Patterns and Risk Factor Profiles of Visual Loss in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study

• Published in: American journal of ophthalmology Vol. 206; pp. 48 - 73
• Main Authors: Wong, Tien Y., Tham, Yih-Chung, Sabanayagam, Charumathi, Cheng, Ching-Yu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2019; Elsevier Limited
• Subjects: Age Distribution; Blindness - ethnology; Blindness - physiopathology; Cardiovascular disease; Cross-Sectional Studies; Cultural differences; Epidemiology; Ethnic Groups; Female; Humans; Male; Middle Aged; Population Surveillance; Prevalence; Retrospective Studies; Risk Assessment - methods; Risk Factors; Sex Distribution; Singapore - epidemiology; Social Class; Socioeconomic factors; Visual Acuity; Visually Impaired Persons - statistics & numerical data; Singapore; United States > US; Asia; Japan
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2019.05.006

To describe the pattern and risk factor traits associated with visual loss (defined as either visual impairment [VI] or blindness) in a multiethnic Asian cohort of Malay, Indian, and Chinese individuals living in Singapore.
A total of 10 020 participants from the Singapore Epidemiology of Eye Diseases Study were examined between 2004 and 2011. All underwent standardized examinations. VI (visual acuity <20/40 to ≥20/200) and blindness (visual acuity <20/200) were defined based on the US definition, better-seeing eye. Singapore Population Census 2010 was used to calculate age-standardized prevalence. Multiple logistic regression analysis was performed to determine the independent and joint risk factors associated with visual loss.
Malay individuals had higher age-standardized prevalence of best-corrected and presenting VI (5.4% and 19.9%, respectively) than Indian (3.6% and 18.0%) and Chinese individuals (3.3% and 17.2%). Cataract was the main cause for presenting and best-corrected blindness; cataract and diabetic retinopathy were the top causes for best-corrected VI, consistently observed across the 3 ethnic groups. Older age, female sex, lower socioeconomic status, diabetes, systemic comorbidities, and cognitive impairment were independently associated with increased risk of best-corrected visual loss (all P ≤ .027). Individuals aged ≥60 years with diabetes were 12.7 times (95% confidence interval, 8.39–19.23) likely to have best-corrected visual loss, compared with younger, nondiabetic individuals. Lower income and education explained 58.1% and 23.2% of best-corrected visual loss in this population, respectively.
In this urban multiethnic Asian population, we identified common traits associated with visual loss across Malay, Indian, and Chinese individuals. These results will be useful for the planning and designing of eye health services and strategies for Asia's rapidly developing populations living in urban communities. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.