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Charumathi Sabanayagam, Miao Li Chee, Yih Chung Tham, Danny Cheung, Stanley Poh, Yijin Tao, Ching-Yu Cheng, Tien Y Wong; Impact of visual impairment and major eye diseases on mortality in Asians.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1388.
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© ARVO (1962-2015); The Authors (2016-present)
Vision impairment (VI) is a major public health problem associated with poor quality of life. We examined the impact of VI on mortality risk and also examined the contribution of major eye diseases to mortality in Asians living in Singapore.
We included 9986 Chinese, Malay and Indian adults, aged 40-80 years who participated in the baseline visit of the Singapore Epidemiology of Eye Diseases Study (SEED, 2004-11). All-cause mortality was obtained by linkage with National Death Registry until May 2017. VI was defined by best-corrected visual acuity (BCVA) in the better eye (VA<20/40) and categorized into normal-vision (≥20/40), low-vision (<20/40 but >20/200) and blindness (≤20/200) based on the US definition. Cataract, retinopathy, glaucoma and age-related macular degeneration (AMD) were assessed using standardized ocular examination, retinal photography and visual field assessments. Survival probability adjusted for age, sex were generated using Kaplan-Meyer survival curves and compared across vision categories using log-rank tests. Associations were examined using Cox proportional hazards regression models adjusted for age, sex, ethnicity, education, income, body mass index, smoking, drinking, diabetes, hypertension, cholesterol levels, and history of cardiovascular disease.
Prevalence of VI in the study population was 5.8% (blind = 0.4%). Over a median follow-up of 8.8 years, 1210 deaths occurred (12.1%). Survival probability was lowest in blind, followed by low-vision (p<0.0001). In multivariable models, compared to normal vision, those with VI had increased risk of mortality (hazards ratio [HR] (95% confidence interval [CI]) = 1.54 (1.30-1.81). In ethnicity-specific analyses, this association was significant in all 3 ethnic groups (1.63 [1.08-2.41], 1.32 [1.07-1.62], and 2.25[1.61-3.15]) in Chinese, Malays, and Indians. Within the vision categories, low-vision was significantly associated with mortality (1.53 [1.30-1.81]). Among eye diseases, cataract including past cataract surgery (1.32 [1.11-1.57]) and diabetic retinopathy (1.74 [1.27 - 2.40] in those with diabetes) were significantly associated with mortality.
VI was a significant predictor of mortality in this multi-ethnic population. Cataract and DR were major contributors to mortality.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Age and sex-adjusted survival curves by vision categories
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