Presbyopia: Impact on Quality of Life in a Rural African Setting

Abstract

Abstract: : Purpose: Currently, the World Health Organization’s Vision 2020 refraction agenda places little emphasis on presbyopia. However, anecdotal evidence suggests a need for good near vision even among illiterate developing world persons. The purpose of this study was to determine the impact of uncorrected presbyopia on quality of life in rural Tanzania. Methods: The Tanzania Near Vision Impairment Project is a cross–sectional population–based study of 1709 village and town–dwelling adults aged 40 and over in rural Tanzania. Subjects underwent distance and near visual acuity testing and were administered a near vision–related quality of life questionnaire we developed to determine the degree of self–rated difficulty with distance and near vision, degree of difficulty in carrying out tasks appropriate to life in a village/town setting, and how much near vision contributed to this difficulty. Scores for near vision–related difficulty with tasks of everyday living were computed in a multi–step process. Based on the distribution of these scores, four categories of near vision difficulty were created. We used multinomial regression models to assess the association of presbyopia with the difficulty groups adjusting for age, level of education, residency (village/town), mental health and distance visual acuity loss. Results: Complete data were available for 1583 (93%) of the subjects. 61.7% of subjects were presbyopic. The majority of presbyopes (94.1%) did not have corrective near vision glasses. 62.5% of subjects reported having problems with their near vision. 54.1% were dissatisfied with their ability to do near work. Compared to non–presbyopes, being presbyopic increased the odds of reporting some difficulty with near vision tasks by over two fold (OR 2.25, 95% CI 1.71–2.92), almost six fold for moderate difficulty (OR 5.75, 95% CI 3.63–9.12) and over nine fold for high difficulty (OR 9.30, 95% CI 3.46–25.28). As the add requirement increased, greater proportions of subjects were in the high difficulty group (p < 0.001). Conclusions: This is the first study to demonstrate the significant impact of uncorrected presbyopia on vision–related quality of life in a rural developing world setting. Given the high prevalence of presbyopia, this study has major implications for the World Health Organization’s Vision 2020 refraction agenda which should place greater emphasis on presbyopia.

Keywords: quality of life • clinical (human) or epidemiologic studies: outcomes/complications • aging: visual performance