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Associations of vision impairment and eye diseases with frailty in community-dwelling older adults: a nationwide longitudinal study in China
  1. Xianwen Shang1,
  2. Guanrong Wu1,
  3. Wei Wang2,
  4. Zhuoting Zhu1,2,
  5. Xueli Zhang1,
  6. Yu Huang1,
  7. Yijun Hu1,
  8. Mingguang He1,2,3,
  9. Honghua Yu1,4
  1. 1Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
  2. 2State Key Laboratory of Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
  3. 3Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  4. 4Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
  1. Correspondence to Professor Honghua Yu, Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, 510317, China; yuhonghua{at}; Professor Mingguang He; mingguang.he{at}; Professor Yijun Hu; huyijun2014{at}


Aims To test whether vision impairment and major ophthalmic conditions are predictive of frailty.

Methods The analysis included 5321 participants aged 60–95 years at baseline from the China Health and Retirement Longitudinal Study. Participants were enrolled in 2011 and followed up in 2013, and 2015 through a face-to-face interview. Distance/near vision impairment was defined by reporting poor eyesight and reporting excellent, very good, good or fair eyesight was used as the reference. A history of cataract surgery and glaucoma were also self-reported. Frailty was defined as the presence of ≥3 of the five components of the Fried phenotype: weakness, slowness, exhaustion, inactivity and shrinking.

Results In the cross-sectional analysis, both near (odds ratio [OR] (95% confidence interval [CI]): 1.62 (1.30 to 2.00)) and distance (1.59 (1.30 to 1.96)) vision impairment was associated with a higher prevalence of frailty independent of confounders. In the longitudinal analysis, the multivariable-adjusted OR (95% CI) for incident frailty associated with glaucoma, distance vision impairment, near vision impairment and vision problem was 3.41 (1.46 to 7.99), 1.59 (1.17 to 2.17), 1.62 (1.17 to 2.23) and 2.11 (1.41 to 3.15), respectively. Vision problem was associated with decreased handgrip strength (β (95% CI): −1.47 (−2.20 to –0.75) kg) during follow-up. Individuals with glaucoma (−0.11 (−0.16 to –0.05) m/s), distance vision impairment (−0.02 (−0.03 to 0.00) m/s) or vision problem (−0.02 (−0.05 to 0.00) m/s) had decreased gait speed compared with the control group.

Conclusions Vision problem, vision impairment and glaucoma are important predictors of frailty in older adults.

  • Vision
  • Public health
  • Glaucoma

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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  • XS, GW and WW are joint first authors.

  • YH, MH and HY contributed equally.

  • Contributors Conceptualisation: XS, HY, MH, YuH and ZZ; Data curation: XS, WW and GW; Formal analysis: XS, GW and WW; Funding acquisition: HY, XS; Methodology: XS, WW; Project administration: HY, MH, YiH and ZZ; Resources: MH; Software: XS; Supervision: HY, MH and YiH; Validation: XS, WW, GW and YuH; Visualisation: XS; Roles/Writing-original draft: XS and WW; Writing-review and editing: XS, GW, XZ, HY, MH and YuH; Responsible for the overall content: XS.

  • Funding The present work was supported by the National Natural Science Foundation of China (81870663, 82171075), Fundamental Research Funds of the State Key Laboratory of Ophthalmology, Project of Investigation on Health Status of Employees in Financial Industry in Guangzhou, China (Z012014075), Science and Technology Program of Guangzhou, China (202002020049).

  • Disclaimer The sponsor or funding organization had no role in the design or conduct of this research.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.