectional design. A random sample born in 1943 (n = 300) was invited to participate. The participants underwent a full eye examination including: patient history, habitual visual acuity (HVA), refraction, best corrected visual acuity (BCVA) and examination of ocular health. The study was approved by the Regional Committee for Medical Research Ethics and reported to the Norwegian Social Science Data Services. Data was analyzed by Fisher’s exact test, χ2-test, student t-test and logistic regression, p < 0.05 was considered statistically significant. Relative risk (RR) and odds ratio (OR) were calculated for correctable visual impairment. In all 129 subjects (43%) participated in the study. Three were excluded from the analysis due to missing data. The analysis included 126 subjects, 67 males and 59 females. None of the participants had permanent visual impairment. Mean (±SD) BCVA was logMAR -0.06 (±0.10) (Snellen decimal 1.2). Six subjects (5%) had correctable visual impairment, HVA logMAR > 0.3 (Snellen < 0.5) in the better eye, which improved with best correction to logMAR ≤ 0.3 (Snellen > 0.5). Eight subjects (6%) had clinically relevant undercorrected refractive error, i.e. an undercorrection in refractive error which when corrected produced an improvement in VA of 10 letters (2 lines on the logMAR chart) or more after refraction, when HVA was logMAR < 0.2 (Snellen 0.63). Long time (> 5 years) since last eye examination was an independent risk factor for correctable visual impairment, OR 2.7, 95% CI [1.0, 7.3], p = 0.046. Subjects with correctable visual impairment had either low refractive error or hyperopia (spherical equivalent refraction (SER) > -0.50 D), but there was no statistically significant association between refractive error and correctable visual impairment. Regular eye examination and correction of low refractive error and hyperopia can prevent unnecessary visual impairment in the elderly.
American Academy of Ophthalmology Preferred Practice Patterns Committee. (2005). Preferred Practice Pattern® Guidelines. Comprehensive Adult Medical Eye Evaluation. San Francisco, CA: American Academy of Ophthalmology.
Attebo, K., Ivers, R. Q., & Mitchell, P. (1999). Refractive errors in an older population: The blue mountains eye study. Ophthalmology, 106(6), 1066-1072. doi: 10.1016/s0161-6420(99)90251-8
Attebo, K., Mitchell, P., & Smith, W. (1996). Visual acuity and the causes of visual loss in Australia. The Blue Mountains Eye Study. Ophthalmology, 103(3), 357-364. doi: 10.1016/S0161-6420(96)30684-2
Beckles, G. L., Williamson, D. F., Brown, A. F., Gregg, E. W., Karter, A. J., Kim, C., . . . Thompson, T. J. (2007). Agreement between self-reports and medical records was only fair in a cross-sectional study of performance of annual eye examinations among adults with diabetes in managed care. Medical Care, 45(9), 876-883. doi: 10.1097/MLR.0b013e3180ca95fa
Buch, H., Vinding, T., La Cour, M., Appleyard, M., Jensen, G. B., & Nielsen, N. V. (2004). Prevalence and causes of visual impairment and blindness among 9980 Scandinavian adults: the Copenhagen City Eye Study. Ophthalmology, 111(1), 53-61. doi: 10.1016/j.ophtha.2003.05.010
Buch, H., Vinding, T., La Cour, M., & Nielsen, N. V. (2001). The prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish population. The Copenhagen City Eye Study. Acta Ophthalmologica Scandinavica, 79(5), 441-449. doi: 10.1034/j.1600-0420.2001.790503.x
Bylsma, G. W., Le, A., Mukesh, B. N., Taylor, H. R., & McCarty, C. A. (2004). Utilization of eye care services by Victorians likely to benefit from eye care. Clinical & Experimental Ophthalmology, 32(6), 573-577. doi: 10.1111/j.1442-9071.2004.00905.x
Cedrone, C., Ricci, F., Nucci, C., Mancino, R., Corsi, A., & Culasso, F. (2009). Age-specific changes in the prevalence and management of optically correctable visual impairment between 1988 and 2000: the Ponza Eye Study. Eye (Lond), 23(3), 522-529. doi: 10.1038/eye.2008.104
Congdon, N., O'Colmain, B., Klaver, C. C., Klein, R., Munoz, B., Friedman, D. S., . . . Mitchell, P. (2004). Causes and prevalence of visual impairment among adults in the United States. Archives of Ophthalmology, 122(4), 477-485.
Fong, C. S.-u., Wang, J. J., Rochtchina, E., Schneider, J., Jakobsen, K. B., Smith, W., & Mitchell1, P. (2009). Survey Effect on Use of Eye Care by Older Persons with Correctable Visual Impairment. Ophthalmic Epidemiology, 16(4), 249-253. doi: 10.3109/09286580902863072
Foran, S., Rose, K., Wang, J. J., & Mitchell, P. (2002). Correctable visual impairment in an older population: the blue mountains eye study. American Journal of Ophthalmology, 134(5), 712-719. doi: S0002939402016732
Forskrift om førerkort m.m. (2004). FOR-2004-01-19-298 Retrieved from http://www.lovdata.no/cgi-wift/ldles?doc=/sf/sf/sf-20040119-0298.html
Fowles, J. B., Rosheim, K., Fowler, E. J., Craft, C., & Arrichiello, L. (1999). The validity of self-reported diabetes quality of care measures. The International Journal for Quality in Health Care, 11(5), 407-412. doi: 10.1093/intqhc/11.5.407
Gunnlaugsdottir, E., Arnarsson, A., & Jonasson, F. (2008). Prevalence and causes of visual impairment and blindness in Icelanders aged 50 years and older: the Reykjavik Eye Study. Acta Ophthalmologica, 86(7), 778-785. doi: 10.1111/j.1755-3768.2008.01191.x
Keeffe, J. E., Weih, L. M., McCarty, C. A., & Taylor, H. R. (2002). Utilisation of eye care services by urban and rural Australians. The British Journal of Ophthalmology, 86(1), 24-27. doi: 10.1136/bjo.86.1.24
Klaver, C. C., Wolfs, R. C., Vingerling, J. R., Hofman, A., & de Jong, P. T. (1998). Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Archives of Ophthalmology, 116(5), 653-658.
Klein, R., Klein, B. E., Linton, K. L., & De Mets, D. L. (1991). The Beaver Dam Eye Study: visual acuity. Ophthalmology, 98(8), 1310-1315. doi: 10.1016/S0161-6420(91)32137-7
Liou, H. L., McCarty, C. A., Jin, C. L., & Taylor, H. R. (1999). Prevalence and predictors of undercorrected refractive errors in the Victorian population. American Journal of Ophthalmology, 127(5), 590-596. doi: 10.1016/S0002-9394(98)00449-8
Muller, A., Keeffe, J. E., & Taylor, H. R. (2007). Changes in eye care utilization following an eye health promotion campaign. Clinical & Experimental Ophthalmology, 35(4), 305-309. doi: 10.1111/j.1442-9071.2007.01450.x
Munoz, B., West, S. K., Rubin, G. S., Schein, O. D., Quigley, H. A., Bressler, S. B., & Bandeen-Roche, K. (2000). Causes of blindness and visual impairment in a population of older Americans: The Salisbury Eye Evaluation Study. Archives of Ophthalmology, 118(6), 819-825.
NOF. (2005). Retningslinjer i klinisk optometri. Oslo: Norges Optikerforbund.
Orr, P., Barrón, Y., Schein, O. D., Rubin, G. S., & West, S. K. (1999). Eye care utilization by older americans: The SEE project. Ophthalmology, 106(5), 904-909. doi: 10.1016/s0161-6420(99)00508-4
Thiagalingam, S., Cumming, R. G., & Mitchell, P. (2002). Factors associated with undercorrected refractive errors in an older population: the Blue Mountains Eye Study. British Journal of Ophthalmology, 86(9), 1041-1045. doi: 10.1136/bjo.86.9.1041
VanNewkirk, M. R., Weih, L., McCarty, C. A., & Taylor, H. R. (2001). Cause-specific prevalence of bilateral visual impairment in Victoria, Australia: the Visual Impairment Project. Ophthalmology, 108(5), 960-967. doi: 10.1016/S0161-6420(01)00554-1
Wang, Q., Klein, B., Klein, R., & Moss, S. (1994). Refractive status in the Beaver Dam Eye Study. Investigative Ophthalmology & Visual Science, 35(13), 4344-4347.
WHO. (1973). World Health Organization Technical Report Series No. 518. The Prevention of Blindness. Report of a WHO Study Group. Geneva.