Prevalence and causes of low vision and blindness in Baotou: A cross-sectional study

The prevalence, incidence, and persistence of self-reported visual impairment among Chinese population with diabetes mellitus: evaluation from a nationally representative survey, 2015-2018

Aims

Our aim was to investigate the prevalence, incidence, and persistence of visual impairment (VI) and their correlates among the Chinese population with diabetes mellitus (DM) over 3 years.

Materials and methods

The China Health and Retirement Longitudinal Survey is the first nationally representative longitudinal survey of the Chinese population. A cross-sectional analysis of prevalent VI in 2015 consisted of 2,173 participants with DM. A longitudinal observation of incident and persistent VI consisted of 1,633 participants from 2015 to 2018. Risk factors of VI were identified via univariate and multivariate logistic regression analyses.

Results

Among our study population with DM, 11.8% reported VI in 2015, 4.5% had persistent VI from 2015 to 2018, and 8.9% developed VI in 2018. Factors identified to be correlated to VI (p < 0.05) were older age, being a woman, lower educational attainment, living in a rural area, application of DM medication and non-pharmacological treatment, receiving DM-related tests, use of spectacles, and poorer health status.

Conclusion

This most recent national data provides a baseline for future public health initiatives on VI among the Chinese population with DM. With multiple risk factors identified, these could provide concurrent targets for various public health strategies and interventions with the aim of reducing the burden of VI among the population with DM in China.

Corneal Blindness in Asia: A Systematic Review and Meta-Analysis to Identify Challenges and Opportunities

PURPOSE

To describe the causes and prevalence of moderate-to-severe visual impairment (MSVI) and blindness from corneal diseases, as well as corneal transplantation across Asia.

METHODS

A meta-analysis of the published literature to identify population-based surveys conducted from 2008 to 2019 in 22 Asian countries regarding the prevalence and causes of MSVI and blindness from corneal disease, and a review of national corneal transplant data and eye bank statistics.

RESULTS

A total of 5307 records were screened to identify 57 reports that were used to estimate a prevalence of MSVI and blindness caused by corneal diseases in Asia of 0.38% (95% confidence interval, 0.29%-0.48%). The most frequent corneal diseases were infectious keratitis, trauma, and pseudophakic bullous keratopathy. As expected, these represented the most common indications for corneal transplantation, although the percentages in each country differed based on the level of economic development, with pseudophakic bullous keratopathy being the most common indication in countries with higher gross national income per capita. Despite this, endothelial keratoplasty is not the most commonly performed form of corneal transplantation in any Asian country and represents only a small percentage of keratoplasty procedures performed in most countries.

CONCLUSIONS

The prevalence of MSVI and blindness from corneal disease in Asia is approximately 0.4%, with a nearly 20-fold difference in the national prevalence across the region. The indications for keratoplasty, reflective of the causes of corneal dysfunction, also vary, more so according to the gross national income than to geographic location, and only a few Asian countries have rates of corneal transplantation above international means.

Prevalence of visual impairment among older Chinese population: A systematic review and meta-analysis

Background

To evaluate the prevalence of visual impairment (VI) among elderly Chinese population.

Methods

All population-based studies on VI prevalence among elderly Chinese populations were searched and only studies with clear definitions of diagnosis were selected. Meta-analysis methods were used to estimate the pooled prevalence and its 95% confidence interval (95%CI) of moderate and severe visual impairment (MSVI) and blindness both by presenting visual acuity (PVA) and best corrected visual acuity (BCVA). Subgroup analysis of gender, district, geographical location, age, education level and examined year were also conducted.

Results

72 studies with 465 039 individuals were included and analyzed. Using PVA, the pooled prevalence of MSVI is 10.9% (95% CI = 9.4%-12.6%) and blindness is 2.2% (95% CI = 1.8%-2.8%), while prevalence of MSVI and blindness by BCVA was 5.4% (95% CI = 4.6%-6.2%) and 2.2% (95% CI = 1.9%-2.5%), respectively. Females, rural residents, older age and lower educational level were risk factors for MSVI and blindness.

Conclusions

VI causes a great health burden among Chinese populations, particularly affecting female subjects, subjects dwelling in rural area, older subjects and subjects with lower educational level.

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

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.

Psychosocial Factors Affecting Artificial Intelligence Adoption in Health Care in China: Cross-Sectional Study

Background

Poor quality primary health care is a major issue in China, particularly in blindness prevention. Artificial intelligence (AI) could provide early screening and accurate auxiliary diagnosis to improve primary care services and reduce unnecessary referrals, but the application of AI in medical settings is still an emerging field.

Objective

This study aimed to investigate the general public’s acceptance of ophthalmic AI devices, with reference to those already used in China, and the interrelated influencing factors that shape people’s intention to use these devices.

Methods

We proposed a model of ophthalmic AI acceptance based on technology acceptance theories and variables from other health care–related studies. The model was verified via a 32-item questionnaire with 7-point Likert scales completed by 474 respondents (nationally random sampled). Structural equation modeling was used to evaluate item and construct reliability and validity via a confirmatory factor analysis, and the model’s path effects, significance, goodness of fit, and mediation and moderation effects were analyzed.

Results

Standardized factor loadings of items were between 0.583 and 0.876. Composite reliability of 9 constructs ranged from 0.673 to 0.841. The discriminant validity of all constructs met the Fornell and Larcker criteria. Model fit indicators such as standardized root mean square residual (0.057), comparative fit index (0.915), and root mean squared error of approximation (0.049) demonstrated good fit. Intention to use (R²=0.515) is significantly affected by subjective norms (beta=.408; P<.001), perceived usefulness (beta=.336; P=.03), and resistance bias (beta=–.237; P=.02). Subjective norms and perceived behavior control had an indirect impact on intention to use through perceived usefulness and perceived ease of use. Eye health consciousness had an indirect positive effect on intention to use through perceived usefulness. Trust had a significant moderation effect (beta=–.095; P=.049) on the effect path of perceived usefulness to intention to use.

Conclusions

The item, construct, and model indicators indicate reliable interpretation power and help explain the levels of public acceptance of ophthalmic AI devices in China. The influence of subjective norms can be linked to Confucian culture, collectivism, authoritarianism, and conformity mentality in China. Overall, the use of AI in diagnostics and clinical laboratory analysis is underdeveloped, and the Chinese public are generally mistrustful of medical staff and the Chinese medical system. Stakeholders such as doctors and AI suppliers should therefore avoid making misleading or over-exaggerated claims in the promotion of AI health care products.

Dual Sensory Loss, Mental Health, and Wellbeing of Older Adults Living in China

Introduction: Deterioration in vision and hearing commonly occurs as adults age. Existing literature shows that Dual Sensory Loss (DSL) is a prevalent condition amongst older adults. In China, it has been estimated that 57.2% of the population experience DSL. Based on a small number of research papers, it has been identified that DSL influences mental health and wellbeing. The aims of this study were to explore the relationship between DSL and mental health and wellbeing in a sample of older adults residing in China; and investigate whether the comorbidities of functional dependency [Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)] and chronic diseases influence the impacts of DSL on mental health and wellbeing.

Method: The China Health and Retirement Longitudinal Study Wave 2, 2013 data collection of a sample of people aged 60 years and over (n = 8,268) was used in this study. The sensory loss variables selected for analysis included a combined variable of self-reported vision and hearing loss (DSL). Mental health was measured by depression, and general wellbeing was measured by life satisfaction. In addition, chronic diseases, and limitations in IADL and ADL were used to test how their comorbidities with DSL influence mental health and wellbeing. Results were analyzed descriptively and using regression and modeling techniques.

Results and Discussion: DSL was significantly and positively associated with advanced age, having difficulty in any ADL or IADL and experiencing depression and less life satisfaction. The observed negative associations between DSL and mental health or wellbeing, are indirect and could be partially explained by its comorbidity with chronic diseases and relationship to functional limitations. It is recommended that health services in China screen for DSL in older people and develop integrated services to assist with appropriate management and rehabilitation of older people with DSL focusing on both functional and mental health issues.

Sensory Loss in China: Prevalence, Use of Aids, and Impacts on Social Participation

The number of older adults with vision and/or hearing loss is growing world-wide, including in China, whose population is aging rapidly. Sensory loss impacts on older people's ability to participate in their communities and their quality of life. This study investigates the prevalence of vision loss, hearing loss, and dual sensory loss (combined vision and hearing loss) in an older adult Chinese population and describes the relationships between these sensory losses and demographic factors, use of glasses and hearing aids, unmet needs, and impacts on social participation. The China Health and Retirement Longitudinal Study is a population-based longitudinal survey conducted since 2011. The 2013 dataset for people aged 60 and over was used in this study. Items analyzed included demographic data (age, gender, education, rurality, and SES), self-reported ratings of vision (including legally blind, excellent-poor long, and short distance vision and the use and frequency of wearing glasses), hearing (excellent-poor hearing and the use of hearing aids), dual sensory loss (both poor/fair vision and hearing), and social participation. Of the sample, 80.2% reported poor/fair vision, 64.9% reported poor/fair hearing, and 57.2% had poor/fair vision and hearing. Few respondents (10%) wore glasses regularly and 20.1% wore glasses from time to time. Only 0.8% of respondents wore hearing aids although the proportion with hearing loss was high (64.9%). The proportion of unmet needs for glasses and hearing aids was 54.9 and 63.9%, respectively. Low socio-economic status (SES), poor education, and rurality were significantly associated with the prevalence of poor/fair vision and hearing, the use of glasses and hearing aids and the unmet needs of glasses/hearing aids. Poor/fair vision and/or hearing, and the unmet needs for glasses/hearing aids were significantly and negatively associated with social participation. Sensory loss is a significant health issue for older Chinese people that impacts on their social participation. Training primary care health professionals in identification and rehabilitation approaches is needed as well as increasing the numbers of vision and hearing specialists working in the field. Providing information on sensory loss and the use of aids to older adults will also help improve older adult's quality of life.

Prevalence of visual impairment and its association with vision-related quality of life among elderly persons in a resettlement colony of Delhi

Background:

The population of India is ageing. The number and percentage of elderly persons is increasing. Visual impairment is common among elderly persons and affects their vision-related quality of life. The objective of this study was to estimate the prevalence of visual impairment among elderly persons aged 60 years and above residing in a resettlement colony of Delhi and study its association with socio-demographic variables and vision-related quality of life.

Methods:

A total of 604 elderly participants were selected by simple random sampling. House-to-house visit was done, and a self-developed pre-tested semi-structured interview schedule was used to collect socio-demographic information. Visual acuity was measured using Snellen's chart, and distant direct ophthalmoscopy was done to diagnose cataract. Vision-related quality of life was assessed by Indian Vision Function Questionnaire-33 (IND-VFQ-33).

Results:

Of the 604 participants, 555 (91.9%) were available for interview. The prevalence of visual impairment was 24.5% (95% CI: 20.9% - 28.1%). Cataract was the leading cause of visual impairment (50.7%), followed by uncorrected refractive error (36.8%). Illiteracy (aOR: 3.49, 1.37-8.87), economic dependence on family members (aOR: 1.92, 1.04 – 3.54), not currently working (aOR: 1.89, 1.20-2.98) and chewing of tobacco products (aOR: 2.56, 1.48-4.42) were significantly associated with visual impairment among study participants. Vison-related quality of life was worse among those with visual impairment.

Conclusion:

Burden of visual impairment is high among elderly persons living in urban resettlement colonies. It is largely avoidable. Eye-care services should be accessible and affordable to them.

Blindness, low vision and cataract surgery outcome among adults in Hohhot of Inner Mongolia: a Rapid Assessment of Avoidable Blindness (RAAB) study

BACKGROUND

To determine the prevalence and causes of visual impairment (VI), and to describe the characteristics of cataract surgery coverage and related barriers among adults aged ≥50 years residing in Hohhot, Inner Mongolia.

METHODS

A population-based cross-sectional study was performed. Presenting visual acuity (PVA) was measured using the Rapid Assessment of Avoidable Blindness (RAAB) methodology. All VI cases were defined using the WHO definition, based on the PVA of the better-seeing eye. Details on history of cataract surgery and barriers to cataract surgery were also obtained using a standardised questionnaire.

RESULTS

Of 4500 eligible individuals, 3985 (88.6% response rate) were examined. The age-standardised prevalence of moderate VI (PVA <6/18 to ≥6/60) was 5.4% (95% CI 4.6% to 6.3%), and severe VI (PVA <6/60 to ≥3/60) was 0.9% (95% CI 0.6% to 1.3%). The age-standardised prevalence of blindness (PVA <3/60) was 1.2% (95% CI 0.8% to 1.6%). Uncorrected refractive error (40.1%) and cataract (37.9%) were the leading causes of overall VI. Cataract (34.9%) was the leading cause of blindness. Among individuals with blindness, cataract surgical coverage was 80.7%. Among individuals with blindness due to cataract, the main barriers to cataract surgery were lack of awareness (38.1%).

CONCLUSIONS

The age-standardised prevalence rate of blindness in Hohhot was lower compared with other RAAB studies in China. Cataract was the leading cause of blindness. These findings provide useful information for the planning of public healthcare services in Inner Mongolia.