Impact of Visual Impairment and Eye diseases on Mortality: the Singapore Malay Eye Study (SiMES)

Abstract

We investigated the relationship of visual impairment (VI) and age-related eye diseases with mortality in a prospective, population-based cohort study of 3,280 Malay adults aged 40–80 years between 2004–2006. Participants underwent a full ophthalmic examination and standardized lens and fundus photographic grading. Visual acuity was measured using logMAR chart. VI was defined as presenting (PVA) and best-corrected (BCVA) visual acuity worse than 0.30 logMAR in the better-seeing eye. Participants were linked with mortality records until 2012. During follow-up (median 7.24 years), 398 (12.2%) persons died. In Cox proportional-hazards models adjusting for relevant factors, participants with VI (PVA) had higher all-cause mortality (hazard ratio[HR], 1.57; 95% confidence interval[CI], 1.25–1.96) and cardiovascular (CVD) mortality (HR 1.75; 95% CI, 1.24–2.49) than participants without. Diabetic retinopathy (DR) was associated with increased all-cause (HR 1.70; 95% CI, 1.25–2.36) and CVD mortality (HR 1.57; 95% CI, 1.05–2.43). Retinal vein occlusion (RVO) was associated with increased CVD mortality (HR 3.14; 95% CI, 1.26–7.73). No significant associations were observed between cataract, glaucoma and age-related macular degeneration with mortality. We conclude that persons with VI were more likely to die than persons without. DR and RVO are markers of CVD mortality.

The association between visual impairment and the risk of mortality: a meta-analysis of prospective studies

“…Eight studies were conducted in women19 22 23 28 31 33 35 36 and seven in men 22 23 28 31 33 35 36. With regard to the study region, nine studies were conducted in North America,4 16 18–20 35 36 four in Oceania,21 22 29 seven in Asia17 23 25 26 28 30 and nine in Europe 24 27 31–34 37. Follow-up duration ranged from 2 to 13.2 years.…”

“…There were nine studies with a follow-up duration shorter than 5 years,4 21 23 27 28 32 36 six studies with a follow-up duration between 5 and 6 years,16 31 33 34 37 seven studies with a follow-up duration between 6 and 8 years17 22 26 30 35 and seven studies with a follow-up duration longer than 8 years 18–20 24 25 29. About VI assessment, 15 studies were assessed by acuity charts,17 19 21 23–27 29–31 33 34 three studies by the International Statistical Classification of Diseases (ICD) code,4 35 seven studies by self-report16 22 28 32 37 and four by other methods 18 20 36. The baseline characteristics of the studies are shown in online supplementary table S1.…”

“…First, the methods of VI assessment varied. Fifteen studies were assessed by acuity charts,17 19 21 23–27 29–31 33 34 and the acuity charts contained many kinds of charts (Snellen E chart, Bailey-Lovie letter chart, Landolt ring chart, etc) and three studies by ICD code,4 35 seven studies by self-report16 22 28 32 37 and four by other methods 18 20 36. The different methods may lead to a misclassification of objects.…”

Association of disease‐specific causes of visual impairment and 10‐year mortality amongst Indigenous Australians: the Central Australian Ocular Health Study

“…Prevalent ocular pathologies in non‐Indigenous Australians such as cataract, age‐related macular degeneration, glaucoma and DR have all been independently linked not only to VI but also to increased risk of mortality and, in some cases, they can be predictive of mortality . However, these findings have not been consistently shown, and the exact reason behind these relationships remains elusive . It is suggested that some eye diseases can be biological markers for cellular ageing .…”

“…VI is typically classified as visual acuity worse than 6/12 vision in a person's better‐seeing eye and has been shown to be associated with higher mortality even after efforts to control for confounders such as age and sex . Some studies also controlled for additional confounders such as socioeconomic status, hypertension, diabetes, smoking, body mass index and history of CVD, and these remained evident . Causes of VI can vary within populations, ages, gender and educational and ethnic groups.…”