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S Foran, P Mitchell, J WangBlue Mountains Eye Study; Causes and Socio-Economic Predictors of 5-year Incident Visual Impairment and Blindness: The Blue Mountains Eye Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):878.
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Purpose:To describe the causes and socioeconomic predictors of 5-year incident visual impairment and blindness in an older population. Methods:3654 participants of the Blue Mountains Eye Study (aged 50+) were examined during 1992-94; 2335 (75.1% of survivors) were re-examined during 1997-99. Socio-economic parameters and medical history were collected. LogMAR visual acuity (VA) was measured, before and after standardized refraction. Visual impairment was defined as: any, VA <20/40 (<39 letters); and blind, VA <20/200 (<4 letters). Incidence of binocular and monocular visual impairment and blindness was assessed, as well as socio-economic associations. Results:5-year incident visual impairment and blindness was strongly age-related. Visual impairment developed binocularly in 1.9% and monocularly in 7.1% of participants. Corresponding rates for incident blindness were 0.1% and 2.1%. With increasing severity of incident bilateral impairment, the proportions due to cataract and age-related maculopathy (ARM) reversed. For incident impairment <20/40, cataract caused 51.4% and ARM, 24.3%. However, for incident binocular blindness, these rates were 0% and 100%. Corresponding proportions of incident monocular impairment due to cataract decreased (53.7% to13.6%), while cases due to ARM increased (19.4% to 54.5%) with increasing severity of impairment. Participants who were married, owned their dwelling, gained post-school qualifications, had high job prestige or were driving, were significantly less likely, by around 30-50%, to develop any incident impairment in one or both eyes, after controlling for age and gender. The adjusted odds ratio (OR) for incident impairment was significantly increased in those who lived alone (OR 1.6), rated their overall health as fair-poor (OR 1.4), had myopia (OR 2.0) or reported diabetes (OR 2.0). Neither mean duration since the last eye exam, nor use of distance correction, was associated with incident impairment. Socio-economic parameters associated with incident visual impairment also predicted development of blindness. Incident blindness, however, was significantly more frequent among those using community support services (OR 2.8), or with a history of heart disease (OR 2.2) or stroke (OR 3.6). Conclusion:Measures of isolation, dependency and low perceived general health predicted 5-year incident visual impairment and blindness, which was due predominantly to cataract and ARM.
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