Cause-specific prevalence of bilateral visual impairment in Victoria, Australia: The visual impairment project

doi:10.1016/S0161-6420(01)00554-1

Ophthalmology

Volume 108, Issue 5, May 2001, Pages 960-967

https://doi.org/10.1016/S0161-6420(01)00554-1 Get rights and content

Abstract

Purpose

To study the cause-specific prevalence of eye diseases causing bilateral visual impairment in Australian adults.

Design

Two-site, population-based cross-sectional study.

Participants

Participants were aged 40 years and older and resident in their homes at the time of recruitment for the study. The study was conducted during 1992 through 1996.

Methods

The study uses a cluster stratified random sample of 4744 participants from two cohorts, urban, and rural Victoria. Participants completed a standardized interview and eye examination, including presenting and best-corrected visual acuity, visual fields, and dilated ocular examination. The major cause of vision loss was identified for all participants found to be visually impaired. Population-based prevalence estimates are weighted to reflect the age and gender distribution of the two cohorts in Victoria.

Main outcome measures

Visual impairment was defined by four levels of severity on the basis of best-corrected visual acuity or visual field: <6/18 ≥6/60 and/or <20° ≥10° radius field, moderate vision impairment; severe vision impairment, <6/60 ≥3/60 and/or <10° ≥5° radius field; and profound vision impairment <3/60 and/or <5° radius field. In addition, less-than-legal driving vision, <6/12 ≥6/18, and/or homonymous hemianopia were defined as mild vision impairment. In Australia, legal blindness includes severe and profound vision impairment.

Results

The population-weighted prevalence of diseases causing less-than-legal driving or worse impairment in the better eye was 42.48/1000 (95% confidence interval [CI], 30.11, 54.86). Uncorrected refractive error was the most frequent cause of bilateral vision impairment, 24.68/1000 (95% CI, 16.12, 33.25), followed by age-related macular degeneration (AMD), 3.86/1000 (95% CI, 2.17, 5.55); other retinal diseases, 2.91/1000 (95% CI, 0.74, 5.08); other disorders, 2.80/1000 (95% CI, 1.17, 4.43); cataract, 2.57/1000 (95% CI, 1.38, 3.76); glaucoma, 2.32/1000 (95% CI, 0.72, 3.92); neuro-ophthalmic disorders, 1.80/1000 (95% CI, 0, 4.11); and diabetic retinopathy, 1.53/1000 (95% CI, 0.71, 2.36). The prevalence of legal blindness was 5.30/1000 (95% CI, 3.24, 7.36). Although not significantly different, the causes of legal blindness were uncorrected refractive errors, AMD, glaucoma, other retinal conditions, and other diseases.

Conclusions

Significant reduction of visual impairment may be attained with the application of current knowledge in refractive errors, diabetes mellitus, cataract, and glaucoma. Although easily preventable, uncorrected refractive error remains a major cause of vision impairment.

Section snippets

Methods

A detailed method has been reported elsewhere.10, 11 The cluster-stratified sample was drawn from nine randomly selected pairs of adjacent census collector districts in urban Melbourne and four pairs of randomly selected adjacent census collector districts in four rural communities in Victoria. Target sample size for the study was based on the ability to measure the prevalence of visual impairment (<6/18 ≥3/60) in Victoria with relative precision of 80% (alpha = 0.05), assuming that the

Results

The numbers of eligible persons identified were 5520, 3912 in the urban residential cohort and 1608 in the rural residential cohort. A total of 4744 (86%) eligible persons, 3271 (84%) urban residents, and 1473 (92%) rural residents participated in interviews and examinations. Participation rates for those aged 65 years and older (1513 of 1786, 85%) compared with those less than 65 years of age (3231 of 3734, 86%) were not statistically different (chi square, 1 df, 3.2, P = 0.07). The age and

Discussion

This study describes the cause-specific population-weighted prevalence of vision impairment in the state of Victoria. Across all levels of vision impairment, the prevalence of visual impairment is greatest in those aged 65 years and older. Uncorrected refractive error is the leading cause of mild through moderate vision impairment. Severe to profound vision impairment is caused by a number of eye conditions, including uncorrected refractive error.

The population-weighted prevalence of

Conclusions

Uncorrected refractive error remains a major cause of vision impairment even though it is easily prevented. Program development to reduce the vision impairment caused by uncorrected refractive error, cataract, glaucoma, and diabetes mellitus should be attainable with current resources and technology.

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^☆: Supported by National Health and Medical Research Council, Canberra, ACT, Australia; Victorian Health Promotion Foundation, Melbourne, Victoria, Australia; Estate of the late Dorothy Edols, Melbourne, Victoria, Australia; Ansell Ophthalmology Foundation, Melbourne, Victoria, Australia; Jack Brockhoff Foundation, Melbourne, Victoria, Australia.

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Cause-specific prevalence of bilateral visual impairment in Victoria, Australia: The visual impairment project☆

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Ophthalmology

Ophthalmology

Am J Ophthalmol

Surv Ophthalmol

Ophthalmology

The Framingham Eye Study monographAn ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973–1975

Surv Ophthalmol

Racial differences in the cause-specific prevalence of blindness in east Baltimore

N Engl J Med

Visual impairment in a rural Appalachian community. Prevalence and causes

JAMA

Age-specific prevalence and causes of blindness and visual impairment in an older populationthe Rotterdam Study

Arch Ophthalmol

The Victorian Yearbook, Number 110

Strategies for the Prevention of Blindness in National ProgrammesA Primary Health Care Approach

Methods for a population-based studythe Melbourne Visual Impairment Project

Ophthalmic Epidemiol