Naël Virginie, Pérès Karine, Carrière Isabelle, Daien Vincent, Scherlen Anne-Catherine, Arleo Angelo, Korobelnik Jean-Francois, Delcourt Cécile, Helmer Catherine
University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, F-33000 Bordeaux, France 2R&D Life and Vision Science, Essilor International, F-75012 Paris, France 3Sorbonne University, UPMC University of Paris 06, INSERM, CNRS, Vision Institute, F-75012 Paris, France.
University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Psychoepidemiology of Aging and Chronic Diseases, UMR 1219, F-33000 Bordeaux, France.
Invest Ophthalmol Vis Sci. 2017 Apr 1;58(4):2359-2365. doi: 10.1167/iovs.17-21525.
As vision is required in almost all activities of daily living, visual impairment (VI) may be one of the major treatable factors for preventing activity limitations. We aimed to evaluate the attributable risk of VI associated with activity limitations and the extent to which limitations are avoidable with optimal optical correction of undercorrected refractive errors.
We analyzed 709 older adults from the Three-City-Alienor population-based study. VI was defined by presenting distance visual acuity in the better-seeing eye. Multivariate modified Poisson regressions were used to estimate the associations between vision, activity limitations, and social participation restrictions. Population attributable risk (PAR) and generalized impact fraction (GIF) were estimated. Bootstrapping was used to estimate 95% confidence intervals (CI).
After adjustment for potential confounders, VI was associated with each domain of activity limitations, except basic activities of daily living (ADL) limitations. These associations were found for even minimal levels of VI. PAR was estimated at 10.1% (95% CI: 5.2-10.6) for mobility limitations, at 26.0% (95% CI: 13.5-41.2) for instrumental ADL (IADL) limitations, and at 24.9% (95% CI: 10.5-47.1) for social participation restrictions. GIF for improvement of undercorrected refractive errors was 6.1% (95% CI: 3.8-8.5) for mobility limitations, 15.8% (95% CI: 11.5-20.1) for IADL limitations and 21.4% (95% CI: 13.8-28.5) for social participation restrictions.
About one-sixth of IADL limitations and one-fifth of social participation restrictions could be prevented by an optimal optical correction. These results underline the importance of eye examinations in older adults to prevent disability.
由于视力在几乎所有日常生活活动中都不可或缺，视力损害（VI）可能是预防活动受限的主要可治疗因素之一。我们旨在评估与活动受限相关的VI归因风险，以及通过对矫正不足的屈光不正进行最佳光学矫正可避免活动受限的程度。
我们分析了来自三城市-阿列诺尔基于人群研究的709名老年人。VI通过较好眼的远视力来定义。采用多变量修正泊松回归来估计视力、活动受限和社会参与受限之间的关联。估计人群归因风险（PAR）和广义影响分数（GIF）。采用自抽样法估计95%置信区间（CI）。
在对潜在混杂因素进行调整后，VI与活动受限的各个领域相关，但与日常生活基本活动（ADL）受限无关。即使是极轻微的VI水平也存在这些关联。行动受限的PAR估计为10.1%（95%CI：5.2 - 10.6），工具性ADL（IADL）受限的PAR为26.0%（95%CI：13.5 - 41.2），社会参与受限的PAR为24.9%（95%CI：10.5 - 47.1）。矫正不足的屈光不正后，行动受限的GIF为6.1%（95%CI：3.8 - 8.5），IADL受限的GIF为15.8%（95%CI：11.5 - 20.1），社会参与受限的GIF为21.4%（95%CI：13.8 - 28.5）。
通过最佳光学矫正可预防约六分之一的IADL受限和五分之一的数据参与受限。这些结果强调了老年人眼部检查对预防残疾的重要性。
