Pattern of visual impairment and major eye diseases in Asians between the “old” and “very-old”: The Singapore Epidemiology of Eye Diseases Study

Abstract

 

Purpose

 

Vision impairment (VI) is a major public health problem globally. Although it is known that older people are more likely to have VI and eye disease, there are few population-based data on the burden of VI and age-related eye diseases in older adults, particular very-old adults in Asia. To address this gap, we compared the prevalence and risk factors of major eye diseases between the old (65-74y) and the very-old (≥75y) adults in a multi-ethnic Asian cohort in Singapore.

 

Methods

 

We examined 2,662 adults (859 Chinese, 1058 Malays and 745 Indians) aged ≥65 years (1,953 old and 709 very-old) who participated in the Singapore Epidemiology of Eye Diseases Study (2007-2011). VI/ blindness was defined as best-corrected visual acuity (BCVA) worse than 20/40 in the better eye. Age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, and under-corrected refractive errors (URE) were assessed using standardized clinical and retinal photographic protocols. Multivariable logistic regression models adjusted for demographic, life style and clinical risk factors were used to examine the relationship between risk factors and outcomes.

 

Results

 

The crude and age-adjusted prevalence of VI/blindness were 38.4% and 41.8% in the whole population and was higher in the very-old (55.8%, and 57% respectively) compared to the old (32.2%, 31.8%). Compared to the old, among the very-old, the prevalence of cataract (95.4% in the very-old vs 81.6% in the old), AMD (20.3% vs 11.7%), and glaucoma (10.2% vs 5.7%) were higher (all p<0.0001), while DR was lower (27.2% vs 36%, p=0.02) and URE was similar (25.8% vs 25.1%, p= 0.7). In multivariable models, age, primary/below education, diabetes, cardiovascular disease and higher cholesterol were associated with VI in the old; female sex, primary/below education, and higher cholesterol levels were associated with VI in the very-old; Indian ethnicity was inversely associated with VI in both old and very-old.

 

Conclusions

 

The prevalence of VI and major age-related eye diseases increased substantially, with AMD and glaucoma almost double the rates, in very-old adults (>75 years) compared to old adults (65-74 years). These findings suggest the need to explore different strategies in screening and prevention of VI and major eye diseases in the very old age-group in Asia.