Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
J Gerontol A Biol Sci Med Sci. 2022 Apr 1;77(4):697-704. doi: 10.1093/gerona/glab325.
Visual impairment has emerged as a potential modifiable risk factor for dementia. However, there is a lack of large studies with objective measures of vision and with more than 10 years of follow-up. We investigated whether visual impairment is associated with an increased risk of incident dementia in UK Biobank and European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk). In both cohorts, visual acuity was measured using a "logarithm of the minimum angle of resolution" (LogMAR) chart and categorized as no (≤0.30 LogMAR), mild (>0.3 to ≤0.50 LogMAR), and moderate to severe (>0.50 LogMAR) impairment. Dementia was ascertained through linkage to electronic medical records. After restricting to those aged ≥60 years, without prevalent dementia and with eye measures available, the analytic samples consisted of 62 206 UK Biobank and 7 337 EPIC-Norfolk participants, respectively. In UK Biobank and EPIC-Norfolk, respectively, 1 113 and 517 participants developed dementia over 11 and 15 years of follow-up. Using multivariable Cox proportional-hazards models, the hazard ratios for mild and moderate to severe visual impairment were 1.26 (95% confidence interval [CI]: 0.92-1.72) and 2.16 (95% CI: 1.37-3.40), in UK Biobank, and 1.05 (95% CI: 0.72-1.53) and 1.93 (95% CI: 1.05-3.56) in EPIC-Norfolk, compared to no visual impairment. When excluding participants censored within 5 years of follow-up or with prevalent poor or fair self-reported health, the direction of the associations remained similar for moderate impairment but was not statistically significant. Our findings suggest visual impairment might be a promising target for dementia prevention; however, the possibility of reverse causation cannot be excluded.
视力障碍已成为痴呆的一个潜在可改变的危险因素。然而，缺乏大样本量、使用客观视力测量方法且随访时间超过 10 年的研究。我们在英国生物库（UK Biobank）和欧洲癌症前瞻性调查（European Prospective Investigation into Cancer in Norfolk，EPIC-Norfolk）中调查了视力障碍是否与事件性痴呆的风险增加有关。在这两个队列中，视力使用“最小分辨角对数（logarithm of the minimum angle of resolution，LogMAR）”图表进行测量，并分为无（≤0.30 LogMAR）、轻度（>0.3 至≤0.50 LogMAR）和中重度（>0.50 LogMAR）损害。痴呆通过与电子病历的关联来确定。在限制年龄≥60 岁、无现患痴呆且有眼部测量值的人群后，分析样本分别包括 62206 名 UK Biobank 和 7337 名 EPIC-Norfolk 参与者。在 UK Biobank 和 EPIC-Norfolk 中，分别有 1113 名和 517 名参与者在 11 年和 15 年的随访中患上痴呆。使用多变量 Cox 比例风险模型，在 UK Biobank 中，轻度和中重度视力障碍的风险比分别为 1.26（95%置信区间[CI]：0.92-1.72）和 2.16（95% CI：1.37-3.40），在 EPIC-Norfolk 中，轻度和中重度视力障碍的风险比分别为 1.05（95% CI：0.72-1.53）和 1.93（95% CI：1.05-3.56），与无视力障碍相比。当排除随访 5 年内被 censored 的参与者或有普遍较差或一般自我报告健康状况的参与者后，中度障碍的关联方向仍然相似，但没有统计学意义。我们的研究结果表明，视力障碍可能是预防痴呆的一个有前途的目标；然而，不能排除反向因果关系的可能性。
