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Rosalynn Grace Siantar, Tien Y Wong, Peng Guan Ong, Khuan Y Chow, Ching-Yu Cheng, Paul Mitchell, Carol Yim-lui Cheung; Visual impairment, age-related eye diseases and mortality: the Singapore Malay Eye Study (SiMES). Invest. Ophthalmol. Vis. Sci. 2014;55(13):2682.
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Visual impairment and age-related eye diseases have been shown to relate to increased mortality, but studies have been confined mostly to Western populations. We investigated the relationship between visual impairment, major age-related eye diseases and mortality in an Asian Malay population.
A prospective, population-based study of 3280 urban Malay adults aged 40 to 80 years at baseline living in Singapore, using data from the Singapore Malay Eye Study conducted between August 2004 and June 2006. All participants underwent a full ophthalmic examination including best-corrected visual acuity (BCVA) using the logMAR vision chart and fundus examination. Visual impairment was defined as BCVA worse than 0.30 logMAR in the better-seeing eye. Standardized lens and fundus photographic grading was conducted to assess presence of cataract, diabetic retinopathy, age-related macular degeneration and retinal vein occlusion. Glaucoma was diagnosed using the International Society Geographical and Epidemiological Ophthalmology criteria. All participants were linked with mortality records maintained by the National Registry of Diseases Office of Singapore during the period between baseline examination and December 31, 2011. Information on the date of death, all-cause deaths and cardiovascular deaths for the participants were extracted.
3273 participants with complete data were included in the analysis. During the follow-up (median 6.3 years), 336 (10.2%) persons had died. In Cox proportional-hazards models adjusting for age, gender, socioeconomic status, hypertension, diabetes, smoking and cardiovascular disease, participants with visual impairment had a higher all-cause mortality rate (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.55-3.29) and cardiovascular-cause mortality rate (hazard ratio [HR] 2.51; 95% confidence interval [CI], 1.39-4.52) than participants without visual impairment. Diabetic retinopathy (HR, 1.76; 95% CI, 1.25-2.45) and retinal vein occlusion (HR, 2.34; 95% CI, 1.04-5.28) were associated with increased risk of mortality. Cataract, glaucoma and age-related macular degeneration were not associated with mortality.
In this Asian population, persons with visual impairment were at higher risk of death than persons without visual impairment. The presence of diabetic retinopathy and retinal vein occlusion were markers of increased mortality risk.
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