Causes of blindness and visual impairment in a population of older Americans -: The Salisbury Eye Evaluation Study
Causes of blindness and visual impairment in a population of older Americans -: The Salisbury Eye Evaluation Study
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DOI：
10.1001/archopht.118.6.819
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发表时间：
2000-06-01
影响因子：
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通讯作者：
Bandeen-Roche, K
中科院分区：
文献类型：
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作者：
Muñoz, B;West, SK;Bandeen-Roche, K
目的：在美国老年人群中确定致盲和视力损害的原因。方法：随机抽取马里兰州索尔兹伯里的3821名年龄在65岁到84岁之间的居民作为调查对象。66%(2520人)同意接受眼科检查；26%的参与者是非洲裔美国人。临床检查包括早期治疗糖尿病视网膜病变研究表的视力测试，视力低于20/30的人的标准化屈光测试，眼科医生的裂隙灯和扩张的视网膜检查，眼压计，晶状体和眼底照相，以及阈值上视野测试。视力损害定义为视力低于20/40且优于20/200的最佳矫正视力，而失明定义为视力低于20/200或更差的视力。对于双眼视力低于20/40的患者，由眼科医生指定一个或多个原因，并由3名专科眼科医生(O.D.S.、H.A.Q和S.B.B.)组成的小组确认每只眼睛的最终原因。结果：双眼视力低于20/40的比例从65-74岁年龄组的4%上升到80-84岁年龄组的16%。视力低于20/40的人中，有三分之一的人屈光度提高到20/40或更高。总体而言，4.5%的最佳矫正视力低于20/40。尽管屈光不正，非裔美国人比白人更有可能保持视力受损(优势比[95%可信区间]，1.7[1.1-2.6])。白人最常因年龄相关性黄斑变性而受损或失明(1.2%比0.5%，P=0.09)。非裔美国人因白内障或后囊混浊(2.7%比1.1%；P=0.006)、青光眼(0.9%比0.1%；P=0.006)和糖尿病视网膜病变(1.2%比0.2%；P=0.004)导致的损伤和失明的发生率更高。结论：超过一半的视力受损或失明的人有手术治疗或潜在预防的疾病。非裔美国人患有不成比例的致盲疾病，特别是那些可以接受眼睛护理干预的疾病。对特定人群进行有针对性的干预，以增加适当的眼睛护理使用，将极大地改善美国老年人的视力和功能。
Objective: To determine the causes of blindness and visual impairment in a population-based sample of older Americans.Methods: A random sample of 3821 residents of Salisbury Md, between the ages of 65 and 84 years was identified from Medicare records. Sixty-six percent (2520 persons) agreed to undergo an eye examination; 26% of the participants were African American. The clinical examination included acuity testing with an Early Treatment Diabetic Retinopathy Study chart and standardized refraction testing for those with a visual acuity worse than 20/30, slitlamp and dilated retinal examination by an ophthalmologist, tonometry, lens and fundus photography, and a suprathreshold visual field test. Visual impairment was defined as a best-corrected acuity in the better-seeing eye worse than 20/40 and better than 20/200, while blindness was acuity in the better-seeing eye of 20/200 or worse. For those with a visual acuity worse than 20/40 in either eye, one or more causes were assigned by an ophthalmologist and a final cause for each eye was confirmed by a panel of 3 subspecialty ophthalmologists (O.D.S., H.A.Q., and S.B.B.) based on all available evidence.Results: Bilateral presenting acuity worse than 20/40 increased from 4% in the 65- to 74-year age group to 16% in the 80- to 84-year age group. One third of those with presenting acuity worse than 20/40 improved to 20/40 or better with refraction. Overall, 4.5% had a best-corrected acuity worse than 20/40. African Americans were more likely to remain visually impaired than were whites despite refraction (odds ratio [95% confidence interval], 1.7 [1.1-2.6]). Whites were most often impaired or blind from age-related macular degeneration (1.2% vs 0.5%, P=.09). African Americans had higher rates of impairment and blindness from cataract or posterior capsular opacification (2.7% vs 1.1%; P=.006), glaucoma (0.9% vs 0.1%; P=.006), and diabetic retinopathy (1.2% vs 0.2%; P=.004).Conclusions: More than half of those with visual impairment or blindness had conditions that were either surgically treatable or potentially preventable. African Americans had a disproportionate number of blinding diseases, particularly those amenable to eye care intervention. Targeted interventions for specific populations to increase appropriate eye care use would greatly improve vision and function in older Americans.