Bugg Victoria A, Eppich Kaleb, Blakley Macey S, Lum Flora, Greene Tom, Hartnett M Elizabeth
Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, Oklahoma.
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
Ophthalmol Sci. 2025 Feb 7;5(4):100735. doi: 10.1016/j.xops.2025.100735. eCollection 2025 Jul-Aug.
To evaluate differences in vision loss and blindness by disease category between men and women in the the United States (US).
Retrospective observational study.
Patients (14 549 105) >50 years old with eye examination data recorded in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) between January 1, 2018, and December 31, 2018.
Patients were assigned to the vision loss cohort and categorized (mild, moderate, severe, blindness) based on the best-corrected visual acuity in the better-seeing eye. The cause of vision loss was assumed using the International Classification of Diseases, 10th Revision codes for cataract, diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, retinal detachment, retinal vein occlusion, corneal opacity, or amblyopia documented in the electronic health record. The no vision loss cohort was created by subtracting the vision loss cohort from the 2018 total IRIS Registry database.
Primary analyses provided age-adjusted prevalence ratios (PRs) for vision loss conditions for women and men within the vision loss cohort relative to the 2018 US census. Secondary analyses computed age-adjusted PRs for women and men for the same conditions relative to the IRIS Registry.
The age-adjusted PR of vision loss in women versus men when comparing our vision loss cohort relative to the US census was 1.28 (95% confidence interval, 1.27, 1.29) for mild vision loss, 1.29 (1.28, 1.30) for moderate vision loss, 1.35 (1.32, 1.38) for severe vision loss, and 1.54 (1.49, 1.59) for blindness. However, these differences were attenuated when age-adjusted prevalences were computed relative to those who were seen in 2018 in the IRIS Registry database. In women, the prevalence of vision loss associated with cataract and AMD was increased in both analyses, while men had a higher prevalence of vision loss associated with retinal detachment in both analyses.
Women in the US are more likely to be diagnosed with vision loss at an IRIS Registry practice compared with men, based on clinical presentations relative to the US census. However, this finding is partly driven by the higher rates at which women presented to ophthalmic practices in both the vision loss cohort and no vision loss cohort. The age-adjusted prevalence for vision loss associated with cataract and AMD was higher in women when utilizing both the US census and the 2018 IRIS Registry database as the denominator, which suggests that a true difference in prevalence is present. The same is true for an increase in the age-adjusted relative risk for vision loss associated with retinal detachment in men. These findings warrant further study.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
评估美国男性和女性之间按疾病类别划分的视力丧失和失明差异。
回顾性观察研究。
2018年1月1日至2018年12月31日期间在美国眼科学会IRIS®注册库（视力智能研究）中记录了眼科检查数据的50岁以上患者（14549105人）。
将患者分配到视力丧失队列，并根据视力较好眼睛的最佳矫正视力进行分类（轻度、中度、重度、失明）。使用电子健康记录中记录的国际疾病分类第10版代码，推测白内障、糖尿病性视网膜病变、年龄相关性黄斑变性（AMD）、青光眼、视网膜脱离、视网膜静脉阻塞、角膜混浊或弱视导致视力丧失的原因。通过从2018年IRIS注册库总数据库中减去视力丧失队列来创建无视力丧失队列。
主要分析提供了视力丧失队列中女性和男性相对于2018年美国人口普查的视力丧失情况的年龄调整患病率比（PRs）。次要分析计算了女性和男性相对于IRIS注册库中相同情况的年龄调整PRs。
将我们的视力丧失队列与美国人口普查进行比较时，女性与男性相比，轻度视力丧失的年龄调整PR为1.28（95%置信区间，1.27，1.29），中度视力丧失为1.29（1.28，1.30），重度视力丧失为1.35（1.32，1.38），失明为1.54（1.49，1.59）。然而，当相对于2018年在IRIS注册库数据库中就诊的人群计算年龄调整患病率时，这些差异有所减弱。在两项分析中，女性中与白内障和AMD相关的视力丧失患病率均有所增加，而男性在两项分析中与视网膜脱离相关的视力丧失患病率较高。
根据相对于美国人口普查的临床表现，在美国眼科学会IRIS注册库的实践中，女性比男性更有可能被诊断为视力丧失。然而，这一发现部分是由视力丧失队列和无视力丧失队列中女性到眼科就诊的较高比例所驱动的。当使用美国人口普查和2018年IRIS注册库数据库作为分母时，女性中与白内障和AMD相关的视力丧失的年龄调整患病率较高，这表明患病率存在真正差异。男性中与视网膜脱离相关的视力丧失的年龄调整相对风险增加也是如此。这些发现值得进一步研究。
本文末尾的脚注和披露中可能会发现专有或商业披露。
