一般人群中屈光不正的视觉后果。

Visual consequences of refractive errors in the general population.

机构信息

Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.

Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.

出版信息

Ophthalmology. 2015 Jan;122(1):101-9. doi: 10.1016/j.ophtha.2014.07.030. Epub 2014 Sep 7.

DOI:10.1016/j.ophtha.2014.07.030

PMID:25208857

Abstract

OBJECTIVE

To study the frequency and causes of visual impairment in relation to refractive error.

DESIGN

Population-based cohort study.

PARTICIPANTS

A total of 6597 participants from Rotterdam Study I (baseline and 4 follow-up examinations) and 2579 participants from Rotterdam Study II (baseline and 2 follow-up examinations), all 55 years or older, were included.

METHODS

Participants underwent an extensive ophthalmic examination, including best-corrected visual acuity and objective refraction, fundus photography, visual field perimetry, and optical coherence tomography imaging of macula and optic disc. We calculated cumulative risks and odds ratios of visual impairment for various refractive error categories and determined causes by using all screening information as well as medical records.

MAIN OUTCOME MEASURES

Unilateral and bilateral low vision (World Health Organization [WHO] criteria, VA < 0.3 and VA ≥ 0.05; United States (US) criteria, VA < 0.5 and VA ≥ 0.1) and blindness (WHO criteria, VA < 0.05; US criteria, VA < 0.1).

RESULTS

Cumulative risks of visual impairment ranged from virtually 0 in all refractive error categories at 55 years of age to 9.5% (standard error, 0.01) for emmetropia and 15.3% (standard error, 0.06) for high hyperopia to 33.7% (standard error, 0.08) for high myopia at 85 years of age. The major causes of visual impairment in highly hyperopic persons were age-related macular degeneration (AMD), cataract, and combined causes (each 25%); in highly myopic persons, the major cause was myopic macular degeneration (38.9%). The major causes of visual impairment for the other refractive error categories were AMD and cataract. Compared with those with emmetropia, those with high myopia had a significantly increased lifetime risk of visual impairment; those with -6 diopters (D) or less and -10 D or more had an odds ratio (OR) risk of 3.4 (95% confidence interval [CI], 1.4-8.2) of visual impairment; those with less than -10 D had an OR of 22.0 (95% CI, 9.2-52.6).

CONCLUSIONS

Of all refractive errors, high myopia has the most severe visual consequences. Irreversible macular pathologic features are the most common cause of visual impairment in this group.

摘要

目的

研究与屈光不正相关的视力障碍的频率和原因。

设计

基于人群的队列研究。

参与者

共纳入 6597 名来自鹿特丹研究 I（基线和 4 次随访检查）和 2579 名来自鹿特丹研究 II（基线和 2 次随访检查）的参与者，年龄均在 55 岁或以上。

方法

参与者接受了广泛的眼科检查，包括最佳矫正视力和客观屈光度、眼底照相、视野检查和黄斑及视盘的光学相干断层扫描成像。我们计算了各种屈光不正类别下视力障碍的累积风险和优势比，并通过使用所有筛查信息和病历确定了病因。

主要观察指标

单侧和双侧低视力（世界卫生组织[WHO]标准，VA < 0.3 和 VA ≥ 0.05；美国[US]标准，VA < 0.5 和 VA ≥ 0.1）和盲（WHO 标准，VA < 0.05；US 标准，VA < 0.1）。

结果

55 岁时，所有屈光不正类别下的视力障碍累积风险几乎为零，而在 85 岁时，正视眼的累积风险为 9.5%（标准误差，0.01），高度远视眼的累积风险为 15.3%（标准误差，0.06），高度近视眼的累积风险为 33.7%（标准误差，0.08）。高度远视人群中视力障碍的主要原因是年龄相关性黄斑变性（AMD）、白内障和联合原因（各占 25%）；高度近视人群中视力障碍的主要原因是近视性黄斑变性（38.9%）。其他屈光不正类别的主要视力障碍原因是 AMD 和白内障。与正视眼人群相比，高度近视眼人群的终身视力障碍风险显著增加；-6 屈光度（D）或以下和-10 D 或以上的人群视力障碍的优势比（OR）风险为 3.4（95%置信区间[CI]，1.4-8.2）；-10 D 以下的人群 OR 为 22.0（95% CI，9.2-52.6）。