Prevalence and causes of bilateral visual impairment in rural areas of Tianjin, China – The Tianjin Eye Study

Abstract

Purpose To estimate the prevalence, causes and risk factors of bilateral visual impairment in rural areas of Tianjin, China. Methods A large population‐based, cross‐sectional study. A stratified random cluster sampling method was used to investigate 12 233 participants in all age groups living in rural Tianjin. Participants completed questionnaires and received professional ophthalmology examinations. Results According to World Health Organization best‐corrected visual acuity (BCVA) criteria, the crude prevalence of bilateral visual impairment (BCVA < 20/63), bilateral low vision (BCVA < 20/63 to ≥20/400) and bilateral blindness (BCVA < 20/400) was 2.53%, 2.40% and 0.14% (age‐ and gender‐standardized prevalence was 1.86%, 1.76% and 0.11%). The prevalence increased with age and was higher in women than men. The most common causes of bilateral visual impairment in the total population were cataract (48.39%), refractive error/amblyopia (17.74%), age‐related macular degeneration (AMD) (10.00%), diabetic retinopathy (5.81%) and glaucoma (3.87%). For participants younger than 50 years, refractive error/amblyopia was the leading cause of low vision and blindness, while cataract was the major cause in the participants over 50. Female gender, older age and self‐reported diabetes were associated with increased risks of visual impairment. Conclusion The age‐ and gender‐standardized prevalence of low vision, especially in the older group (50+), was higher in this study compared with previous studies in China. Refractive error/amblyopia was the leading cause of bilateral visual impairment in younger group, while cataract was the primary cause in the older group. These findings will provide useful information for planning comprehensive eye healthcare programmes in China.

Health insurance enrollment and vision health in rural China: an epidemiological survey

“…Due to limited space, the results of control variables are not presented here a Insurance_hat represents the predicted health insurance enrollment obtained by using the coefficients estimated from the first step of the IV method b The eye diseases here refer to the eye diseases studied in the basic eye conditions in this paper, including glaucoma, diabetic retinopathy, macular degeneration, and retinal vein obstruction vision was related to less education and older age [37], and a similar conclusion have also been demonstrated in another study conducted in Shaanxi, China [38]. Actually, not only the older people and less educated people, but also the female was also found to be more likely to have VI [22,39,40]. Since the pervasive inequality exists in the vulnerable populations, more care should be given to the vulnerable groups to a greater extent in the process of formulating health insurance, so as to reduce the inequality [24].…”

“…An existing study also based on rural Chinese adults which was conducted in Handan found that low vision was related to less education and older age [ 37 ], and a similar conclusion have also been demonstrated in another study conducted in Shaanxi, China [ 38 ]. Actually, not only the older people and less educated people, but also the female was also found to be more likely to have VI [ 22 , 39 , 40 ]. Since the pervasive inequality exists in the vulnerable populations, more care should be given to the vulnerable groups to a greater extent in the process of formulating health insurance, so as to reduce the inequality [ 24 ].…”

“…Glaucoma, cataract, and DR were also leading causes of blindness, based on the National Eye Survey of Trinidad and Tobago [18]. DR and glaucoma were two common causes of bilateral visual impairment, based on a study of rural areas in Tianjin, China [22]. The effects of DR, MD, and glaucoma on VI are especially strong [51][52][53][54][55][56].…”

“…Given the relative backward and unbalanced economic and social development in China, the rural sector often cannot meet the need for chronic disease prevention and treatment, including VI. In rural China, the prevalence of VI is relatively high, while the access and use of eye care services are comparatively low [ 22 ]. Statistics show that in 2018, about 2.5 billion people in developing countries suffered from vision problems, with 30 % of them were Chinese.…”

Primary glaucomas in adults: Epidemiology and public health‐A review

“…Using the best‐corrected visual acuity (BCVA), the leading causes of blindness in adults with 50 years and older in Shaanxi Province were cataract, corneal opacities and glaucoma (67.9%, 10.7% and 7.1%, respectively) 67 . Using the same visual acuity criteria but including all ages, another survey in Tianjin city also reported that cataract (52.9%) and glaucoma (23.5%) were the main causes of blindness 68 . In inner Mongolia, the prevalence of presenting visual acuity (PVA) glaucoma blindness in rural Chinese with 40 years and older was 10.9% of all blindness, representing the third cause more prevalent in the region 69 …”