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新加坡马来眼研究中视敏度变化与视觉功能指数的关系

Fenwick EK, Man RE, Ong PG, et al.

期刊名称:JAMA Ophthalmology

卷期:2016年第134卷第11期

关键词:
中视 马来 敏度

摘要

关于视力缺失对视功能指数(VSF)影响的纵向人群基础数据十分稀少,尤其是亚洲人群。目的:检查目前视力(PVA)变化和VSF之间的关联。设计、设置和参与者:以纵向人群为基础的新加坡马来眼研究,评估了1895名成年人基线(2004120日至2006731日)和随访阶段(2010628日至2014731日)的视觉功能指数。修饰视觉功能指数结果的平均(SD)差和效果大小通过随访阶段更好视力眼PVA3类差异计算(PVA增加³2[+0.2 log MAR],无变化(PVA+2-2之间),PVA减少³2[-0.2 log MAR])PVA减少组进一步分级为偶发视力损伤(VI)(基线PVA³6/12),VI进展阶段(基线PVA<6/12),进展阶段是指随访期间低于2或者更多。用多元线性回归模型评估PVAVSF变化之间的关系。暴露:眼科检查时基线和随访阶段用log MAR表测量目前视力。主要预后和措施:VSFVSF变化与PVA之间的关联。结果:1895名参与者(基线平均年龄56.9岁;8621033女),随访阶段319人(16.8%)失去2个或更多PVA(平均PVA减少0.34[0.22] logMAR; P<.001),这与VSF平均分对数-0.87[2.12]减少有关(中间效应量-0.61)。在319名参与者中,153人(48%)有偶发VI166人(52%)有VI进展,分别与VSF减少有关(平均-1.082.15)效应量-0.86,平均-0.642.06)效应量-0.41)。在调整模型中,与PVA无变化的参与者相比,减少2或者更多的参与者VSF显著下降117%(β, -0.39; 95% 可信区间, -0.62 to -0.16)。老年(VSF分对数减少-0.55; 95% 可信区间, -0.66 to -0.43)和女性(VSF分对数减少-0.25; 95% 可信区间, -0.45 to -0.06)都与随访阶段VSF下降有关(P<0.01)。结论和相关性:大约6个马来成年人里有1个在研究的6年中PVA减少超过2;这种减少与VSF恶化程度有关。新发VI患者比已有VI恶化患者,其VSF的减少更多。

Importance:Longitudinal population-based data on the effect of vision loss on vision-specific functioning (VSF) are scarce, particularly in Asian populations.Objective:To examine the association between changes in presenting visual acuity (PVA) and VSF.Design, Setting, and Participants:Vision-specific functioning of 1895 adults was assessed in the baseline (January 20, 2004-July 31, 2006) and follow-up (June 28, 2010-July 31, 2014) phases of the longitudinal population-based Singapore Malay Eye Study. Mean (SD) differences and effect sizes for results of the modified Visual Function Index were calculated for 3 categories of change in PVA in the eye with better vision during the follow-up period (PVA gain of 2 lines [+0.2 logMAR], no change [PVA between a loss of 2 lines and a gain of 2 lines], and PVA loss of 2 lines [-0.2 logMAR]). The group with PVA loss was further stratified into incident vision impairment (VI) (baseline PVA 6/12) and progression of VI (baseline PVA <6/12) that worsened by 2 or more lines at follow-up. Associations between PVA and VSF changes were assessed using multiple linear regression models.Exposures:Presenting visual acuity was measured using a logMAR chart during an ophthalmic examination at baseline and follow-up.Main Outcomes and Measures:Vision-specific functioning and associations between PVA and changes in VSF.Results:Of the 1895 participants (mean [SD] age at baseline, 56.9 [10.1] years; 862 men and 1033 women), at follow-up, 319 (16.8%) had lost 2 or more lines of PVA (mean [SD] PVA loss, 0.34 [0.22] logMAR; P<.001), which was associated with a mean (SD) -0.87 [2.12] logit decrease in VSF (medium effect size, -0.61). Of these 319 participants, 153 (48%) had incident VI and 166 (52%) had progression of VI, which were associated with mean (SD) -1.08 (2.15) (effect size, -0.86) and -0.64 (2.06) (effect size, -0.41) logit reductions in VSF, respectively. In adjusted models, compared with participants with no change in PVA, those who lost 2 or more lines had a significant 117% reduction in VSF (β, -0.39; 95% CI, -0.62 to -0.16). Older age (-0.55 logit decrease in VSF; 95% CI, -0.66 to -0.43) and female sex (-0.25 logit decrease in VSF; 95% CI, -0.45 to -0.06) were also independently associated with poorer VSF at follow-up (P<.01).Conclusions and Relevance:Approximately 1 in 6 Malay adults lost 2 or more lines of PVA during the 6 years of the study; this loss was associated with a sizable deterioration in VSF. Loss of VSF was greater in participants with new-onset VI compared with those whose existing VI worsened. In older adults, strategies to prevent the onset of new VI may have more relative effect than delaying further progression among those with existing VI.


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