Elsevier

Ophthalmology

Volume 128, Issue 2, February 2021, Pages 188-196
Ophthalmology

Original article
Influence of Distance and Near Visual Impairment on Self-Reported Near Visual Functioning in a Multinational Study

https://doi.org/10.1016/j.ophtha.2020.07.006Get rights and content

Purpose

To assess the influence of distance and near visual impairment on self-reported near visual functioning (VF) in a multinational study.

Design

Population-based cross-sectional study.

Participants

Participants aged 35 years or older were selected randomly with cluster sampling at 7 sites: rural sites in Nepal (Kaski) and India (Madurai), a semirural site in China (Shunyi), semiurban sites in South Africa (Durban) and Niger (Dosso), and urban sites in the United States (Los Angeles) and China (Guangzhou).

Methods

Binocular presenting distance and near visual acuity (VA) were measured with a logarithm of the minimum angle of resolution tumbling E chart at 4 m and 40 cm, respectively. A 12-item near VF questionnaire interview was administered by trained local interviewers, with responses scored from 100 to 0 as visual disability increased. Multiple linear regression was used to investigate the association of age, gender, education, and VA with overall eyesight, difficulty with activities, and social functioning subscale scores.

Main Outcome Measures

Visual functioning subscale scores.

Results

The study sample consisted of 6851 questionnaire respondents. The VF subscale scores decreased significantly with worse distance and near VA, and even mildly impaired VA could result in reduced VF. Lower VF subscale scores were associated with older age at 4 sites, female gender at 3 sites, and greater education at 2 sites. The influence of near VA was greater than distance VA at 3 sites, and at 1 site, distance VA was more influential than near VA. With study site included in the regression modeling, lower scores for the overall eyesight subscale (compared with the Shunyi reference site) were found in Guangzhou, Kaski, and Durban; lower difficulty in activities scores were found in Kaski and Durban, but better scores were found in Guangzhou and Madurai; and social functioning scores were lower in Kaski, Durban, and Dosso.

Conclusions

Along the entire VA spectrum, lower levels of distance and near VA led to significant reductions in VF subscale scores, with wide variation both within and between study sites. The impact of near vision on VF should receive greater emphasis with further investigation in various socioeconomic and cultural settings.

Section snippets

Study Sites and Sampling

Details of the study sites and sampling methods have been described previously.13 In brief, this cross-sectional study was conducted among different populations at 7 sites in 6 countries in 2008 and 2009: 1 rural site (Kaski) in Nepal, 1 rural site (Madurai District) in India, 1 semiurban site (Durban) in South Africa, 1 semiurban site (Dosso) in Niger, 1 urban site (Los Angeles) in the United States, and 1 urban site (Guangzhou) and 1 semirural site (Shunyi) in China.

Participants 35 years of

Results

Among the 14 804 participants examined within the 7 sites, 6851(46.3%) completed the questionnaire interview, with site-specific distributions across age, gender, and education as shown in Table S1 (available at www.aaojournal.org). Overall, 58.1% of those interviewed were women, ranging from 75.8% in Durban to 53.7% in Guangzhou; 39.9% were 65 years of age or older, ranging from 29.7% in Los Angeles to 44.3% in Kaski; and 38.3% were without education, ranging from 3.3% in Los Angeles and 3.4%

Discussion

This study was carried out at 7 sites, within 6 developed and less-developed countries with widely varying distributions of age, gender, and education. The study sample was representative of both rural and urban populations with different ethnicities, cultures, and socioeconomic statuses. Strengths include a population-based design, a large multinational population, and a standardized interviewer-administered VF questionnaire.

The questionnaire comprised 12 items representing overall eyesight,

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    Disclosure(s): All authors have completed and submitted the ICMJE disclosures form.

    The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the World Health Organization, Geneva, Switzerland (under National Institutes of Health [Bethesda, Maryland] contract no.: N01-EY-2103); the China Postdoctoral Science Foundation (grant no.: 2019TQ0365 [X.H.]); the National Key R&D Program of China (2018YFC0116500 [M.H.]); the Fundamental Research Funds of the State Key Laboratory of Ophthalmology (M.H.); and the Science and Technology Planning Project of Guangdong Province (grant no.: 2013B20400003 [M.H.]. The sponsor or funding organization had no role in the design or conduct of this research.

    HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at the World Health Organization Secretariat Committee on Research Involving Human Subjects approved the study. Ethical approval for this study was obtained from the Institutional Review Board (IRB)/Ethics Committee at the Zhongshan Ophthalmic Center, the Programme National de Lutte Contre la Cécité (PNLCC), the University of KwaZulu Natal-AVRI, the Nepal Netra Jyoti Sangh; the Lions Aravind Institute of Community Ophthalmology, the University of Southern California, and the Peking Union Medical College Hospital. All research adhered to the tenets of the Declaration of Helsinki. All participants provided informed consent.

    No animal subjects were included in this study.

    Author Contributions:

    Conception and design: Ellwein, Abdou, Naidoo, Sapkota, Thulasiraj, Varma, Zhao, He

    Analysis and interpretation: Han, Ellwein, He

    Data collection: Han, Ellwein, Abdou, Naidoo, Sapkota, Thulasiraj, Varma, Zhao, He

    Obtained funding: Ellwein

    Overall responsibility: Han, He

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