Visual Impairment, Major Eye Diseases and Mortality in a multi-ethnic Asian population and a Meta-analysis of Prospective Studies.

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Vision impairment (VI) is associated with poor quality of life and increased risk of falls. Few prospective data are available on the impact of VI and the major eye diseases on mortality risk in Asians.Prospective cohort study with meta-analysis METHODS: We conducted a multi-ethnic prospective study of adults (40-80 years) in the Singapore Epidemiology of Eye Diseases Study (baseline 2004-11). All-cause mortality was obtained from the National Death Registry until May 2017. VI was defined by best-corrected visual acuity (BCVA) <20/40 in the better eye. Major eye diseases were assessed using standard protocols. We examined associations using multivariable-adjusted Cox proportional-hazards regression models. Finally, we conducted a meta-analysis on the associations between VI and mortality.Of 9,986 participants, 1210 deaths occurred (12.1%) over a median follow-up of 8.8 years. Compared to those with normal vision, persons with VI had increased risk of mortality (hazards ratio 1.53, 95% confidence interval [1.30-1.81] in multivariable models. In ethnicity-specific analyses, this association was significant across Chinese (1.63 [1.08-2.48]), Malays (1.31 [1.06-1.62]), and Indians (2.25[1.61-3.15]). Cataract, under-corrected refractive errors (URE) and diabetic retinopathy (DR) were significantly associated with mortality (HRs: 1.30, 1.22 and 1.54 respectively). In a meta-analysis of 12 studies including 58034 persons, VI was associated with 30% increased risk of mortality (1.3, [1.2-1.5]).In this multi-ethnic Asian population, VI and preventable eye conditions (cataract, URE and DR) were associated with mortality, emphasizing the need for early detection and intervention to prevent and treat VI and major eye diseases.

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Authors: Clarissa Ng Yin Ling, Sudarshan Seshasai, Miao Li Chee, He Feng, Yih Chung Tham, Ching-Yu Cheng, Tien Y Wong, Charumathi Sabanayagam