Visual impairment and unintentional injury mortality: the National Health Interview Survey 1986-1994

PURPOSE: To examine the relationship between reported visual impairment and unintentional injury mortality. DESIGN: Mortality linkage study of a population-based survey. METHODS: Mortality linkage through 1997 of 116,796 adult participants, aged 18 years and older, from the 1986 to 1994 National Health Interview Survey was analyzed with respect to reported visual impairment using Cox regression models.The average follow-up was 7.0 years, and 295 unintentional injury deaths were identified. After controlling for survey design, age, sex, and the presence and number of eye diseases, participants with severe, bilateral visual impairment were at increased risk of death relative to participants without visual impairment (hazard ratio: 7.4; 95% confidence interval: 3.0-17.8). CONCLUSIONS: Our data provide evidence that severe, bilateral visual impairment is associated with an increased risk of unintentional mortality among adults in the United States.     

Visual acuity change and mortality in older adults

PURPOSE: Several studies indicate an increased mortality rate in older adults who have visual impairment, but few have attempted to address a potential causal mechanism. The goals of this study are to determine whether visual acuity loss increases the risk of dying and to examine whether depressive symptoms act as a mediator in this relationship. METHODS: Data were derived from the 2520 older adults who participated in the Salisbury Eye Evaluation project, a population-based prospective 8-year cohort study. Presenting binocular visual acuity was measured with the Early Treatment Diabetic Retinopathy Study [ETDRS] eye chart and depressive symptoms with the General Health Questionnaire Part D subscale. Mortality data were collected by staff follow-up. Analyses were performed with the Cox proportional hazards regression. RESULTS: Worse baseline acuity was associated with a higher mortality rate (hazard ratio [HR] = 1.05; 95% confidence interval [CI], 1.01-1.09). Also, those who gained two or more lines of visual acuity over 2 years had a lower adjusted risk of dying (HR = 0.47; 95% CI, 0.23-0.95). An interaction was detected, in that women who lost > or =3 lines of visual acuity over a 2-year period had a higher adjusted risk of dying (HR = 3.97; 95% CI, 2.21-7.15), whereas men did not (HR = 1.32; 95% CI, 0.66-2.63). Depressive symptoms did not mediate these relationships. CONCLUSIONS: If the relationship between visual acuity and mortality is indeed causal, it most likely acts via numerous pathways through a variety of intervening variables. The identification of these intervening variables could give additional targets for intervention if acuity cannot be restored.     

Visual impairment, causes of vision loss, and falls: the singapore malay eye study

PURPOSE: To report associations of visual impairment and the main causes of vision loss with falls in an older Asian population. METHODS: The population-based Singapore Malay Eye Study examined 3280 (78.7% response rate) Malay adults 40 to 80 years of age. Details about any fall in the previous 12 months and personal and sociodemographic information were collected. Presenting visual acuity (PVA) was measured. Mild or moderate visual impairment (0.3 < logMar < 1.0), severe visual impairment (logMAR > or = 1.0), and the primary causes of visual impairment were determined by ophthalmologists at examination. RESULTS: Of the 3280 participants, 3266 (99.6%) provided information about falls. Of these, 14.7% (n = 480) reported having fallen in the past 12 months. After adjustment for gender, age, body mass index, history of angina, heart attack, stroke, hypertension, diabetes, and self-rated health, the results showed that severe visual impairment in the worse eye significantly increased the risk of falling (60%; OR = 1.6; 95% CI 1.1 to 2.3). Severe visual impairment in one eye and mild or moderate visual impairment in the other also doubled the risk of falls (OR = 2.1; 95% CI 1.4-3.1). Having glaucoma (n = 21) increased the risk of falling by more than fourfold (OR = 4.2; 95% CI 1.2-12.3) after adjustment for visual acuity. Although mild or moderate visual impairment was not significantly associated with falls, odds ratios tended toward the direction of risk. CONCLUSIONS: Findings from this Asian population provide further evidence in support of the association between severe visual impairment and falls in older persons.     

Cause-specific prevalence of bilateral visual impairment in Victoria, Australia: the Visual Impairment Project

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 > or =6/60 and/or <20 degrees > or =10 degrees radius field, moderate vision impairment; severe vision impairment, <6/60 > or =3/60 and/or <10 degrees > or =5 degrees radius field; and profound vision impairment <3/60 and/or <5 degrees radius field. In addition, less-than-legal driving vision, <6/12 > or =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.     

Glaucoma and mortality in the Beijing Eye Study

PURPOSE: To assess the relationship between glaucoma and mortality in a population-based setting.METHODS: At baseline in 2001, the Beijing Eye Study examined 4356 subjects for glaucoma with a detected glaucoma frequency of 135/4356 or 3.1%. Mean age was 55.9+/-10.4 years (40-101 years). In 2006, all study participants were reinvited for a follow-up examination.RESULTS: Out of the 4356 subjects, 3208 (73.6%) subjects returned for follow-up examination, while 124 (2.8%) subjects were dead, and 1024 (23.5%) subjects did not agree to be re-examined or had moved away. Mortality rate was significantly (P<0.001; odds ratio (OR): 4.72; 95% confidence interval (CI): 2.67, 8.33) higher in the 135 glaucoma subjects (15/135 or 11.1+/-2.7%; 95% CI: 5.8, 16.4) than in the 4221 participants without glaucoma (109/4221 or 2.6+/-0.2%; 95% CI: 2.2, 3.0). In binary logistic regression analysis, mortality was significantly associated with age (P<0.001), gender (P<0.001; OR: 0.44; 95% CI: 0.29, 0.66), level of education (P<0.001; OR: 0.64; 95% CI: 0.55, 0.74), and the presence of glaucoma (P=0.007; OR: 2.30; 95% CI: 1.26, 4.20). If the whole glaucoma group was differentiated into an open-angle glaucoma group and an angle-closure group, mortality was still significantly associated with age (P<0.001), gender (P<0.001), level of education (P<0.001), and with the presence of angle-closure glaucoma (P=0.006; OR: 3.09; 95% CI: 1.49, 10.2), while the association with the presence of open-angle glaucoma was marginally significant (P=0.13; OR: 1.83; 95% CI: 0.84, 4.01).CONCLUSIONS: The data suggest that glaucoma, particularly angle-closure glaucoma, may be associated with an increased rate of mortality in adult Chinese in Greater Beijing.     

Age-Related Macular Degeneration and Mortality: A Systematic Review and Meta-Analysis

Purpose: Age-related macular degeneration (AMD) is the leading cause of severe, irreversible vision loss in older adults. Evidence for an association between AMD and mortality remains inconclusive despite evidence for an association with cardiovascular and inflammatory diseases. We aim to compare all-cause, cardiovascular and cancer mortality between those with early or late AMD and control study participants.

Methods: A protocol was registered at PROSPERO (CRD42015020622). A systematic search of Medline (Ovid), PubMed, and Embase (Ovid) was conducted on 6 June 2015. Reference lists from identified studies and four clinical trial registries were searched for additional studies. Participants were required to be over the age of 40 years, and AMD status must have been objectively assessed. The Risk Of Bias In Non-Randomized Studies – of Interventions (ROBINS-I) tool was used to assess the risk of bias. Random-effects meta-analyses were performed.

Results: A total of 12 reports from 10 studies were included in the meta-analysis. Late AMD was associated with elevated rates of all-cause (nine studies, hazard ratio (HR) 1.20, 95% confidence interval, CI, 1.02–1.41) and cardiovascular mortality (six studies, HR 1.46, 95% CI 1.13–1.98), but early AMD was not (all-cause mortality, 10 studies, HR 1.06, 95% CI 0.98–1.14; cardiovascular mortality, five studies, HR 1.12, 95% CI 0.96–1.31). There was no evidence of an association between early or late AMD and cancer mortality (early AMD, three studies, HR 1.17, 95% CI 0.78–1.75; late AMD, three studies, HR 1.01, 95% CI 0.77–1.33).

Conclusion: Late AMD is associated with increased rates of all-cause and cardiovascular mortality, suggesting shared pathways between late AMD and systemic disease.     

Visual impairment and ten-year mortality: the Liwan Eye Study

ObjectivesTo explore associations between visual impairment (VI) and mortality in an adult population in urban China.MethodsThe Liwan Eye Study was a population-based prevalence survey conducted in Guangzhou, Southern China. The baseline examination was carried out in 2003. All baseline participants were invited for the 10-year follow-up visit. VI was defined as the visual acuity of 20/40 or worse in the better-seeing eye with habitual correction if worn. Correctable VI was defined as the VI correctable to 20/40 or better by subjective refraction, and non-correctable VI was defined as the VI correctable to worse than 20/40. Mortality rates were compared using the log-rank test and Cox proportional hazards regression models.ResultsOf the 1399 participants (mean age: 65.3 ± 9.93 years; 56.4% female) with available baseline visual acuity measurement, 320 participants (22.9%) had VI. After 10 years, 314 (22.4%) participants died. Visually impaired participants had a significantly increased 10-year mortality compared with those without VI (40.0% vs. 17.2%, P < 0.05). After adjusting for age, gender, income, educational attainment, BMI, history of diabetes and hypertension, both VI (HR, 1.55; 95% CI, 1.14–2.11) and non-correctable VI (HR, 2.72; 95% CI, 1.86–3.98) were significantly associated with poorer survival, while correctable VI (HR, 0.99; 95% CI, 0.66–1.49) was not an independent risk factor for 10-year mortality.ConclusionsOur findings that VI, particularly non-correctable VI, predicting poorer survival may imply the underlying mechanism behind VI-mortality association and reinforce the importance of preventing and treating disabling ocular diseases to prevent premature mortality in the elderly.Subject terms: Vision disorders, Risk factors     

Is glaucoma associated with motor vehicle collision involvement and driving avoidance?

PURPOSE: To evaluate the association between the diagnosis of glaucoma and motor vehicle collision (MVC) involvement and driving avoidance in drivers aged > or =50 years. METHODS: Two groups of patients, one with glaucoma and one without, were identified in three university-affiliated eye care practices. Demographic, clinical, and driving characteristics were obtained by chart abstractions and a patient survey. Information regarding MVC involvement was obtained from police records. RESULTS: Patients with glaucoma were less likely (relative risk [RR], 0.67; 95% confidence interval [CI], 0.47-0.97) to be involved in collisions than patients without glaucoma. There was no difference between the at-fault crash rates of the patients with glaucoma and those without (RR, 1.22; 95% CI, 0.67-2.22). Patients with glaucoma had significantly higher levels of avoidance for driving at night (odds ratio [OR], 2.06; 95% CI, 1.11-3.82), driving in fog (OR, 3.80; 95% CI, 1.93-7.48), driving in the rain (OR, 2.99; 95% CI, 1.32-6.76), driving during rush hour (OR, 2.24; 95% CI, 1.16-4.34), driving on the highway (OR, 2.81; 95% CI, 1.19-6.64), and high density driving (OR, 2.88; 95% CI, 1.28-6.46). These associations were adjusted for demographic and medical characteristics as well as visual acuity. CONCLUSIONS: Older persons with glaucoma drive at least as safely as, if not more safely than, older persons without glaucoma.     

Prevalence of visual impairment in adults with intellectual disabilities in the Netherlands: cross-sectional study

PURPOSE: To obtain the first representative and valid population-based prevalence figures on visual impairment and blindness in adults with intellectual disabilities (ID) and to identify risk groups. METHODS: STUDY DESIGN: Cross-sectional survey. An age-Down's syndrome-stratified random sample of 1,598 persons from a base population of 9,012 adult users of ID services with mild to profound intellectual disabilities was screened. Participants underwent protocollised on-site screening of visual functions. Results were related to degree of ID, occurrence of Down's syndrome (DS) and age. MAIN OUTCOME MEASURE: Prevalences of visual impairment and blindness in the study population and in subgroups and weighted prevalences in the total Dutch population using ID services. RESULTS: Prevalences of visual impairment ranged from 2.2% (95% confidence interval (CI), 0.5-6.4) in young adults with mild ID and no Down's syndrome to 66.7% (95% CI, 41.0-86.7) in older adults with profound ID and Down's syndrome; prevalences of blindness ranged from 0.7% (95% CI, 0.1-4.1) to 38.9% (95% CI, 28.1-50.3). Weighted prevalences of visual impairment and blindness in the total Dutch population of adult users of intellectual disability services are 13.8% (95% CI, 9.3-18.4) and 5.0% (95% CI, 3.8-6.2), respectively. Prior to this study, visual impairment or blindness had remained undiagnosed in 106/261 (40.6%) persons. CONCLUSIONS: As compared to published figures for the general Dutch population aged 55 years and over (visual impairment 1.4%, blindness 0.5%), prevalences of visual impairment and blindness are higher in all subgroups with intellectual disabilities, including the young and mildly handicapped group. The diagnosis is too often missed. All persons with severe or profound intellectual disabilities, and all older adults with Down's syndrome, should be considered visually impaired until proved otherwise.