Institut National de la Santé et de la Recherche Medicale (INSERM), Bordeaux Population Health Research Center, Unité Mixte de Recherché 1219, University of Bordeaux, Bordeaux, France.
R&D Life and Vision Science, Essilor International, Paris, France.
JAMA Ophthalmol. 2019 Jan 1;137(1):3-11. doi: 10.1001/jamaophthalmol.2018.4229.
Uncorrected refractive error (URE) is a common cause of visual impairment, but its prevalence in groups of older adults who could be pragmatic targets for improving optical correction remains unknown.
To estimate the prevalence of URE in older adults, particularly in those with age-related eye disease and those who are unable to attend an outpatient clinic, and to identify the factors associated with URE.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional analysis included 707 adults 78 years or older from the Alienor Study in Bordeaux, France. Data were collected from February 12, 2011, through December 21, 2012, and analyzed from November 1, 2017, through July 7, 2018.
Uncorrected refractive error was defined as the presenting distance visual acuity in the better-seeing eye improved by at least 5 letters on the Early Treatment Diabetic Retinopathy Study chart (≥1 line on the logMAR chart) using the best-achieved optical correction. Multivariate logistic regressions were used to determine the factors associated with URE.
The study population of 707 adults 78 years or older (64.8% women; mean [SD] age, 84.3 [4.4] years) had a prevalence of URE of 38.8% (95% CI, 35.2%-42.5%). Prevalence was high for participants with eye disease (range, 35.0% [95% CI, 28.4%-42.0%] to 44.1% [95% CI, 27.2%-62.1%], depending on the disease) and those without eye disease (30.1%; 95% CI, 24.0%-36.7%). Prevalence was higher in participants who were examined at home (because they could not come to the clinic) than in those examined at the clinic (49.4% [95% CI, 42.8%-55.9%] vs 33.5% [95% CI, 29.2%-37.9%]; P < .001). Having an eye examination performed at home (odds ratio [OR], 1.64; 95% CI, 1.13-2.37), living alone (OR, 0.65; 95% CI, 0.47-0.90), and having the perceptions that the ophthalmologist consultation fees are too expensive (OR, 1.94; 95% CI, 1.12-3.36) and that declining visual acuity is normal with aging (OR, 1.47; 95% CI, 1.04-2.08) were all associated with URE.
These study results show that the prevalence of URE was high in this population and suggest that preventive strategies aimed at enhancing optical correction could be directed to all older adults and to specific groups by implementing at-home eye examinations for those who have difficulties attending an outpatient clinic and by focusing on those with eye disease who probably already have a regular ophthalmologic follow-up. More studies are needed to evaluate prevalence of URE in different populations and countries with various eye care systems.
未矫正的屈光不正（URE）是视力损害的常见原因，但在那些可能是改善光学矫正的实际目标的老年人群体中，其患病率尚不清楚。
估计老年人中 URE 的患病率，特别是在与年龄相关的眼病患者和那些无法到门诊就诊的患者中，以及确定与 URE 相关的因素。
设计、地点和参与者：这项基于人群的横断面分析包括来自法国波尔多 Alienor 研究的 707 名 78 岁或以上的成年人。数据于 2011 年 2 月 12 日至 2012 年 12 月 21 日收集，并于 2017 年 11 月 1 日至 2018 年 7 月 7 日进行分析。
未矫正的屈光不正定义为在使用最佳获得的光学矫正后，在较好眼的远距视力上提高至少 5 个字母（早期治疗糖尿病视网膜病变研究图表上≥1 行[logMAR 图表]）。使用多变量逻辑回归确定与 URE 相关的因素。
该研究人群为 707 名 78 岁或以上的成年人（64.8%为女性；平均[SD]年龄为 84.3[4.4]岁），URE 的患病率为 38.8%（95%CI，35.2%-42.5%）。在有眼病的患者中（范围为 35.0%[95%CI，28.4%-42.0%]至 44.1%[95%CI，27.2%-62.1%]，具体取决于疾病）和无眼病的患者（30.1%；95%CI，24.0%-36.7%）中，患病率较高。在因无法到诊所而在家接受检查的患者中，患病率高于在诊所接受检查的患者（49.4%[95%CI，42.8%-55.9%] vs 33.5%[95%CI，29.2%-37.9%]；P<0.001）。在家中进行眼部检查（比值比[OR]，1.64；95%CI，1.13-2.37）、独居（OR，0.65；95%CI，0.47-0.90）以及认为眼科医生咨询费太贵（OR，1.94；95%CI，1.12-3.36）和视力下降随着年龄增长而正常（OR，1.47；95%CI，1.04-2.08）都与 URE 相关。
这些研究结果表明，该人群中 URE 的患病率较高，表明旨在增强光学矫正的预防策略可以针对所有老年人，对于那些因难以到门诊就诊而在家中进行眼部检查的特定人群，并针对那些可能已经有定期眼科随访的有眼病患者，实施有针对性的策略。需要更多的研究来评估不同人群和具有不同眼科保健系统的国家中 URE 的患病率。
