title: Nine-year incidence of visual impairment in the Barbados Eye Studies.
abstract: OBJECTIVE
  To describe the 9-year incidence of visual impairment and primary causes of blindness among black participants of the Barbados Eye Studies (BES).
  
  
  METHODS
  Population-based prospective cohort study.
  
  
  METHODS
  The BES followed a nationally representative cohort selected by simple random sampling, aged 40 to 84 years at baseline, with reexaminations after 4 years (Barbados Incidence Study of Eye Diseases [BISED]) and 9 years (BISED II). BISED II included 2793 (81%) of those eligible.
  
  
  METHODS
  Cumulative 9-year incidence rates were estimated by the Product-Limit approach. The study was reviewed and approved by the institutional review boards of collaborating institutions.
  
  
  METHODS
  Best-corrected visual acuity (VA) was assessed by the Ferris-Bailey chart, following a modified Early Treatment of Diabetic Retinopathy Study protocol. Low vision and blindness were defined by World Health Organization (WHO) criteria as VA <6/18 to 6/120, and <6/120, respectively, in the better eye, and by U.S. criteria as VA < or =20/40 and < or =20/200, respectively. Vision loss was defined as a decrease of 15 letters or more read correctly in the better eye between baseline and follow-up examinations.
  
  
  RESULTS
  The 9-year incidence was 1.0% and 2.1% for blindness and 6.0% and 9.0% for low vision, by WHO and U.S. criteria, respectively. Older age at baseline was associated with higher incidence of low vision and blindness, reaching 23.0% (95% confidence interval [CI], 18.8-28.0) and 4.3% (95% CI, 2.7-6.9) at age 70 years or more, based on WHO criteria. The primary causes of incident bilateral blindness (U.S. criteria) in 126 eyes were age-related cataract (48.3%), open-angle glaucoma (OAG) (14.3%), combined cataract and OAG (6.3%), diabetic retinopathy (8.7%), and optic atrophy (7.1%). Age-related macular degeneration (2.4%) rarely caused blindness.
  
  
  CONCLUSIONS
  Incident visual impairment is exceedingly high in this population. Cataract, OAG, and diabetic retinopathy remain the major causes of blindness, underpinning the clinical and public health significance of these conditions in this and similar populations.
authors.affiliation: Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York, USA. anselm.hennis@cavehill.uwi.edu
authors.forename: Anselm J
authors.initials: AJ
authors.lastname: Hennis
authors.forename: Suh-Yuh
authors.initials: SY
authors.lastname: Wu
authors.forename: Barbara
authors.initials: B
authors.lastname: Nemesure
authors.forename: Leslie
authors.initials: L
authors.lastname: Hyman
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Schachat
authors.forename: M Cristina
authors.initials: MC
authors.lastname: Leske
mesh_terms: 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; D005128:Eye Diseases / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017678:Sex Distribution; D015354:Vision, Low / Q000208:ethnology* / Q000209:etiology; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*; D014944:World Health Organization