Abstract
Objective
To determine the relationship between visual impairment and other disabilities in a developing country.
Methods
In this cross-sectional ancillary study, all individuals 50 years and older in 18 communities in the Chitwan region of Nepal were administered visual acuity screening and the Washington Group Short Set (WGSS) of questions on disability. The WGSS elicits a 4-level response for six disability domains: vision, hearing, walking/climbing, memory/concentration, washing/dressing, and communication. The association between visual impairment and disability was assessed with age- and sex-adjusted logistic regression models.
Results
Overall, 4719 of 4726 individuals successfully completed visual acuity and disability screening. Median age of participants was 61 years (interquartile range: 55–69 years), and 2449 (51.9%) were female. Participants with vision worse than 6/60 in the better-seeing eye were significantly more likely to be classified as having a disability in vision (OR 18.4, 95% CI 9.9–33.5), walking (OR 5.3, 95% CI 2.9–9.1), washing (OR 9.4, 95% CI 4.0–21.1), and communication (OR 5.0, 95% CI 1.7–13.0), but not in hearing (OR 0.6, 95% CI 0.006–2.2) or memory (OR 2.2, 95% CI 0.7–5.1).
Conclusions
Visually impaired participants were more likely to self-report disabilities, though causality could not be ascertained. Public health programs designed to reduce visual impairment could use the WGSS to determine unintended benefits of their interventions.
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Data availability
The data that support the findings of this study are available on request from the corresponding author, JMN.
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Funding
The study was supported by the National Eye Institute and the Fogarty International Center of the National Institutes of Health (NIH) [Award Number D43TW009343] as well as the University of California Global Health Institute (UCGHI) in the form of a Fogarty grant to JMN and grants from That Man May See, the Fortisure Foundation, the Harper-Inglis Memorial for Eye Research, the Peierls Foundation, the Alta California Eye Research Foundation, the Bofinger Glaucoma Research Fund, and Research to Prevent Blindness. The authors held no agreement with the funders that may have limited their ability to complete the research as planned and have full control of all primary data.
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Concept and design: JDK, KSO, JSM, and VMS. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: JMN and JDK. Critical revision of the manuscript for important intellectual content: All Authors. Administrative, technical, or material support: RPK, RB, BP, HB, SB, KSO, VMS, and JSM. Supervision: JDK.
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41433_2021_1498_MOESM3_ESM.eps
Supplemental Figure 2. Association of visual impairment and pinhole visual acuity. Panel A shows the proportion of people in each visual acuity category, with acuity defined as the best pinhole acuity in the better-seeing eye, and with proportions stratified by age group. Panel B shows the number of people in each visual acuity category. Panel C shows the distribution of raw disability scores within each vision group, stratified by type of disability. Panel D shows the results from age- and sex-adjusted logistic regression models in which the presence of disability (defined as “a lot” or “unable to do” in one or more domains) is modeled as a function of a dichotomous pinhole visual acuity exposure variable (able to read the respective line of vision relative to those unable to read the line); dots represent odds ratios and bars represent 95% confidence intervals, and the dashed line represents an odds ratio of 1.
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Nesemann, J.M., Kandel, R.P., Byanju, R. et al. Association of visual impairment with disability: a population-based study. Eye 36, 540–546 (2022). https://doi.org/10.1038/s41433-021-01498-x
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DOI: https://doi.org/10.1038/s41433-021-01498-x
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