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Prevalence and Associations of Presenting Near-Vision Impairment in the Australian National Eye Health Survey

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Prevalence and Associations of Presenting Near-Vision Impairment in the Australian National Eye Health Survey Eye (2018) 32, 506–514 © 2018 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0950-222X/18 www.nature.com/eye Continuing Medical Education: Prevalence and S Keel1,5, J Foreman1,2,5,JXie1, HR Taylor3 and associations of M Dirani1,4 presenting near- vision impairment in the Australian National Eye Health Survey Release date: 23 February 2018; Expiration date: 23 February 2019 In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Springer Nature. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)t. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at www.medscape.org/journal/eye; (4) view/print certificate. Learning Objectives a speaker or a member of a speakers bureau for: Bayer, Allergan, Novartis, Optos. Received grants Upon completion of this activity, participants for clinical research from: Bayer, Allergan, Novartis, will be able to: Optos, Boehringer Ingelheim. 1. Describe the prevalence and associations of Stuart Keel has disclosed no relevant financial near vision impairment (NVI) in Indigenous relationships. Australians, based on an analysis from the Joshua Foreman has disclosed no relevant population-based National Eye Health Survey. financial relationships. 2. Discuss the prevalence and associations of Jing Xie has disclosed no relevant financial NVI in non-Indigenous Australians. relationships. 3. Determine the clinical and public health Hugh R. Taylor has disclosed no relevant fi implications regarding the prevalence and nancial relationships. associations of NVI in Indigenous and non- Mohamed Dirani has disclosed no relevant fi Indigenous Australians. nancial relationships. Authors/Editors disclosure information Journal CME author disclosure information. Sobha Sivaprasad has disclosed the following Laurie Barclay has disclosed the following relevant financial relationships: Served as an relevant financial relationships: Owns stock, advisor or consultant for: Bayer, Allergan, Novartis, stock options, or bonds from: Alnylam; Biogen; Heidelberg, Optos, Boehringer Ingelheim. Served as Pfizer Inc. Near-vision impairment in Australia S Keel et al 507 1,5 1,2,5 1 3 Prevalence and S Keel , J Foreman ,JXie, HR Taylor and CLINICAL STUDY M Dirani1,4 associations of presenting near-vision impairment in the Australian National Eye Health Survey Abstract Australian and one-third of Indigenous Australian adults. Purpose To describe the prevalence and Eye (2018) 32, 506–514; doi:10.1038/eye.2017.317; associations of presenting near vision published online 23 February 2018 1 impairment (NVI) in Indigenous and non- Centre for Eye Research Indigenous Australians. Australia, Royal Victorian Eye & Ear Hospital, Methods A sample of 3098 non-Indigenous Melbourne, VIC, Australia Australians (aged 50–98 years) and 1738 – Indigenous Australians (aged 40 92 years) Introduction 2Ophthalmology, living in 30 randomly selected Australian University of Melbourne, sites were examined as part of the Near vision impairment (NVI) is an important Department of Surgery, population-based National Eye Health Survey public health problem in our aging society. The Melbourne, VIC, Australia (NEHS). Binocular presenting NVI was prevalence of NVI increases substantially with 3Indigenous Eye Health defined as near vision worse than N8 (20/50). age, with the majority of cases attributed to fi Unit, Melbourne School of Results In total, 4817 participants (99.6% of presbyopia. NVI signi cantly impacts on quality Population and Global 1–3 the total sample, comprising 3084 non- of life (QoL), and poses a considerable Health, The University of Indigenous Australians and 1733 Indigenous financial burden with an estimated global Melbourne, Melbourne, Australians) had complete data on near visual productivity loss of over $25 billion.4 Currently, VIC, Australia acuity. The overall weighted prevalence of there is a paucity of reliable data on the 4Singapore Eye Research presenting NVI was 21.6% (95% CI: 19.6, 23.8) prevalence of NVI from population-based Institute, Singapore in non-Indigenous Australians and 34.7% surveys conducted in Australia. As the majority National Eye Centre, (95% CI: 29.2, 40.8) among Indigenous of NVI is readily treatable with spectacle Singapore, Singapore Australians. In the non-Indigenous correction, this data is useful to quantify population, higher odds of presenting NVI Australia’s burden of NVI and inform targeted Correspondence: were associated with older age (OR = 1.68 per resource allocation. S Keel, Level seven, Centre for Eye Research Australia, 10 years, o0.001), fewer years of education Until recently, very few countries had P 32 Gisborne Street, East = o (OR 0.95 per year, P 0.001) and residing in estimated the prevalence NVI, with the majority Melbourne, VIC 3002, Remote geographical areas (OR = 1.71, focusing solely on distance visual impairment Australia P = 0.003) after multivariate adjustments. and its causes. To date, the most robust Tel: +61 3 8532 1976; + Among Indigenous Australians, older age epidemiological data can be derived from He Fax: 61 3 9929 8705. E-mail: stuart.keel@ (OR = 1.69 per 10 years, Po0.001), fewer years 5 and co-workers (2014) who assessed the unimelb.edu.au of education (OR = 0.91 per year, P = 0.003) prevalence of NVI (≤20/40) across multiple and residing in Inner Regional (OR = 2.01, countries, including China, India, Nepal, Niger, = = P 0.008), Outer Regional (OR 2.17, South Africa and the United States. The 5These authors contributed P = o0.001) and Remote geographical areas prevalence of best-corrected NVI was reported equally to this work. (OR = 1.72, P = 0.03) were associated with to range from 10% in urban China to 23% in greater odds of presenting NVI. urban India. More recently, the National Health Received: 2 May 2017 Accepted in revised form: 3 Conclusions NVI represents a notable public and Nutrition Survey (NHANS) conducted in November 2017 health concern in Australia, affecting the United States reported the prevalence of Published online: 23 approximately 20% of non-Indigenous presenting NVI (o20/40) to be 13.6% among February 2018 Near-vision impairment in Australia S Keel et al 508 adults 50 years and over.6 In Australia, only one Examination procedures population-based study conducted in 1992, the Sociodemographic data including age, gender, Melbourne Visual Impairment Project (VIP), has provided Indigenous status, ethnicity, years of education, language estimates of the distribution of NVI in non-Indigenous spoken at home, utilisation of eye health services, as well adults.7 Adopting the slightly more conservative as medical and ocular histories were collected via an definition than NHANS, o20/50, the VIP 8 reported the interviewer-administered questionnaire. Ethnicity was prevalence of presenting NVI to be 19% in Australian categorised according to the Australian Standard adults aged 40 years or over. Considerably higher rates Classification of Cultural and Ethnic Groups (ASCCEG) have been reported in a nationally representative cohort 2011.12 of Indigenous Australian adults, with Taylor et al (2008)9 Self-reported use of near, distance or bifocal corrective reporting the prevalence of 40% for presenting NVI. lenses were recorded at the time of examination. Despite this, robust comparisons between these studies Presenting distance visual acuity was measured in each are problematic due to differences in testing protocols eye using a logMAR chart (Brien Holden Vision Institute, employed and age distributions of participants. Australia) in well-lit room conditions. Participants wore Furthermore, given the continual aging of Australia’s their usual distance correction if available at the time of population and an increasing reliance on adequate near examination. Pinhole testing was performed on vision to engage in daily activities such as the use of participants with visual acuity o6/12 in one or both eyes, computers and hand-held devices, up-to-date data on the followed by automated refraction (Nidek ARK-30 Type-R prevalence of NVI in Australia are warranted. Hand-held auto-refractor/keratometer, Nidek Co., LTD, The National Eye Health Survey (NEHS), with its Tokyo, Japan) if VA improved to ≥ 6/12 in either eye. nationally representative sample stratified by Indigenous Vision loss was defined as a visual acuity of o6/12 in the status, provides an ideal setting in which to investigate better eye. Participants with vision loss were considered the epidemiology of NVI in the Australian population. to have uncorrected or under-corrected refractive error if Herein, we describe the prevalence and associations of the distance visual acuity improved to ≥ 6/12 with NVI in Indigenous Australians aged 40 years and over pinhole testing or auto-refraction in one or both eyes. and non-Indigenous Australians aged 50 years and over. Vision loss from other causes was defined as a best- corrected visual acuity of o6/12 in the better eye. Materials and methods Binocular presenting near vision was assessed using a CERA tumbling E near vision card (Centre for Eye Study population Research Australia, Australia) held at the participant’s The NEHS is a population-based, cross-sectional survey preferred reading distance. Near correction was worn if conducted between March 2015 and April 2016 with the normally used and near vision was recorded as N8, N20, primary objective of determining the prevalence and N48 or oN48. Presenting NVI was defined as near vision causes of vision impairment and blindness in non- worse than N8.
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