Department of Ophthalmology, Hospital Selayang, Batu Caves, Selangor, Malaysia.
Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia.
PLoS One. 2018 Jun 26;13(6):e0198799. doi: 10.1371/journal.pone.0198799. eCollection 2018.
Population-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique.
Malaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling 'E' Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed.
A total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0-1.4%), 1.0% (95%CI: 0.8-1.2%) and 5.9% (5.3-6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively.
Increased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.
人口统计学数据关于患病率、失明原因和眼科服务范围对于眼部健康项目的有效实施和评估是必要的。鉴于马来西亚在视力障碍和失明患病率方面数据稀缺，本研究旨在使用快速性盲症评估（Rapid Assessment of Avoidable Blindness，RAAB）调查技术，估计老年人中视力障碍（VI）的患病率和原因。
马来西亚被分为六个区域，每个区域包含 50 个集群。采用多阶段聚类抽样方法，每个集群包含 50 名 50 岁及以上的居民。对合格的受试者进行访谈，并记录相关的人口统计学细节、白内障手术障碍、医疗和眼部病史。使用滚动“E”Snellen 视力表进行视力评估，使用直接检眼镜进行眼部检查。记录 VI 的主要原因。对各个区域的结果进行计算，并使用加权平均值得出该国的总体患病率。确定了区域间和全国范围内的失明、重度 VI 和中度 VI 的患病率。评估了 VI 的原因、白内障手术覆盖率和白内障手术障碍。
共检查了 15000 名受试者，应答率为 95.3%。年龄和性别调整后的失明、重度视力障碍和中度视力障碍的患病率分别为 1.2%（95%置信区间：1.0-1.4%）、1.0%（95%CI：0.8-1.2%）和 5.9%（5.3-6.5%）。未经治疗的白内障（58.6%）、糖尿病视网膜病变（10.4%）和青光眼（6.6%）是失明的最常见原因。总体而言，86.3%的失明原因是可避免的。白内障手术覆盖率（CSC）在失明、重度视力障碍和中度视力障碍的人群中分别为 90%、86%和 66%。
马来西亚需要进一步加强患者教育和扩大眼科服务，以进一步减少可避免的失明。
