Correctable visual impairment in an older population: the blue mountains eye study

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Abstract

PURPOSE: To describe temporal changes in the characteristics of older persons with visual impairment in their better eye correctable by refraction.

DESIGN: Study of two cross sections of a community 6 years apart.

METHODS: The Blue Mountains Eye Study examined 3654 persons aged 49 to 97 during 1992 to 1994 (cross-section 1) and 3509 persons (2335 cohort survivors plus 1174 persons who moved to the area and age group) during 1997 to 2000 (cross-section 2). Logarithm of minimal angle of resolution visual acuity was measured before and after refraction. Correctable visual impairment was defined as visual impairment < 20/40 in the better eye before refraction that improved after refraction to no impairment (≥ 20/40). Factors associated with correctable visual impairment and persistent correctable impairment were determined.

RESULTS: Cross-sections 1 and 2 had similar age-gender distributions. In cross-section 1, 7.5% of participants had correctable visual impairment, 3.6% had noncorrectable visual impairment, and 88.9% had no impairment. Corresponding rates in cross-section 2 were 5.6%, 2.7%, and 91.7%. In both cross sections, similar proportions (around 68%) of those visually impaired had correctable visual impairment and similar sociodemographic measures predicted correctable visual impairment. Cross-section 1 participants who were married, owned their home, had high job prestige, gained qualifications after high school, or were current drivers were less likely to have correctable visual impairment after controlling for age and gender. Adjusted odds for correctable visual impairment increased in those living alone, using community support services, dependent on others, with myopia, wearing distance glasses, or with low perceived health and heart disease. Histories of stroke, cancer, and diabetes were similar between groups with correctable and no visual impairment.

CONCLUSION: Socioeconomic parameters, myopia, wearing distance glasses, reported health problems, and poor perceived health were associated with correctable visual impairment in this older population.

Section snippets

Design

This study analyzed two cross sections of a community 6 years apart.

Study population

The Blue Mountains Eye Study (BMES) is a population-based survey of vision and common eye diseases in an urban population aged 49 years or older resident in two postal codes of the Blue Mountains region, west of Sydney, Australia. A number of reports have described the methods used.1, 12, 13 The present report uses findings from two cross sections from this population.

Blue Mountain Eye Study I identified 4433 eligible noninstitutionalized permanent residents in a door-to-door census conducted

Results

Table 1 shows characteristics of participants in cross-sections 1 and 2. Age and gender distribution, the duration since the last eye examination, and the proportions married, living alone, owning their home, self-reporting heart disease and stroke, or currently having distance glasses were similar. However, in cross-section 2, a significantly higher proportion had high occupational prestige or self-reported cancer and diabetes, were current drivers, or were dependent on others. Although the

Discussion

Recent reports from the Visual Impairment Project (VIP) and the Blue Mountains Eye Study (BMES) from Australia have highlighted the high frequency of under-corrected or uncorrected refractive error as a cause of visual impairment in older persons.12, 18, 19 The VIP assessed the causes of visual impairment (<20/40) and blindness (either < 20/200 or < 20/400) for both presenting and best-corrected acuity. Under-corrected refraction was responsible for 58% of visual impairment. In the BMES,

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This work was supported by the Australian National Health & Medical Research Council, Canberra, Australia (grants 974159, 991407).

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