Abstract
Purpose
To estimate the prevalence of visual impairment (VI) in a population sample of older adults of the province of Cuenca, Spain and to evaluate the impact of VI on health-related quality of life (HRQOL) in this population group.
Methods
Cross-sectional observational study of the cohort of all persons over the age of 64 years from an urban area and rural nucleus of the province of Cuenca, Spain. Sociodemographic data were obtained and the VF-14 and SF-12 questionnaires were administered in an interview. One ophthalmologist evaluated the visual acuity (VA) and the presence of lens opacities, glaucoma, diabetic retinopathy, and age-related maculopathy. Prevalence of VI and blindness was defined according to the WHO criteria (0.5 log MAR ≤ VA < 1.2 log MAR and VA ≥ 1.2 log MAR) and the European criteria (0.3 log MAR ≤ VA < 1 log MAR and VA ≥ 1 log MAR) in the better eye.
Results
The study enrolled 1155 people out of a total of 1435 who were invited to participate (response rate 80.5%). The prevalence of VI and blindness according to the WHO criteria was 6.3 and 2%, respectively. Using the European criteria, the prevalence of VI was 21.1 and 2.4% the prevalence of blindness. The prevalence of VI was greater in older subjects (p < 0.0001); no significant gender-related differences were observed. The mean VF-14 score and means of the Physical Composite Score (PCS) and Mental Composite Score (MCS) of the SF-12 were lower in women than in men for all categories of visual acuity. The mean VF-14 score diminished as the degree of VI increased in all the pathologies studied, except glaucoma. The mean PCS score differed significantly by categories of VI, cataract, and diabetic retinopathy. The mean MCS score only differed with the degree of impairment of diabetic retinopathy.
Conclusions
The prevalence of VI was among the highest reported until now in adults over 64 years old and increased with age. The deterioration in quality of life related to visual function increased with increased degree of VI for all the pathologies studied (cataract, diabetic retinopathy, age-related maculopathy) except glaucoma. The HRQOL was consistently worse in women than in men for all categories of deterioration of visual acuity.
Similar content being viewed by others
References
Tielsch, J. M., Sommer, A., UIT, K., Katz, J., & Royall, R. M. (1990). Blindness and visual impairment in an American urban population: The Baltimore eye survey. Archives of Ophthalmology, 108, 286–290.
Klein, R., Klein, B. E., Linton, K. L., & De Mets, D. L. (1991). The beaver dam eye study: Visual acuity. Ophthalmology, 98, 1310–1315.
Attebo, K., Mitchell, P., & Smith, W. (1996). Visual acuity and the causes of visual loss in Australia: The blue mountains eye study. Ophthalmology, 103, 357–364.
Ivers, R. Q., Cumming, R. G., Mitchell, P., & Attebo, K. (1998). Visual impairment and falls in older adults: The blue mountains eye study. Journal of the American Geriatrics Society, 46, 58–64.
Ivers, R. Q., Norton, R., Cumming, R. G., Butler, M., & Campbell, A. J. (2000). Visual impairment and risk of hip fracture. American Journal of Epidemiology, 152, 633–639.
Wang, J. J., Mitchell, P., Cumming, R. G., & Smith, W. (2003). Visual impairment and nursing home placement in older Australians: The Blue Mountains eye study. Ophthalmic Epidemiology, 10, 3–13.
Klein, R., Klein, B. E., & Moss, S. E. (1995). Age-related eye disease and survival: The Beaver Dam eye study. Archives of Ophthalmology, 113, 333–339.
Wang, J. J., Mitchell, P., Simpson, J. M., Cumming, R. G., & Smith, W. (2001). Visual impairment, age-related cataract, and mortality. Archives of Ophthalmology, 119, 1186–1190.
Gill, T. M., & Feinstein, A. R. (1994). A critical appraisal of the quality of quality-of-life measurements. JAMA, 272, 619–626.
Bergner, M., Bobbitt, R. A., Carter, W. B., & Gilson, B. S. (1981). The sickness impact profile: Development and final revision of a health status measure. Medical Care, 19, 787–805.
Hunt, S. M., McKenna, S. P., McEwen, J., Williams, J., & Papp, E. (1981). The Nottingham Health Profile: Subjective health status and medical consultations. Social Science and Medicine, 15, 221–229.
Ware, J. E. Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483.
Mangione, C. M., Phillips, R. S., Seddon, J. M., et al. (1992). Development of the “Activities of Daily Vision Scale”: A measure of visual functional status. Medical Care, 30, 1111–1126.
Steinberg, E. P., Tielsch, J. M., Schein, O. D., et al. (1994). The VF-14: An index of functional impairment in patients with cataract. Archives of Ophthalmology, 112, 630–638.
Mangione, C. M., Lee, P. P., Pitts, J., Gutierrez, P., Berry, S., & Hays, R. D. (1998). Psychometric properties of the national eye institute visual function questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators. Archives of Ophthalmology, 116, 1496–1504.
Friedman, D. S., Tielsch, J. M., Vitale, S., Bass, E. B., Schein, O. D., & Steinberg, E. P. (2002). VF-14 item specific responses in patients undergoing first eye cataract surgery: Can the length of the VF-14 be reduced? The British Journal of Ophthalmology, 86, 885–891.
Parrish, R. K. 2nd, Gedde, S. J., Scott, I. U., Feuer, W. J., Schiffman, J. C., Mangione, C. M., & Montenegro-Piniella, A. (1997). Visual function and quality of life among patients with glaucoma. Archives of Ophthalmology, 115, 1447–1455.
Linder, M., Chang, T. S., Scott, I. U., Hay, D., Chambers, K., Sibley, L. M., & Weis, E. (1999). Validity of the visual function index (VF-14) in patients with retinal disease. Archives of Ophthalmology, 117, 1611–1616.
Riusala, A., Sarna, S., & Immonen, I. (2003). Visual function index (VF-14) in exudative age-related macular degeneration of long duration. American Journal of Ophthalmology, 135, 206–212.
Alonso, J., Espallargues, M., Andersen, T., Cassard, S., & Dunn, E. (1997). International applicability of the VF-14. An index of visual function in patients with cataracts. Ophthalmology, 104, 799–807.
Globe, D. R., Levin, S., Chang, T. S., Mackenzie, P. J., & Azen, S. (2002). Validity of the SF-12 quality of life instrument in patients with retinal diseases. Ophthalmology, 109, 1793–1798.
Derek, M. A., Bruce, M. A., Andrew, M. D., Maxwell, A., Rajagopalan, K., Barnes, R., Harris, B., & Hileman, K. (2005). Quality-of-life improvements in cataract patients with bilateral blue light-filtering intraocular lenses: Clinical trial. Cataract and Refractive Surgery, 31, 1952–1959.
Cahill, M. T., Banks, A. D., Stinnett, S. S., & Toth, C. A. (2005). Vision- related quality of life in patients with bilateral severe age-related macular degeneration. Ophthalmology, 112, 152–158.
Balkrishnan, R., Bond, J. B., Byerly, W. G., Camacho, F. T., & Anderson, R. T. (2003). Medication-related predictors of health-related quality of life in glaucoma patients enrolled in a Medicare health maintenance organization. The American Journal of Geriatric Pharmacotherapy, 1, 75–81.
Lamoureux, E. L., Hassell, J. B., & Keeffe, J. E. (2004). The impact of diabetic retinopathy on participation in daily living. Archives of Ophthalmology, 122, 84–88.
Navarro Esteban, J. J., Gutiérrez Leiva, J. A., Valero Caracena, N., Buendia Bermejo, J., Calle Puron, M. E., & Martinez Vizcaino, V. J. (2007). Prevalence and risk factors of lens opacities in the elderly in Cuenca, Spain. European Journal of Ophthalmology, 17, 29–37.
Steinberg, E. P., Tielsch, J. M., Schein, O. D., Javitt, J. C., Sharkey, P., Cassard, S. D., Legro, M. W., Diener-West, M., Bass, E. B., Damiano, A. M., et al. (1994). National study of cataract surgery outcomes. Variation in 4-month postoperative outcomes as reflected in multiple outcome measures. Ophthalmology, 101, 1131–1140.
Ware, J. E., Kosinski, M., Turner-Bowker, D. M., & Gandek, B. (2002). How to score Version 2 of the SF-12 ® health survey (with a supplement documenting Version 1). Lincoln, RI: QualityMetric Incorporated.
Bailey, I. L., & Lovie, J. E. (1976). New design principles for visual acuity letter charts. American Journal of Optometry and Physiological Optics, 53, 740–745.
Ferris, F. L. 3rd, Kassoff, A., Bresnick, G. H., & Bailey, I. L. (1982). New acuity charts for clinical research. American Journal of Ophthalmology, 94, 91–96.
Thylefors, B., Chylack, L. T., Konyama, K., et al. (2002). A simplified cataract grading system. Ophthalmic Epidemiology, 9, 83–95.
Bayer, A., Harasymowycz, P., Henderer, J. D., Steinmann, W. G., & Spaeth, G. L. (2002). Validity of a new disk grading scale for estimating glaucomatous damage: Correlation with visual field damage. American Journal of Ophthalmology, 133, 758–763.
Bengtsson, B., Olsson, J., Heijl, A., & Rootzén, H. (1997). A new generation of algorithms for computerized threshold perimetry, SITA. Acta Ophthalmologica Scandinavica, 75, 368–375.
Bengtsson, B., & Heijl, A. (1998). Evaluation of a new perimetric threshold strategy, SITA, in patients with manifest and suspect glaucoma. Acta Ophthalmologica Scandinavica, 76, 268–272.
Bengtsson, B., & Heijl, A. (1999). Comparing significance and magnitude of glaucomatous visual field defects using SITA and full threshold strategies. Acta Ophthalmologica Scandinavica, 77, 143–146.
Artes, P. H., Iwase, A., Ohno, Y., Kitazawa, Y., & Chauhan, B. C. (2002). Properties of perimetric threshold estimates from full threshold, SITA standard, and SITA fast strategies. Investigative Ophthalmology and Visual Science, 43, 2654–2659.
Sharma, A. K., Goldberg, I., Graham, S. L., & Mohsin, M. (2000). Comparison of the Humphrey Swedish interactive Thresholding algorithm (SITA) and the full threshold strategies. Journal of Glaucoma, 9, 20–27.
Kristinsson, J. K. (1997). Diabetic retinopathy. Screening and prevention of blindness. Acta Ophthalmologica Scandinavica, 75(Suppl. 223), 1–76.
Bird, A. C., Bressler, S., Bressler, N., Chisholm, I. H., Coscas, G., Davis, M. D., de Jong, P., Klaver, C., Klein, B., Klein, R., others. (1995). An international classification and grading system for age-related macular degeneration. The International ARM Epidemiological Study Group. Survey of Ophthalmology, 39, 367–374.
Cohen, J. (1977). Statistical power analysis for the behavioural sciences. New York: Academic.
Rubin, G., West, S., Muñoz, B., Bandeen-Roche, K., Zeger, S., Schein, O., & Fried, L. (1997). A comprehensive assessment of visual impairment in a population of older Americans. Investigative Ophthalmology and Visual Science, 38, 557–568.
Klaver, C., Wolfs, R., Vingerling, J., Hofman, A., & de Jong, P. (1998). Age-specific prevalence and causes of blindness and visual impairment in an older population. The Rotterdam Study. Archives of Ophthalmology, 116, 653–658.
Buch, H., Vinding, T., La Cour, M., & Nielsen, N. V. (2001). The prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish. The Copenhagen city eye study. Acta Ophthalmologica Scandinavica, 79, 441–449.
Rahmani, B., Tielsch, J., Katz, J., Gottsch, J., Quigley, H. A., Javitt, J. C., et al. (1996). The cause-specific prevalence of visual impairment in an urban population. The Baltimore Eye Survey. Ophthalmology, 103, 1721–1726.
Tsai, S. Y., Chi, L. Y., Cheng, C. Y., Hsu, W. M., Liu, J. H., & Chou, P. (2004). The impact of visual impairment and use of eye services on health-related quality of life among the elderly in Taiwan: The Shihpai Eye Study. Quality of Life Research, 13, 1415–1424.
Castells, X., Alonso, J., Ribo, C., Casado, A., Buil, J. A., Badia, M., & Castilla, M. (1999). Comparison of the results of first and second cataract eye surgery. Ophthalmology, 106, 676–682.
Parrish, R. K. 2nd (1996). Visual impairment, visual functioning, and quality of life assessments in patients with glaucoma. Transactions of the American Ophthalmological Society, 94, 919–1028.
Mackenzie, P. J., Chang, T. S., Scott, I. U., et al. (2002). Assessment of vision-related function in patients with age-related macular degeneration. Ophthalmology, 109, 720–729.
Riusala, A., Sarna, S., & Immonen, I. (2003). Visual function index (VF-14) in exudative age-related macular degeneration of long duration. American Journal of Ophthalmology, 135, 206–212.
Chia, E. M., Wang, J. J., Rochtchina, E., Smith, W., Cumming, R. R., & Mitchell, P. (2004). Impact of bilateral visual impairment on health-related quality of life: The Blue Mountains Eye Study. Investigative Ophthalmology and Visual Science, 45, 71–76.
Salomon, J. A., & Murria, C. J. L. (2002). Estimating health state valuations using a simple-method. In C. J. L. Murray, J. A. Salomon, C. D. Mathers, & A. D. López (Eds.), Summary measures of population health: Concepts, ethics, measurement and applications (pp. 487–500). Geneva: World Health Organization.
Acknowledgments
This study was financed by a grant from the Health Council of the Government of Castilla-La Mancha (grant CSAN020015). Additional funding was provided by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Red de Investigación en Actividades Preventivas y de Promoción de Salud (grant RD06/0018/0038). Proprietary interest statement: The authors have no proprietary interest in any aspect of the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Esteban, J.J.N., Martínez, M.S., Navalón, P.G. et al. Visual impairment and quality of life: gender differences in the elderly in Cuenca, Spain. Qual Life Res 17, 37–45 (2008). https://doi.org/10.1007/s11136-007-9280-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-007-9280-7