Prevalence and causes of visual impairment in The Barbados Eye Study.
OBJECTIVE
To determine the prevalence and causes of low vision and blindness in a predominantly black population.


METHODS
Population-based prevalence study of a simple random sample of Barbados-born citizens aged 40 to 84 years.


METHODS
Four thousand seven hundred nine persons (84% participation).


METHODS
The standardized protocol included best-corrected visual acuity (with a Ferris-Bailey chart), automated perimetry, lens gradings (LOCS II), and an interview. Participants with visual acuity of worse than 20/30, other positive findings, and a 10% sample also had an ophthalmologic examination that evaluated the cause and extent of vision loss (resulting from that cause), if any.


METHODS
Low vision and blindness were defined as visual acuity in the better eye between 6/18 and 6/120 and visual acuity worse than 6/120, respectively (World Health Organization [WHO] criteria).


RESULTS
Of the 4631 participants with complete examinations, 4314 (93%) reported their race as black, 184 (4%) reported their race as mixed (black and white), and 133 (3%) reported their race as white or other. Low vision was found in 5.9% of the black, 2.7% of the mixed, and 3.0% of white or other participants. Bilateral blindness was similar for black and mixed race participants (1.7% and 1.6%, respectively) and was not found in whites. Among black and mixed participants, the prevalence of low vision increased with age (from 0.3% at 40-49 years to 26.8% at 80 years or older). The prevalence of blindness was higher (P < 0.001) for men than women at each age group (0.5% versus 0.3% at ages 40-49 and 10.9% versus 7.3% at 80 years or more). Sixty percent of blindness was due to open-angle glaucoma and age-related cataract, each accounting for more than one fourth of cases. Other major causes were optic atrophy or neuropathy and macular and other retinal diseases. Few cases of blindness were due to diabetic retinopathy (1.4%), and none were due to age-related macular degeneration.


CONCLUSIONS
Using the WHO criteria, prevalence of visual impairment was high in this African-origin population, particularly at older ages. Most blindness was due to open-angle glaucoma and cataract, with open-angle glaucoma causing a higher proportion of blindness than previously reported. The increased prevalence of blindness in men may be due to the increased male prevalence of glaucoma in this population and warrants further investigation. Results underline the need for blindness prevention programs, with emphasis on effective treatment of age-related cataract and enhancing strategies for early detection and treatment of open-angle glaucoma.
Hyman
L
L
Department of Preventive Medicine, University Medical Center at Stony Brook, Stony Brook, New York, USA. lhyman@uhmc.sunysb.edu
Wu
S Y
SY
Connell
A M
AM
Schachat
A
A
Nemesure
B
B
Hennis
A
A
Leske
M C
MC
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001460:Barbados / Q000453:epidemiology; D044383:Black People; D001766:Blindness / Q000208:ethnology* / Q000209:etiology; D002386:Cataract / Q000150:complications / Q000208:ethnology*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D015354:Vision, Low / Q000208:ethnology* / Q000209:etiology; D014792:Visual Acuity; D044465:White People