Incidence and correction of vision impairment among elderly population in southern urban China

Abstract

Importance Data on the incidence of presenting vision impairment (PVI) and spectacle coverage rate (SCR) in urban China is limited. Background To estimate the 6‐year incidence and risk factors for PVI and the SCR in urban Southern China. Design Population‐based cohort study. Participants A total of 1817 participants aged ≥35 years were identified from Guangzhou in 2008 at baseline and 1427 attended follow‐up examination in 2014. Methods Presenting visual acuity (PVA) was measured using the ETDRS chart with habitual spectacles. Participants with PVA ≤20/40 underwent subjective refraction at the follow‐up visit. Incidence of PVI was calculated using the WHO and US criteria, respectively. The met‐need SCR was defined as the percentage of participants with PVA <20/40 that had been improved to ≥20/40 after correction. Main Outcome Measures Incidence of PVI and SCR. Results Incidence of PVI was 8.3% (95%CI, 6.9‐9.8) and 12.2% (95%CI, 10.5‐14.0) based on the WHO and US definition, respectively. Older age, female, lower education level, more myopic spherical equivalent and worse PVA at baseline were significantly related to a higher PVI incidence based on the WHO criteria, with similar associations identified using the US criteria except for gender. The overall met‐need SCR was 42.5%, and was lower among the elderly, more hyperopic participants or participants with lower education level. Conclusions and Relevance The incidence of PVI is high in urban Southern China and spectacle wearing is available in less than half of those in need. This highlights the needs to promote spectacle coverage even in the urban population.

Self‐reported vision impairment, vision correction, and depressive symptoms among middle‐aged and older Chinese: Findings from the China health and retirement longitudinal study

“…It was possible that the habitual glasses could not correct visual acuity (VA) of some VI adults to a normal level. 5 One previous study found that despite provision of glasses, 31% of older adults could not see satisfactorily. 50 In addition, refractive status changes with age and age-related eye diseases.…”

“…However, this study also reported that 42% of participants had their VA improved at least one line of the ETDRS chart with habitual glasses. 5 Moreover, findings from a nursing home population reported that dispensing glasses for treating VI was associated with reduced psychological distress, increased social interaction and decreased depressive symptoms. 19 It was possible that VC may be beneficial for reduced adverse health outcomes such as depressive symptoms partially through improved visual function for VI individuals despite that their vision may not be completely corrected to the normal vision.…”

“…Although VC could improve visual function and decrease risk of depressive symptoms, there was a low rate of VC especially in developing countries. 5,56 In addition, screening for VI was a well-debated topic that one review suggested screening for VI could not improve visual function of community older adults. 57 Findings from our results suggested that it is helpful to recognize the importance of identifying the older population with vision improvement potential and providing them effective interventions such as glasses.…”

“…3,4 However, only 12.7% of Chinese adults aged over 65 years met the need of glasses among those in need of vision correction (VC) by wearing glasses, due to lack of awareness for VI, or poor affordability/accessibility of eye care in urban Southern China. 5 Depressive symptoms at late life have become an increasingly serious public health concern in current global aging situation and studies have been conducted to identify vulnerable populations of older adults. 6,7 In China, depressive symptoms are common psychological disorders and affect 32.1% middle-aged and older adults.…”

“…1 However, there was low glasses coverage with a large unmet need, especially among older adults in developing countries, including China. 5,29 Previous studies have reported that wearing glasses can help correct vision, therefore preventing depressive symptoms 19 and cognitive decline, 30 while it remains unclear for the joint effect of VI and VC on depressive symptoms among older populations. Additionally, previous studies evaluating the associations between VI and depressive symptoms were mostly conducted among older population in Western countries.…”