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Normative patterns and factors associated with presbyopia progression in a multiethnic Asian population: the Singapore Epidemiology of Eye Diseases Study
  1. Shivani Majithia1,
  2. Kah Hie Wong1,
  3. Miao Li Chee1,
  4. Zhi-Da Soh1,
  5. Sahil Thakur1,
  6. Xiao Ling Fang1,
  7. Zhen Ling Teo1,
  8. Charumathi Sabanayagam1,2,
  9. Yih Chung Tham1,2,
  10. Ching-Yu Cheng1,2,3
  1. 1Ocular Epidemiology, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  2. 2Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
  3. 3Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  1. Correspondence to Professor Ching-Yu Cheng, Singapore Eye Research Institue, 20 College Road, The Academia, Level 6, Singapore, Singapore 169856; chingyu.cheng{at}


Background/Aim To investigate normative patterns and factors associated with presbyopia progression in a multiethnic Asian population.

Methods Malay, Indian and Chinese participants aged 40–80 years who had baseline and 6-year follow-up examinations with subjective refraction data were recruited from the Singapore Epidemiology of Eye Diseases Study. Presbyopia progression was defined as an increase in near addition power of ≥+0.50 dioptre (D) from baseline to follow-up visit. Modified Poisson regression analyses were used to determine baseline factors associated with presbyopia progression.

Results From the eligible 3974 eyes, 2608 eyes were included for final analysis after excluding eyes with a history of cataract surgery (929 eyes) and best-corrected distance visual acuity worse than 20/40 (342 eyes). Overall the mean near addition power change over 6 years was +0.25 D; Malays showed greater change (+0.37 D) compared with Indians (+0.23 D) and Chinese (+0.16 D). After adjusting for baseline age, gender, body mass index, hypertension, cataract, refractive error and daily hours of reading and writing, Malays were more likely to have presbyopia progression compared with Chinese (RR (relative risk)=1.67; 95% CI 1.43 to 1.95; p<0.001) and Indians (RR=1.45; 95% CI 1.25 to 1.68; p<0.001). Individuals aged 60–69 years (RR=0.77; p=0.006) and ≥70 years (RR=0.51; p<0.001) were less likely to progress in presbyopia compared with those aged 40–49.

Conclusion In this Asian population, the near addition power change over 6 years was lower than the current near addition prescription guidelines (+0.25 D vs +0.60 D). Our findings may help update near addition prescription guidelines that can be more tailored to Asians.

  • optics and refraction
  • eye (globe)
  • vision
  • epidemiology
  • public health

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  • SM and KHW contributed equally.

  • YCT and C-YC contributed equally.

  • —————

  • SM and KHW are joint first authors.

  • YCT and C-YC are joint senior authors.

  • SM and KHW contributed equally.

  • YCT and C-YC contributed equally.

  • Contributors SM, KHW, YCT, CS and C-YC conceived and designed the study. SM, KHW, YCT, MLC, Z-DS, ST, XLF and ZLT analysed and interpreted the data. SM, KHW, MLC and YCT wrote the manuscript. All authors reviewed and provided critical feedback to the final manuscript.

  • Funding This study is funded by the National Medical Research Council (grant numbers: NMRC/CIRG/1417/2015, NMRC/MOH-TA18nov-0002, NMRC/0796/2003 and A*STAR BMRC 08/1/35/19/550, NMRC/1249/2010, and NMRC/CIRG/1371/2013).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All study procedures were conducted in accordance with the Declaration of Helsinki and were approved by the SingHealth Centralised Institutional Review Board. Informed consent was obtained from all study participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Please contact the corresponding author for data availability (