Elsevier

Ophthalmology

Volume 117, Issue 12, December 2010, Pages 2315-2321
Ophthalmology

Original article
Prevalence and Causes of Low Vision and Blindness in a Rural Southwest Island of Japan: The Kumejima Study

https://doi.org/10.1016/j.ophtha.2010.03.043Get rights and content

Purpose

To determine the prevalence and causes of low vision and blindness in an adult population on a rural southwest island of Japan.

Design

Population-based, cross-sectional study.

Participants

All residents of Kumejima Island, Japan, 40 years of age and older.

Methods

Of the 4632 residents 40 years of age and older, 3762 (response rate, 81.2%) underwent a detailed ocular examination including measurement of the best-corrected visual acuity (BCVA) with a Landolt ring chart at 5 m. The age- and gender-specific prevalence rates of low vision and blindness were estimated and causes were identified.

Main Outcome Measures

Low vision and blindness were defined, according to the definition of the World Health Organization, as a BCVA in the better eye below 20/60 to a lower limit of 20/400 and worse than 20/400, respectively.

Results

The prevalence of bilateral low vision was 0.58% (95% confidence interval [CI], 0.38–0.89). The primary causes of low vision were cataract (0.11%), corneal opacity (0.08%), retinitis pigmentosa (RP; 0.06%), and diabetic retinopathy (0.06%). The prevalence of bilateral blindness was 0.39% (95% CI, 0.23–0.65). The primary causes of blindness were RP (0.17%) and glaucoma (0.11%). The primary causes of monocular low vision were cataract (0.65%), corneal opacity (0.16%), age-related macular degeneration (0.16%), and diabetic retinopathy (0.11%), whereas those of monocular blindness were cataract (0.29%), trauma (0.25%), and glaucoma (0.22%). Logistic analysis showed that female gender (P = 0.001; odds ratio [OR], 7.37; 95% CI, 2.20–24.71) and lower body weight (P = 0.015; OR, 0.94; 95% CI, 0.90–0.99) were associated significantly with visual impairment.

Conclusions

The prevalences of low vision and blindness in the adult residents of an island in southwest Japan were 1.5 to 3 times higher than the prevalences reported in an urban city on the Japanese mainland. The prevalence of visual impairment caused by RP on this island was much higher than on the mainland, suggesting a genetic characteristic of the population. Furthermore, the prevalence of visual impairment resulting from cataract and corneal opacity was higher than that on the mainland. The prevalence of visual impairment resulting from myopic macular degeneration was less.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

The prevalences of low vision and blindness were examined as part of a population-based epidemiologic survey of ocular diseases in all residents of Kumejima Island 40 years of age or older. This small (area, 63 km2) rural island in southwest Japan is 100 km west of Naha City, Okinawa, 1600 km southwest of Tokyo, and 600 km north of Taipei City, Taiwan. The weather is warm and humid, with average daily temperatures of 22.7° C and a total yearly rainfall of 2138 mm. The population-based survey

Results

Of the 4632 eligible residents, 3762 (81.2%) underwent the screening examination. The mean age±standard deviation of the 3762 participants was older than that of the 870 nonparticipants (61.8±14.0 and 59.1±14.9 years, respectively; P<0.001, unpaired t test), and there was a higher percentage of women among the participants (male-to-female ratio, 1833:1929 vs. 555:315; P<0.001, chi-square test). Among the 3762 screened subjects, 168 did not undergo a reliable VA examination at 5 m because they

Discussion

The current study reports for the first time population-based data on the prevalence and causes of visual impairment in an adult population in a rural region in Japan. The prevalence of bilateral visual impairment (low vision plus blindness) was 0.97% according to the WHO criteria. In Japan, a population-based study (the Tajimi Study) conducted in an urban suburb reported a considerably lower prevalence of visual impairment (0.47%).4 Based on those results, the authors estimated that 340 000

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    Manuscript no. 2009-1273.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by a Grant-in-Aid for Scientific Research by the Ministry of Health, Labour and Welfare of Japan, Tokyo, Japan (no.: H18-Sensory-General-001); a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan (grant no.: (C) 17591845); and a fund from the Japan National Society for the Prevention of Blindness, Tokyo, Japan.

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