Incidence, individual, and macro level risk factors of severe binocular visual impairment and blindness in persons aged 50 and older

Abstract

Objective This study aims to estimate the incidence of severe binocular vision impairment and blindness (SVI/B) and to identify eye diseases and regional risk factors of persons with SVI/B at ages 50 years and older. Methods We designed an observational cohort study based on longitudinal, multifactorial, and administrative information of a random sample of 250,000 persons at ages 50+. All individuals were included in the process-produced health claims register of the Allgemeine Ortskrankenkasse in 2004, and were followed until 2015. We analyzed ten selected eye diseases and regional characteristics as risk factors for SVI/B using Cox models, adjusting for demographic characteristics and multi-morbidity. Results The age-standardized incidence was 79 new diagnoses of SVI/B per 100,000 person-years (95%-CI: 76-82); 77 for males (72-82) and 81 for females (77-85). By adjusting for multiple factors, the model revealed and confirmed that individuals who were very old (Hazard ratio90+: 6.67; 3.59-12.71), male (1.18; 1.01-1.38), had multi-morbidities (three+ diseases: 3.36; 2.51-4.49), or had diabetes (1.26; 1.07-1.49) had an increased risk of SVI/B. Compared to persons without the particular eye disease (all p<0.001), persons diagnosed with secondary glaucoma had a multiple-adjusted 4.66 times (3.17-6.85) higher risk, those with retinal vascular occlusion had a 4.51 times (3.27-6.23) higher risk, and those with angle-closure glaucoma had a 4.22 times (2.60-6.85) higher risk. Population density was not a risk factor, while persons living in wealthier regions had 0.75 times (p=0.003) to 0.70 times (p<0.001) the risk of SVI/B than persons in the least wealthy regions of Germany. Conclusion The study revealed and confirmed some profound risk factors of SVI/B at both the individual and the macro level. The sizes of the effects of the characteristics of the living context were smaller than those of the individual characteristics, especially for some severe eye diseases. While urbanity and access to health services had no effect, regional economic wealth was a risk factor for SVI/B. Future health care measures and advice by physicians should take these dimensions of inequalities in SVI/B into account.

Optimization of an Injectable Hydrogel Depot System for the Controlled Release of Retinal-Targeted Hybrid Nanoparticles

“…Several multifactorial disorders can result in retinal impairments, such as diabetes, retinal detachment, age-related retinal degenerations and tumors, or inherited forms of retinal degeneration. These are an important burden to society because almost 300 million people suffer from severe visual impairment and blindness worldwide [ 1 , 2 , 3 ]. The retina is well protected by both the blood–retinal barrier and the inner limiting membrane (at the retinal–vitreal interface), regulating the flux into and out of the retina, which greatly limits administration routes.…”

Progression to severe visual impairment and blindness in POAG patients: pace and risk factors—a cohort study using German health claims data

“… 5 8 12–16 Based on the results of our previous study, which referred to the impact of incident eye diseases on the risk of SVI/B, in this study we analysed ten eye diseases as risk factors for the incidence of SVI/B in incident POAG patients. 17 …”

“…For the pathogenesis of SVI/B, relevant conditions include AMD, retinopathy, glaucoma and cataract as well as myopia, retinal vascular occlusions, injuries of the eye and optic nerve diseases 5 8 12–16. Based on the results of our previous study, which referred to the impact of incident eye diseases on the risk of SVI/B, in this study we analysed ten eye diseases as risk factors for the incidence of SVI/B in incident POAG patients 17…”