北京市顺义区35岁及以上人群中近视力损伤的横断面调查及进展的随访研究
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摘要
目的：评估北京市顺义区35岁及以上人群中近视力损伤的发生及进展情况,分析年龄、性别及受教育程度对近视力损伤的影响,了解受检者视近视功能的自我评价,调查受检者近用镜佩戴情况及近视力损伤对工作效率的影响,评估近视力损伤的社会经济负担。
对象和方法：研究设计为以人群为基础的横断面调查研究及前瞻性纵向随访研究。2009年4月～6月对北京市顺义区35岁及以上人群2445名受检者进行近视力损伤的横断面调查研究,2011年8月～10月对参加该研究的受检者进行了随访调查。
调查队由北京协和医院眼科、顺义区公安医院眼科医务人员组成。研究的内容包括远视力及近视力的测量及其矫正。如果任何一眼未矫正的远视力或者近视力≤0.5,则需进行屈光矫正获得最佳矫正远视力及近视力。我们将未矫正近视力≤0.5,定义为未矫正近视力损伤。日常生活近视力≤0.5,定义为日常生活近视力损伤。最佳矫正近视力≤0.5,定义为最佳矫正近视力损伤。
通过随机整群抽样获得有代表性的以人群为基础的样本,并进行视功能问卷及戴镜和工作效率问卷的调查,评价受检者日常生活中的视近视功能,了解近用镜佩戴情况,调查近视力损伤对生活及工作能力的影响。
采用STATA统计软件进行了数据的清理和分析处理。采用SAS统计软件运用F检验,X2检验,logistic回归分析,多元线性回归分析分别对检测数据进行统计学分析。
结果：2009年基线横断面研究中共有2445名受检者接受了检查,基线横断面研究受检率为89.96%(2445/2771)。2011年随访研究中,在2445名受检者中2019名接受了随访检查,随访研究受检率为82.58%(2019/2445)。
在基线横断面研究及随访研究中,受检者的未矫正近视力与日常生活近视力的分布近似,受检者的最佳矫正近视力较日常生活近视力有明显提高。
在基线横断面研究中,双眼未矫正近视力损伤的患病率为72.79%,双眼日常生活近视力损伤的患病率为72.74%,双眼最佳矫正近视力损伤的患病率为15.33%。随着年龄的增加,近视力损伤患病率显著增加。随着受教育程度的提高,患病率显著降低。性别不是影响近视力损伤患病率的主要因素。随着年龄的增加,近视力损伤患病风险显著增加。受教育程度较高的受检者患病风险显著降低。
在35-49岁组双眼未矫正近视力损伤的发病率为25.63%,50-64岁组双眼未矫正近视力损伤的发病率为76.04%,65岁以上组双眼未矫正近视力损伤的发病率为100.00%。男性发病率为29.17%,女性发病率为40.25%。随着年龄的增加,近视力损伤发病率亦显著增加。女性近视力损伤发病风险高于男性。随着受教育程度的下降,发病风险显著增高。
视功能问卷调查显示随着年龄的增加,视功能问卷分值显著下降。不同性别及受教育程度对视功能问卷分值无显著影响。在基线横断面研究中,88.02%(1132/1286)受检者没有矫正近视力的眼镜。在随访研究中,42.74%(421/985)受检者没有矫正近视力的眼镜。戴镜及工作效率问卷结果显示在基线横断面研究及随访研究中,近视力损伤矫正率均较低。
在28个月随访期间,双眼未矫正近视力损伤、日常生活近视力损伤及最佳矫正近视力损伤患病率均有显著提高。视功能问卷分值显著下降,近视力损伤对中老年人群生活质量的影响仍在加剧,尤其在高龄受检者对视近视功能的整体评价及视近工作的困难程度方面表现突出。
结论：年龄是近视力损伤患病率的主要影响因素。高龄、女性是近视力损伤发病的危险因素。高龄受试人群中视近视功能的自我评价较低,近视力损伤对其生活质量影响明显。受试人群中近用矫正眼镜覆盖率有待提高。近视力损伤是重要的公共卫生课题,提倡建立中老年近视力保护计划,重点关注老龄和女性,为他们提供质高价廉的眼科保健服务。
Purpose:To estimate the prevalence and incidence of the near vision impairment among adults aged≥35years in Shunyi District of Beijing China, to study the effect of age, sex and education on near vision impairment, to assess the participant-reported near visual function, to evaluate of spectacle usage and work impact associated with near vision impairment, to assess socioeconomic burden of near vision impairment.
Methods:The study was devided into two parts. The first was designed as a population-based cross-sectional survey,and the second was a prospective longitudinal epidemiological survey. A sample of2445adults aged≥35years in Shunyi District of Beijing were examined as baseline cross-sectional survey from April to June in2009They were reexamined between August2011and November2011as the follow-up study.
The staff of this study was recruited from Peking Union Medical College Hospital and Shunyi Public Security Hospital. Besides the visual acuity examination, such as the near visual acuity, refraction were also measured Those with uncorrected visual acuity, as well as near visual acuity equal or less than0.5, were progressively tested to obtain the best corrected visual acuity and the best corrected near visual acuity. The uncorrected near visual acuity equal or less than0.5is defined as uncorrected near vision impairment. The presenting near visual acuity equal or less than0.5is defined as presenting near vision impairment. The best corrected near visual acuity equal or less than0.5is defined as the best corrected near vision impairment.
Cluster sampling was used in randomly selecting individuals. Individuals were invited to answer Self-reported Visual Function Questionnaire and the Spectacle and Work Productivity Questionnaire in order to assess the impact of near-vision impairment on visual functioning and quality of life, and the status of the refractive service.
After the field work, all the data were cleaned and analyzed by STATA. SAS software was used for F test,χ2test, logistic regression analysis and multiple linear regressions. Results:2445adults were examined in the baseline study in2009.The response rate was89.96%(2445/2771).Among those2445participants,2016adults were followed up in2011.The follow-up response rate was82.58%(2019/2445).
In the baseline and follow-up study, the distribution of the uncorrected near visual acuity was similar with the presenting near visual acuity. The best corrected near visual acuity was better than the presenting near visual acuity.
In baseline cross-sectional survey,the prevalence of uncorrected near vision impairment was72.79%. The prevalence of presenting near vision impairment was72.74%. The prevalence of the best near vision impairment was15.33%.The prevalence of near vision impairment was increasing by ageing significantly. The prevalence of near vision impairment was significantly decreased by the increase of education. Sex was not the main influencing factor. The risk of near vision impairment increased by aging, but decreased by increase of education.
The incidence of near vision impairment among age35to49year groups was25.63%, among age50to64year groups was76.04%, among age equal or more than65year groups was100.00%. The incidence of near vision impairment among the male was29.17%, among the female was40.25%.The incidence of near vision impairment increased by aging significantly. The female were more suffered from near vision impairment significantly. The risk of near vision impairment incidence increased by the decrease of education.
The score of Self-reported Visual Function Questionnaires was decreased by ageing significantly. Sex and education did not affect the score of Self-reported Visual Function Questionnaires. In baseline cross-sectional survey,88.02%(1132/1286) of respondents had reading glasses. In follow-up study,42.74%(421/985) of participants had reading glasses. The result of the Spectacle and Work Productivity Questionnaires showed that the rate of correcting near vision impairment was ineffective in the baseline and the follow-up study.
During the28months, the prevalence of the uncorrected near vision impairment,the presenting near vision impairment and the best corrected near vision impairment was significantly increased respectively. The score of Self-reported Visual Function Questionnaire was decreasing significantly. The effect of adults aged≥35years caused by near vision impairment was deteriorated, especially the performance of the older participants on the overall evaluation of the near vision function and the difficulty of the close work.
Conclusion:Age is the main influencing factor on the prevalence of near vision impairment.Female gender and the older age are associated with an increased risk of near vision impairment. The self-reported visual function of the senior participants is worse, and the quality of life of them has been affected by the near vision impairment. The recent coverage of corrected glasses for near visual acuity should be improved. Near vision impairment is an important public health problem. Near vision impairment prevention programs should be expanded, particularly for women and the older adults. Greater attention should also be given to correction of refractive error.
对象和方法：研究设计为以人群为基础的横断面调查研究及前瞻性纵向随访研究。2009年4月～6月对北京市顺义区35岁及以上人群2445名受检者进行近视力损伤的横断面调查研究,2011年8月～10月对参加该研究的受检者进行了随访调查。
调查队由北京协和医院眼科、顺义区公安医院眼科医务人员组成。研究的内容包括远视力及近视力的测量及其矫正。如果任何一眼未矫正的远视力或者近视力≤0.5,则需进行屈光矫正获得最佳矫正远视力及近视力。我们将未矫正近视力≤0.5,定义为未矫正近视力损伤。日常生活近视力≤0.5,定义为日常生活近视力损伤。最佳矫正近视力≤0.5,定义为最佳矫正近视力损伤。
通过随机整群抽样获得有代表性的以人群为基础的样本,并进行视功能问卷及戴镜和工作效率问卷的调查,评价受检者日常生活中的视近视功能,了解近用镜佩戴情况,调查近视力损伤对生活及工作能力的影响。
采用STATA统计软件进行了数据的清理和分析处理。采用SAS统计软件运用F检验,X2检验,logistic回归分析,多元线性回归分析分别对检测数据进行统计学分析。
结果：2009年基线横断面研究中共有2445名受检者接受了检查,基线横断面研究受检率为89.96%(2445/2771)。2011年随访研究中,在2445名受检者中2019名接受了随访检查,随访研究受检率为82.58%(2019/2445)。
在基线横断面研究及随访研究中,受检者的未矫正近视力与日常生活近视力的分布近似,受检者的最佳矫正近视力较日常生活近视力有明显提高。
在基线横断面研究中,双眼未矫正近视力损伤的患病率为72.79%,双眼日常生活近视力损伤的患病率为72.74%,双眼最佳矫正近视力损伤的患病率为15.33%。随着年龄的增加,近视力损伤患病率显著增加。随着受教育程度的提高,患病率显著降低。性别不是影响近视力损伤患病率的主要因素。随着年龄的增加,近视力损伤患病风险显著增加。受教育程度较高的受检者患病风险显著降低。
在35-49岁组双眼未矫正近视力损伤的发病率为25.63%,50-64岁组双眼未矫正近视力损伤的发病率为76.04%,65岁以上组双眼未矫正近视力损伤的发病率为100.00%。男性发病率为29.17%,女性发病率为40.25%。随着年龄的增加,近视力损伤发病率亦显著增加。女性近视力损伤发病风险高于男性。随着受教育程度的下降,发病风险显著增高。
视功能问卷调查显示随着年龄的增加,视功能问卷分值显著下降。不同性别及受教育程度对视功能问卷分值无显著影响。在基线横断面研究中,88.02%(1132/1286)受检者没有矫正近视力的眼镜。在随访研究中,42.74%(421/985)受检者没有矫正近视力的眼镜。戴镜及工作效率问卷结果显示在基线横断面研究及随访研究中,近视力损伤矫正率均较低。
在28个月随访期间,双眼未矫正近视力损伤、日常生活近视力损伤及最佳矫正近视力损伤患病率均有显著提高。视功能问卷分值显著下降,近视力损伤对中老年人群生活质量的影响仍在加剧,尤其在高龄受检者对视近视功能的整体评价及视近工作的困难程度方面表现突出。
结论：年龄是近视力损伤患病率的主要影响因素。高龄、女性是近视力损伤发病的危险因素。高龄受试人群中视近视功能的自我评价较低,近视力损伤对其生活质量影响明显。受试人群中近用矫正眼镜覆盖率有待提高。近视力损伤是重要的公共卫生课题,提倡建立中老年近视力保护计划,重点关注老龄和女性,为他们提供质高价廉的眼科保健服务。
Purpose:To estimate the prevalence and incidence of the near vision impairment among adults aged≥35years in Shunyi District of Beijing China, to study the effect of age, sex and education on near vision impairment, to assess the participant-reported near visual function, to evaluate of spectacle usage and work impact associated with near vision impairment, to assess socioeconomic burden of near vision impairment.
Methods:The study was devided into two parts. The first was designed as a population-based cross-sectional survey,and the second was a prospective longitudinal epidemiological survey. A sample of2445adults aged≥35years in Shunyi District of Beijing were examined as baseline cross-sectional survey from April to June in2009They were reexamined between August2011and November2011as the follow-up study.
The staff of this study was recruited from Peking Union Medical College Hospital and Shunyi Public Security Hospital. Besides the visual acuity examination, such as the near visual acuity, refraction were also measured Those with uncorrected visual acuity, as well as near visual acuity equal or less than0.5, were progressively tested to obtain the best corrected visual acuity and the best corrected near visual acuity. The uncorrected near visual acuity equal or less than0.5is defined as uncorrected near vision impairment. The presenting near visual acuity equal or less than0.5is defined as presenting near vision impairment. The best corrected near visual acuity equal or less than0.5is defined as the best corrected near vision impairment.
Cluster sampling was used in randomly selecting individuals. Individuals were invited to answer Self-reported Visual Function Questionnaire and the Spectacle and Work Productivity Questionnaire in order to assess the impact of near-vision impairment on visual functioning and quality of life, and the status of the refractive service.
After the field work, all the data were cleaned and analyzed by STATA. SAS software was used for F test,χ2test, logistic regression analysis and multiple linear regressions. Results:2445adults were examined in the baseline study in2009.The response rate was89.96%(2445/2771).Among those2445participants,2016adults were followed up in2011.The follow-up response rate was82.58%(2019/2445).
In the baseline and follow-up study, the distribution of the uncorrected near visual acuity was similar with the presenting near visual acuity. The best corrected near visual acuity was better than the presenting near visual acuity.
In baseline cross-sectional survey,the prevalence of uncorrected near vision impairment was72.79%. The prevalence of presenting near vision impairment was72.74%. The prevalence of the best near vision impairment was15.33%.The prevalence of near vision impairment was increasing by ageing significantly. The prevalence of near vision impairment was significantly decreased by the increase of education. Sex was not the main influencing factor. The risk of near vision impairment increased by aging, but decreased by increase of education.
The incidence of near vision impairment among age35to49year groups was25.63%, among age50to64year groups was76.04%, among age equal or more than65year groups was100.00%. The incidence of near vision impairment among the male was29.17%, among the female was40.25%.The incidence of near vision impairment increased by aging significantly. The female were more suffered from near vision impairment significantly. The risk of near vision impairment incidence increased by the decrease of education.
The score of Self-reported Visual Function Questionnaires was decreased by ageing significantly. Sex and education did not affect the score of Self-reported Visual Function Questionnaires. In baseline cross-sectional survey,88.02%(1132/1286) of respondents had reading glasses. In follow-up study,42.74%(421/985) of participants had reading glasses. The result of the Spectacle and Work Productivity Questionnaires showed that the rate of correcting near vision impairment was ineffective in the baseline and the follow-up study.
During the28months, the prevalence of the uncorrected near vision impairment,the presenting near vision impairment and the best corrected near vision impairment was significantly increased respectively. The score of Self-reported Visual Function Questionnaire was decreasing significantly. The effect of adults aged≥35years caused by near vision impairment was deteriorated, especially the performance of the older participants on the overall evaluation of the near vision function and the difficulty of the close work.
Conclusion:Age is the main influencing factor on the prevalence of near vision impairment.Female gender and the older age are associated with an increased risk of near vision impairment. The self-reported visual function of the senior participants is worse, and the quality of life of them has been affected by the near vision impairment. The recent coverage of corrected glasses for near visual acuity should be improved. Near vision impairment is an important public health problem. Near vision impairment prevention programs should be expanded, particularly for women and the older adults. Greater attention should also be given to correction of refractive error.
引文
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36. Celestin Habiyakare, Susan Lewallen, Paul Courtrigbt. Presbyopic spectacles in elderly Tanzanians. Invest Ophthalmol Vis Sci.2010,51:6897-6898.
37. Heidi R Laviers, Fatma Omar, Hakika Jecha, et al. Presbyopic spectacle coverage, willingness to pay for near correction, and the impact of correcting uncorrected presbyopia in adults in Zanzibar, East Africa. Invest Ophthalmol Vis Sci.2010,51:1234-1241.
38. Mark J Haran, Ian D Cameron, Rebecca Q lvers,et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers:visible randomised controlled trial. BMJ, 2010,340:2265-2272.
39. Byoung Sun Cbu, Joanne M Wood, Micbael J Collins. The effect of presbyopic vision corrections on nighttime driving performance. Invest Ophthalmol Vis Sci.2010,51:4861-4866.
40. Jorge L Alio, Francisco Amparo, Dolores Ortizc, et al. Corneal multifocality with excimer laser for presbyopia correction. Current Opinion in Ophthalmology.2009,20:264-271.
41. Minoru Tomita, Miyuki Watabe, Mitsutoshi Ito, et al. Conductive keratoplasty for the treatment of presbyopia:comparative study between post- and non-LASIK eyes. Clinical Ophthalmology. 2011,5,231-237.
42. Georges Bailoff. Surgical treatment of presbyopia:scleral, corneal, and lenticular. Curr Opin Ophthalmol.2004,15:365-369.
43. Irene C Kuo. Trends in refractive surgery at an academic center:2007-2009. Kuo BMC Ophthalmology 2011,11:1-6.
44. Beatrice Cochener, Antoine Lafuma, Babak Khoshnood,et al. Comparison of outcomes with multifocal intraocular lenses:a meta-analysis. Clinical Ophthalmology 2011,5:45-56.
45. Beatrice Cochene, Luis Fernandez-Vega, Jose F Alfonso. Spectacle independence and subjective satisfaction of ReSTOR multifocal intraocular lens after cataract or presbyopia surgery in two European countries. Clinical Ophthalmology.2010,4:81-89.
46. Gilles Berdeaux, Juliette Meunier, Benoit Arnould. Measuring benefits and patients' satisfaction when glasses are not needed after cataract and presbyopia surgery:scoring and psychometric validation of the Freedom from Glasses Value Scale. BMC Ophthalmology.2010,10:15-26.
47. Priyanka Sood, Maria A Woodward. Patient acceptability of the Tecnis multifocal intraocular lens. Clinical Ophthalmology 2011,5:403-410.
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49. Alejandro Lichtinger, David S Rootman. Intraocular lenses for presbyopia correction:past, present, and future. Curr Opin Ophthalmol.2012,23:40-46.
50. Thomas Kohnen, Anja Strenger, Oliver K Klaproth. Basic knowledge of refractive surgery. Dtsch Arztebl Int.2008,105:163-172.
51. Carlos Buznego, William B Trattler. Presbyopia-correcting intraocular lenses. Current Opinion in Ophthalmology.2009,20:13-18.
52. Asheesh Tewari, Gaurav K Shah, Presbyopia-correcting intraocular lenses. Retina.2008,28: 535-537.
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55. C O Bekibele,O Gureje. Impact of self-reported visual impairment on quality of life in the Ibadan study of ageing. Br J Ophthalmol.2008,92:612-615.
56. Llesh Patel, Shella K West.Presbyopia:prevalence, impact, and interventions. Community Eye Health Journal.2007,20:40-41.
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33. Noel M Ziebartb, David Borja, Esdras Arrieta,et al. Role of the lens capsule on the mechanical accommodative response in a lens stretcher. Invest Ophthalmol Vis Sci.2008,49:4490-4496.
34. loannis G Pallikaris, Georgios A Kontadakis, Dimitra M Portaliou.Real and pseudoaccommodation in accommodative lenses. Journal of Ophthalmology.2011,2011:1-8.
35. Indu Vedamurtby, Wendy W Harrison, Yue Liu,et al. The influence of first near-spectacle reading correction on accommodation and its interaction with convergence. Invest Ophthalmol Vis Sci. 2009,50:4215-4222.
36. Celestin Habiyakare, Susan Lewallen, Paul Courtrigbt. Presbyopic spectacles in elderly Tanzanians. Invest Ophthalmol Vis Sci.2010,51:6897-6898.
37. Heidi R Laviers, Fatma Omar, Hakika Jecha, et al. Presbyopic spectacle coverage, willingness to pay for near correction, and the impact of correcting uncorrected presbyopia in adults in Zanzibar, East Africa. Invest Ophthalmol Vis Sci.2010,51:1234-1241.
38. Mark J Haran, Ian D Cameron, Rebecca Q lvers,et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers:visible randomised controlled trial. BMJ, 2010,340:2265-2272.
39. Byoung Sun Cbu, Joanne M Wood, Micbael J Collins. The effect of presbyopic vision corrections on nighttime driving performance. Invest Ophthalmol Vis Sci.2010,51:4861-4866.
40. Jorge L Alio, Francisco Amparo, Dolores Ortizc, et al. Corneal multifocality with excimer laser for presbyopia correction. Current Opinion in Ophthalmology.2009,20:264-271.
41. Minoru Tomita, Miyuki Watabe, Mitsutoshi Ito, et al. Conductive keratoplasty for the treatment of presbyopia:comparative study between post- and non-LASIK eyes. Clinical Ophthalmology. 2011,5,231-237.
42. Georges Bailoff. Surgical treatment of presbyopia:scleral, corneal, and lenticular. Curr Opin Ophthalmol.2004,15:365-369.
43. Irene C Kuo. Trends in refractive surgery at an academic center:2007-2009. Kuo BMC Ophthalmology 2011,11:1-6.
44. Beatrice Cochener, Antoine Lafuma, Babak Khoshnood,et al. Comparison of outcomes with multifocal intraocular lenses:a meta-analysis. Clinical Ophthalmology 2011,5:45-56.
45. Beatrice Cochene, Luis Fernandez-Vega, Jose F Alfonso. Spectacle independence and subjective satisfaction of ReSTOR multifocal intraocular lens after cataract or presbyopia surgery in two European countries. Clinical Ophthalmology.2010,4:81-89.
46. Gilles Berdeaux, Juliette Meunier, Benoit Arnould. Measuring benefits and patients' satisfaction when glasses are not needed after cataract and presbyopia surgery:scoring and psychometric validation of the Freedom from Glasses Value Scale. BMC Ophthalmology.2010,10:15-26.
47. Priyanka Sood, Maria A Woodward. Patient acceptability of the Tecnis multifocal intraocular lens. Clinical Ophthalmology 2011,5:403-410.
48. BY Jay S, Daozhi Wang, Griffith E. Comparison of through-focus image quality across five presbyopia-correcting intraocular lenses(an American ophthalmological society thesis). Trans Am Ophthalmol Soc 2011;109:221-231.
49. Alejandro Lichtinger, David S Rootman. Intraocular lenses for presbyopia correction:past, present, and future. Curr Opin Ophthalmol.2012,23:40-46.
50. Thomas Kohnen, Anja Strenger, Oliver K Klaproth. Basic knowledge of refractive surgery. Dtsch Arztebl Int.2008,105:163-172.
51. Carlos Buznego, William B Trattler. Presbyopia-correcting intraocular lenses. Current Opinion in Ophthalmology.2009,20:13-18.
52. Asheesh Tewari, Gaurav K Shah, Presbyopia-correcting intraocular lenses. Retina.2008,28: 535-537.
53. Uri Polat, Clifton Schor, Jian-Liang Tong, et al. Training the brain to overcome the effect of aging on the human eye. Scientific Reports.2012,2:1-6.
54. Rupert R A Bourne, Uncorrected refractive error and presbyopia:accommodating the unmet need. Br J Ophthalmol.2007,91:848-850.
55. C O Bekibele,O Gureje. Impact of self-reported visual impairment on quality of life in the Ibadan study of ageing. Br J Ophthalmol.2008,92:612-615.
56. Llesh Patel, Shella K West.Presbyopia:prevalence, impact, and interventions. Community Eye Health Journal.2007,20:40-41.
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