CLINICAL SCIENCE

Prevalence of visual impairment in people aged 75 years and older in Britain: results from the MRC trial of assessment and management of older people in the community

J R Evans¹, A E Fletcher², R P L Wormald¹, E Siu-Woon Ng², S Stirling², L Smeeth², E Breeze², C J Bulpitt³, M Nunes³, D Jones⁴ and A Tulloch⁵

¹ Department of Epidemiology and International Eye Health, Institute of Ophthalmology, London, UK
² Centre for Ageing and Public Health, London School of Hygiene and Tropical Medicine, London, UK
³ Section of Care of the Elderly, Faculty of Medicine, Imperial College, Hammersmith Campus, London, UK
⁴ Department of Geriatric Medicine, University of Wales College of Medicine, Cardiff, UK
⁵ General Practice Unit of Health Care Epidemiology, University of Oxford, Oxford, UK

Correspondence to:
Correspondence to:
Ms Jennifer Evans, Department of Epidemiology and International Eye Health, Institute of Ophthalmology, London, UK

Aims: To measure the prevalence of visual impairment in a large representative sample of people aged 75 years and over participating in the MRC trial of assessment and management of older people in the community.

Methods: 53 practices in the MRC general practice research framework. Data were obtained from 14 600 participants aged 75 years and older. Prevalence of visual impairment overall (binocular visual acuity <6/18) which was categorised separately into low vision (binocular visual acuity <6/18–3/60) or blindness (binocular visual acuity of <3/60). The prevalence of binocular acuity <6/12 was presented for comparison with other studies. Visual acuity was measured using Glasgow acuity charts; glasses, if worn, were not removed.

Results: Visual acuity was available for 14 600 people out of 21 241 invited (69%). Among people with visual acuity data, 12.4% overall (1803) were visually impaired (95% confidence intervals 10.8% to 13.9%); 1501 (10.3%) were categorised as having low vision (8.7% to 11.8%), and 302 (2.1%) were blind (1.8% to 2.4%). At ages 75–79, 6.2% of the cohort were visually impaired (5.1% to 7.3%) with 36.9% at age 90+ (32.5% to 41.3%). At ages 75–79, 0.6% (0.4% to 0.8%) of the study population were blind, with 6.9% (4.8% to 9.0%) at age 90+. In multivariate regression, controlling for age, women had significant excess risk of visual impairment (odds ratio 1.43, 95% confidence interval 1.29 to 1.58). Overall, 19.9% of study participants had a binocular acuity of less than 6/12 (17.8% to 22.0%).

Conclusion: The results from this large study show that visual impairment is common in the older population and that this risk increases rapidly with advancing age, especially for women. A relatively conservative measure of visual impairment was used. If visual impairment had been defined as visual acuity of <6/12 (American definition of visual impairment), the age specific prevalence estimates would have increased by 60%.

Keywords: visual impairment; blindness; prevalence; elderly

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