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Karen Hong; Visual impairment and mortality: Systematic review and meta-analysis with data from the EPIC-Norfolk Eye Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3639.
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© ARVO (1962-2015); The Authors (2016-present)
Visual impairment (VI) has been associated with worse mental health, impaired activities of daily living, and increased hospitalizations. Despite the significant impact of VI on quality of life, little has been summarized on how VI influences mortality. We hypothesize that there is a direct relationship between visual impairment and mortality risk.
Participants aged 48-92 resident in Norfolk, England received standard Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing as part of the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) Eye Study between 2006-2011. VI was defined as a logMAR presenting visual acuity of > 0.30. Vital status was determined prospectively through data linkage to the United Kingdom Office of National Statistics through 2016. The relationship between VI with all-cause and cardiovascular (CV) mortality were examined with Cox proportional hazards models adjusted for age, sex, body mass index, social class, education level, smoking status, self-reported history of diabetes, history of a stroke event, and systolic blood pressure. Meta-analysis using random effects modeling pooled our results from the EPIC-Norfolk Eye Study (ENES) with associations found from a systematic review of the literature.
Of the 8559 participants, 3.6% (n=305) had VI. VI had an adjusted hazard ratio (HR, (95% CI)) of 1.30 (0.97, 1.76) for all-cause mortality and 1.28 (0.72, 2.28) for CV mortality. Incorporating our results on VI and all-cause mortality with 32 studies from the literature gave a pooled estimate of 1.34 (1.25, 1.43). The risk estimate of VI and CV mortality from this and 10 other studies was 1.29 (1.16, 1.43), and found to have an even stronger association at 1.67 (1.40, 2.01) when including only studies measuring VI by logMAR chart.
VI was not significantly associated with mortality in the ENES. However, our results pooled with the existing literature suggested an association between VI and increased risk of all-cause and CV mortality, especially among studies using standardized charts for visual acuity testing. This association requires further investigation as this could indicate a true causal relationship or that both VI with increased mortality risk may reflect another underlying condition.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Forest plot of VI and A) all-cause and B) CV mortality
Survival curve for A) all-cause and B) CV mortality
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