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Fisher DE, Shrager S, Shea SJ, Burke GL, Klein R, Wong TY, Klein BE, Cotch MF. Visual Impairment in White, Chinese, Black, and Hispanic Participants from the Multi-Ethnic Study of Atherosclerosis Cohort. Ophthalmic Epidemiol 2016; 22:321-32. [PMID: 26395659 DOI: 10.3109/09286586.2015.1066395] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe the prevalence of visual impairment and examine its association with demographic, socioeconomic, and health characteristics in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. METHODS Visual acuity data were obtained from 6134 participants, aged 46-87 years at time of examination between 2002 and 2004 (mean age 64 years, 47.6% male), from six communities in the United States. Visual impairment was defined as presenting visual acuity 20/50 or worse in the better-seeing eye. Risk factors were included in multivariable logistic regression models to determine their impact on visual impairment for men and women in each racial/ethnic group. RESULTS Among all participants, 6.6% (n = 421) had visual impairment, including 5.6% of men (n = 178) and 7.5% of women (n = 243). Prevalence of impairment ranged from 4.2% (n = 52) and 6.0% (n = 77) in white men and women, respectively, to 7.6% (n = 37) and 11.6% (n = 44) in Chinese men and women, respectively. Older age was significantly associated with visual impairment in both men and women, particularly in those with lower socioeconomic status, but the effects of increasing age were more pronounced in men. Two-thirds of participants already wore distance correction, and not unexpectedly, a lower prevalence of visual impairment was seen in this group; however, 2.4% of men and 3.5% of women with current distance correction had correctable visual impairment, most notably among seniors. CONCLUSION Even in the U.S. where prevalence of refractive correction is high, both visual impairment and uncorrected refractive error represent current public health challenges.
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Affiliation(s)
- Diana E Fisher
- a Division of Epidemiology and Clinical Applications , Intramural Research Program, National Eye Institute (NEI), National Institutes of Health (NIH) , Bethesda , MD , USA
| | - Sandi Shrager
- b Department of Biostatistics , University of Washington , Seattle , WA , USA
| | - Steven J Shea
- c Departments of Medicine and Epidemiology , Columbia University , New York , NY , USA
| | - Gregory L Burke
- d Division of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Ronald Klein
- e Department of Ophthalmology and Visual Sciences , University of Wisconsin--Madison , Madison , WI , USA
| | - Tien Y Wong
- f Department of Ophthalmology , Yong Loo Lin School of Medicine, National University of Singapore , Singapore , and.,g Singapore Eye Research Institute, Singapore National Eye Centre , Singapore
| | - Barbara E Klein
- e Department of Ophthalmology and Visual Sciences , University of Wisconsin--Madison , Madison , WI , USA
| | - Mary Frances Cotch
- a Division of Epidemiology and Clinical Applications , Intramural Research Program, National Eye Institute (NEI), National Institutes of Health (NIH) , Bethesda , MD , USA
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Chou CF, Frances Cotch M, Vitale S, Zhang X, Klein R, Friedman DS, Klein BEK, Saaddine JB. Age-related eye diseases and visual impairment among U.S. adults. Am J Prev Med 2013; 45:29-35. [PMID: 23790986 PMCID: PMC4072030 DOI: 10.1016/j.amepre.2013.02.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/07/2012] [Accepted: 02/25/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Visual impairment is a common health-related disability in the U.S. The association between clinical measurements of age-related eye diseases and visual impairment in data from a national survey has not been reported. PURPOSE To examine common eye conditions and other correlates associated with visual impairment in the U.S. METHODS Data from the 2005-2008 National Health and Nutrition Examination Survey of 5222 Americans aged ≥40 years were analyzed in 2012 for visual impairment (presenting distance visual acuity worse than 20/40 in the better-seeing eye), and visual impairment not due to refractive error (distance visual acuity worse than 20/40 after refraction). Diabetic retinopathy (DR) and age-related macular degeneration (AMD) were assessed from retinal fundus images; glaucoma was assessed from two successive frequency-doubling tests and a cup-to-disc ratio measurement. RESULTS Prevalence of visual impairment and of visual impairment not due to refractive error was 7.5% (95% CI=6.9%, 8.1%) and 2.0% (1.7%, 2.3%), respectively. The prevalence of visual impairment not due to refractive error was significantly higher among people with AMD (2.2%) compared to those without AMD (0.8%), or with DR (3.5%) compared to those without DR (1.2%). Independent predictive factors of visual impairment not due to refractive error were AMD (OR=4.52, 95% CI=2.50, 8.17); increasing age (OR=1.09 per year, 95% CI=1.06, 1.13); and less than a high school education (OR=2.99, 95% CI=1.18, 7.55). CONCLUSIONS Visual impairment is a public health problem in the U.S. Visual impairment in two thirds of adults could be eliminated with refractive correction. Screening of the older population may identify adults at increased risk of visual impairment due to eye diseases.
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Affiliation(s)
- Chiu-Fang Chou
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Mary Frances Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, NIH, Bethesda
| | - Susan Vitale
- Division of Epidemiology and Clinical Applications, National Eye Institute, NIH, Bethesda
| | - Xinzhi Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - David S Friedman
- Wilmer Eye Institute , Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Jinan B Saaddine
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Furtado JM, Lansingh VC, Carter MJ, Milanese MF, Peña BN, Ghersi HA, Bote PL, Nano ME, Silva JC. Causes of blindness and visual impairment in Latin America. Surv Ophthalmol 2011; 57:149-77. [PMID: 22137039 DOI: 10.1016/j.survophthal.2011.07.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 07/12/2011] [Accepted: 07/19/2011] [Indexed: 11/26/2022]
Abstract
We review what is known in each country of the Latin American region with regards to blindness and visual impairment and make some comparisons to Hispanic populations in the United States. Prevalence of blindness varied from 1.1% in Argentina to 4.1% in Guatemala in people 50 years of age and older, with the major cause being cataract. Diabetic retinopathy and glaucoma are starting to make serious inroads, although epidemiological data are limited, and age-related macular degeneration is now a concern in some populations. Infectious diseases such as trachoma and onchocerciasis are quickly diminishing. Although progress has been made, retinopathy of prematurity remains the major cause of childhood blindness. If VISION 2020 is to succeed, many more epidemiological studies will be needed to set priorities, although some can be of the Rapid Assessment of Avoidable Blindness design. Developing the infrastructure for screening and treatment of ophthalmic disease in Latin America continues to be a challenge.
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Affiliation(s)
- João M Furtado
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
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Sullivan DA. Tearful relationships? Sex, hormones, the lacrimal gland, and aqueous-deficient dry eye. Ocul Surf 2007; 2:92-123. [PMID: 17216082 DOI: 10.1016/s1542-0124(12)70147-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sex and the endocrine system exert a significant influence on the physiology and pathophysiology of the lacrimal gland. The purpose of this article is to briefly review the nature and magnitude of these interactions between sex, hormones and lacrimal tissue, and to address how they may relate to the pathogenesis of aqueous-deficient dry eye. Towards this end, this article has a 3-fold approach: first, to summarize the influence of androgens, estrogens, glucocorticoids, mineralocorticoids, retinoic acid, prolactin, alpha-melanocyte stimulating hormone, adrenocorticotropic hormone, luteinizing hormone, follicle-stimulating hormone, growth hormone, thyroid-stimulating hormone, arginine vasopressin, oxytocin, thyroxine, parathyroid hormone, insulin, glucagon, melatonin, human chorionic gonadotropin and cholecystokinin on the structure and function of the lacrimal gland; second, to discuss the mechanism of action of each hormone on lacrimal tissue; and third, to discuss the clinical relevance of the endocrine-lacrimal gland interrelationship, with a particular focus on each hormone's role (i.e. if relevant) in the development of aqueous-tear deficiency.
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Affiliation(s)
- David A Sullivan
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Lee DJ, Lam BL, Gómez-Marín O, Zheng DD, Caban AJ. Concurrent hearing and visual impairment and morbidity in community-residing adults: the National Health Interview Survey, 1986 to 1996. J Aging Health 2005; 17:531-46. [PMID: 16177449 DOI: 10.1177/0898264305277956] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the association between the presence and severity of concurrent hearing and visual impairment (HI+VI) and morbidity. METHODS Data for adults 45 years and older were obtained from the National Health Interview Survey, 1986 to 1996 (n = 60,997). Covariate-adjusted logistic regression analyses were used to examine associations between HI+VI and five morbidity indicators: restricted activity days, bed rest days, doctor visits, hospitalizations and self-rated health. RESULTS Associations with morbidity indicators tended to be stronger in adults with HI+VI, and in particular, among adults with more severe HI+VI, relative to adults reporting no impairment. These associations were somewhat stronger in adults 45 to 64 years versus older adults. DISCUSSION HI+VI is associated with morbidity, although the strength of these associations varies across subgroups. Findings indicate that an increased focus on the provision of hearing and eye care services is required. Insurance coverage for these services should also be pursued by health policy makers.
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Affiliation(s)
- David J Lee
- Department of Epidemiology & Public Health, University of Miami Miller School of Medicine, P.O. Box 016069, Miami, FL 33101,
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Lee DJ, Gómez-Marín O, Lam BL, Zheng DD, Caban A. Visual impairment and morbidity in community-residing adults: the national health interview survey 1986-1996. Ophthalmic Epidemiol 2005; 12:13-7. [PMID: 15848916 DOI: 10.1080/09286580490907751] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine the association between visual impairment (VI) and morbidity. METHODS Using pooled, annual population-based household interview survey data (n = 140,366) from the 1986-1996 National Health Interview Survey, covariate-adjusted, gender and age group specific logistic regression analyses were used to examine associations between VI and five morbidity indicators: restricted activity days, bed rest days, doctor visits, hospitalizations, and self-rated health. RESULTS After controlling for educational status, race and the number of reported non-ocular health conditions, fair or poor health status (compared to excellent, very good, or good health status) was generally more strongly associated with severe, bilateral VI (range of odds ratios [OR's]: 2.14-7.24) than with some VI (OR's: 1.45-2.21). Severe, bilateral VI was also associated with more frequent doctor and hospital visits among adults 18-64 years of age (range of OR's: 1.69-3.34), and restricted activity and bed rest days among males 45 years and older (range of OR's: 1.95-3.69). CONCLUSIONS The present findings, in conjunction with other studies documenting the impact of VI on morbidity outcomes, indicate that an increased focus on the provision of eye care services will be necessary to address the growing burden of VI in aging societies.
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Affiliation(s)
- David J Lee
- Department of Epidemiology & Public Health, University of Miami School of Medicine, Miami, Florida 33101, USA.
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