Ufa Eye Research Institute, Ufa, Bashkortostan, Russia.
Privatpraxis Jonas and Panda-Jonas, Heidelberg, Germany.
JAMA Netw Open. 2021 Aug 2;4(8):e2121138. doi: 10.1001/jamanetworkopen.2021.21138.
Visual performance is important for quality of life. However, vision impairment among adults 85 years and older has not been intensively examined.
To assess the prevalence of mild vision impairment (VI), moderate to severe vision impairment, and blindness and the factors associated with these conditions among a population 85 years and older.
DESIGN, SETTING, AND PARTICIPANTS: The Ural Very Old Study was a population-based cohort study conducted in rural and urban areas in Bashkortostan, Russia from 2017 to 2020. Among 1882 eligible individuals 85 years and older, 1526 participants (81.1%) were enrolled.
Ophthalmologic, physical, and mental examinations.
Prevalence of vision impairment and blindness based on best-corrected visual acuity (BCVA; measured using modified Early Treatment of Diabetic Retinopathy Study charts) in the better eye or both eyes. Mild vision impairment was defined as BCVA worse than 6/12 to 6/18, and moderate to severe VI was defined as BCVA worse than 6/18 but equal to or better than 3/60. Blindness was defined as BCVA worse than 3/60.
Among 1526 participants, 1149 individuals (75.3%; 846 women [73.6%]; mean [SD] age, 88.2 [2.8 years]) had available BCVA measurements and were included in the present analysis. Mild vision impairment was present in 114 individuals (9.9%; 95% CI, 8.2%-11.7%), moderate to severe VI in 562 individuals (48.9%; 95% CI, 46.0%-51.8%), and blindness in 68 individuals (5.9%; 95% CI, 4.6%-7.3%). Factors associated with moderate to severe VI were cataracts (324 individuals [57.7% of those with moderate to severe VI and 28.2% of total population; 95% CI, 25.6%-30.8%]), secondary cataracts (4 individuals [0.7% of those with moderate to severe VI and 0.3% of total population; 95% CI, 0%-0.7%]), age-related macular degeneration (78 individuals [13.9% of those with moderate to severe VI and 6.8% of total population; 95% CI, 5.3%-8.3%]), glaucoma (45 individuals [8.0% of those with moderate to severe VI and 3.9% of total population; 95% CI, 2.8%-5.0%]), corneal opacifications (26 individuals [4.6% of those with moderate to severe VI and 2.3% of total population; 95% CI, 1.4%-3.1%]), myopic maculopathy (13 individuals [2.3% of those with moderate to severe VI and 1.1% of total population; 95% CI, 0.5%-1.7%]), and nonglaucomatous optic nerve damage (4 individuals [0.7% of those with moderate to severe VI and 0.3% of total population; 95% CI, 0%-0.7%]). Factors associated with blindness were cataracts (33 individuals [48.5% of those with blindness and 2.9% of total population; 95% CI, 1.9%-3.8%]), age-related macular degeneration (15 individuals [22.1% of those with blindness and 1.3% of total population; 95% CI, 0.7%-2.0%]), glaucoma (7 individuals [10.3% of those with blindness and 0.6% of total population; 95% CI, 0.2%-1.1%]), myopic maculopathy (3 individuals [4.4% of those with blindness and 0.3% of total population; 95% CI, 0%-0.6%]), and corneal opacifications (2 individuals [2.9% of those with blindness and 0.2% of total population; 95% CI, 0%-0.4%]). Higher moderate to severe VI prevalence was associated with older age (odds ratio [OR], 1.19; 95% CI, 1.11-1.28; P < .001), higher blood pressure (OR, 1.01; 95% CI, 1.00-1.02; P = .03), lower hand grip force (OR, 0.88; 95% CI, 0.83-0.95; P < .001), lower score on the Mini-Mental State Examination (OR, 0.95; 95% CI, 0.92-0.98; P < .001), lower prothrombin index (OR, 0.93; 95% CI, 0.89-0.97; P < .001), lower refractive error (OR, 0.91; 95% CI, 0.85-0.97; P = .006), and lower prevalence of previous cataract surgery (OR, 0.48; 95% CI, 0.33-0.68; P < .001).
In this cohort study of individuals 85 years and older, the prevalence of moderate to severe VI and blindness was relatively high. Cataracts were the main reversible condition associated with vision loss, and age-related macular degeneration, glaucoma, and myopic maculopathy were the main irreversible conditions. Because a higher prevalence of moderate to severe VI was associated with lower cognitive function and physical strength, improvement of vision through increases in cataract surgery and measures to prevent and treat irreversible conditions may help to improve cognitive function and physical strength.
视觉表现对于生活质量很重要。然而，85 岁及以上成年人的视力障碍尚未得到深入研究。
评估在一个 85 岁及以上的人群中，轻度视力障碍（VI）、中度至重度视力障碍和失明的流行率，以及与这些情况相关的因素。
设计、地点和参与者：乌拉尔高龄研究是一项基于人群的队列研究，于 2017 年至 2020 年在俄罗斯巴什科尔托斯坦的农村和城市地区进行。在 1882 名符合条件的 85 岁及以上的个体中，有 1526 名参与者（81.1%）入组。
眼科、身体和精神检查。
使用改良的糖尿病视网膜病变早期治疗研究图表测量的最佳矫正视力（BCVA；用更好的眼睛或双眼的 BCVA 衡量）的视力障碍和失明的患病率。轻度视力障碍定义为 BCVA 差于 6/12 至 6/18，中度至重度 VI 定义为 BCVA 差于 6/18 但等于或好于 3/60。失明定义为 BCVA 差于 3/60。
在 1526 名参与者中，有 1149 名（75.3%；846 名女性[73.6%]；平均[标准差]年龄为 88.2[2.8]岁）有可用的 BCVA 测量值，并纳入本分析。114 人（9.9%；95%置信区间[CI]，8.2%-11.7%）有轻度视力障碍，562 人（48.9%；95% CI，46.0%-51.8%）有中度至重度 VI，68 人（5.9%；95% CI，4.6%-7.3%）有失明。与中度至重度 VI 相关的因素包括白内障（324 人[57.7%的中度至重度 VI 患者和 28.2%的总人群；95% CI，25.6%-30.8%]）、继发性白内障（4 人[0.7%的中度至重度 VI 患者和 0.3%的总人群；95% CI，0%-0.7%]）、年龄相关性黄斑变性（78 人[13.9%的中度至重度 VI 患者和 6.8%的总人群；95% CI，5.3%-8.3%]）、青光眼（45 人[8.0%的中度至重度 VI 患者和 3.9%的总人群；95% CI，2.8%-5.0%]）、角膜混浊（26 人[4.6%的中度至重度 VI 患者和 2.3%的总人群；95% CI，1.4%-3.1%]）、近视性黄斑病变（13 人[2.3%的中度至重度 VI 患者和 1.1%的总人群；95% CI，0.5%-1.7%]）和非青光眼性视神经损伤（4 人[0.7%的中度至重度 VI 患者和 0.3%的总人群；95% CI，0%-0.7%]）。与失明相关的因素包括白内障（33 人[48.5%的失明患者和 2.9%的总人群；95% CI，1.9%-3.8%]）、年龄相关性黄斑变性（15 人[22.1%的失明患者和 1.3%的总人群；95% CI，0.7%-2.0%]）、青光眼（7 人[10.3%的失明患者和 0.6%的总人群；95% CI，0.2%-1.1%]）、近视性黄斑病变（3 人[4.4%的失明患者和 0.3%的总人群；95% CI，0%-0.6%]）和角膜混浊（2 人[2.9%的失明患者和 0.2%的总人群；95% CI，0%-0.4%]）。较高的中度至重度 VI 患病率与年龄较大（优势比[OR]，1.19；95% CI，1.11-1.28；P < .001）、较高的血压（OR，1.01；95% CI，1.00-1.02；P = .03）、较低的手握力（OR，0.88；95% CI，0.83-0.95；P < .001）、较低的简易精神状态检查评分（OR，0.95；95% CI，0.92-0.98；P < .001）、较低的凝血酶原指数（OR，0.93；95% CI，0.89-0.97；P < .001）、较低的屈光不正（OR，0.91；95% CI，0.85-0.97；P = .006）和较低的白内障手术史（OR，0.48；95% CI，0.33-0.68；P < .001）相关。
在这项对 85 岁及以上人群的队列研究中，中度至重度 VI 和失明的患病率相对较高。白内障是与视力丧失相关的主要可逆性疾病，而年龄相关性黄斑变性、青光眼和近视性黄斑病变是主要的不可逆转性疾病。由于较高的中度至重度 VI 患病率与认知功能和体力下降相关，通过增加白内障手术和采取措施预防和治疗不可逆转疾病来改善视力，可能有助于改善认知功能和体力。
