Dandona L, Dandona R, Naduvilath T J, McCarty C A, Srinivas M, Mandal P, Nanda A, Rao G N
Public Health Ophthalmology Service, L.V. Prasad Eye Institute, Hyderabad, India.
Ophthalmology. 1999 Mar;106(3):497-504. doi: 10.1016/S0161-6420(99)90107-0.
To assess the prevalence and causes of moderate visual impairment in an urban population in southern India.
Population-based, cross-sectional study.
A total of 2522 (85.4% of the eligible) persons of all ages, including 1399 persons 30 years of age or older, from 24 clusters representative of the population of Hyderabad city.
The eligible subjects underwent a detailed ocular evaluation, including logarithm of the minimum angle of resolution (logMAR) visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, cataract grading, and stereoscopic dilated fundus evaluation. Automated threshold visual fields and slit-lamp and fundus photography were done when indicated by standardized criteria.
Moderate visual impairment was defined as presenting distance visual acuity less than 20/40 to 20/200 or visual field loss by predefined standardized conservative criteria in the better eye.
In addition to the 1% prevalence of blindness in this sample reported earlier, moderate visual impairment was present in 303 subjects, an age-gender-adjusted prevalence of 7.2% (95% confidence interval [CI], 4.5%-9.9%; design effect, 2.7). The major cause of moderate visual impairment was refractive error (59.4%, 95% CI, 52.3%-66.5%) followed by cataract (25.3%, 95% CI, 19%-31.6%). Multivariate analysis showed that the prevalence of moderate visual impairment was significantly higher in those 40 years of age or older (odds ratio, 10.9; 95% CI, 8-15) and females (odds ratio, 1.89; 95% CI, 1.41-2.53) and lower in those belonging to the highest socioeconomic status (odds ratio, 0.27; 95% CI, 0.14-0.51). However, because of the pyramidal age distribution of the population, 38.1% of the total moderate visual impairment was present in those younger than 40 years of age. The proportion of moderate visual impairment caused by refractive error was higher in the younger than in the older age groups (P < 0.0001).
Projecting the results to the 26.5% urban population of India, there would be 18.4 million (95% CI, 11.5-25.2 million) persons with moderate visual impairment in urban India alone. Refractive error was the major cause of moderate visual impairment in the population studied. The absolute proportion of moderate visual impairment in those younger than 40 years of age was considerable. The eyecare policy of India, apart from dealing with blindness, should address the issue of the relatively easily treatable uncorrected refractive error as the cause of moderate visual impairment in an estimated 10.9 million persons in urban India.
评估印度南部城市人口中中度视力损害的患病率及病因。
基于人群的横断面研究。
来自代表海得拉巴市人口的24个群组的共2522人（占符合条件者的85.4%），各年龄段均有，其中包括1399名30岁及以上者。
符合条件的受试者接受了详细的眼部评估，包括最小分辨角对数（logMAR）视力、验光、裂隙灯生物显微镜检查、压平眼压测量、前房角镜检查、白内障分级以及立体眼底散瞳评估。当符合标准化标准时，进行自动阈值视野检查以及裂隙灯和眼底照相。
中度视力损害定义为较好眼的远视力小于20/40至20/200，或根据预定义的标准化保守标准出现视野缺损。
除了之前报道的该样本中1%的失明患病率外，303名受试者存在中度视力损害，年龄和性别调整后的患病率为7.2%（95%置信区间[CI]，4.5% - 9.9%；设计效应，2.7）。中度视力损害的主要原因是屈光不正（59.4%，95% CI，52.3% - 66.5%），其次是白内障（25.3%，95% CI，19% - 31.6%）。多因素分析显示，40岁及以上者（优势比，10.9；95% CI，8 - 15）和女性（优势比，1.89；95% CI，1.41 - 2.53）中度视力损害的患病率显著更高，而社会经济地位最高者的患病率较低（优势比，0.27；95% CI，0.14 - 0.51）。然而，由于人群的年龄分布呈金字塔形，38.1%的中度视力损害患者年龄小于40岁。屈光不正导致的中度视力损害比例在较年轻年龄组高于较年长年龄组（P < 0.0001）。
将结果推算至印度26.5%的城市人口，仅在印度城市地区就会有1840万人（95% CI，1150万 - 2520万）存在中度视力损害。屈光不正是所研究人群中度视力损害的主要原因。年龄小于40岁者中度视力损害的绝对比例相当可观。印度的眼保健政策除了应对失明问题外，还应解决相对容易治疗的未矫正屈光不正问题，因为这是印度城市地区估计1090万人中度视力损害的病因。
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