title: Prevalence, Risk Factors, and Impact of Undiagnosed Visually Significant Cataract: The Singapore Epidemiology of Eye Diseases Study.
abstract: OBJECTIVE
  To determine the prevalence, risk factors, and impact of undiagnosed visually significant cataract in an Asian population.
  
  
  METHODS
  The Singapore Epidemiology of Eye Diseases is a population-based study where 8,697 adults of Malay, Indian, and Chinese ethnicities aged > 40 years were invited for an eye examination, including lens photograph, to establish cataract diagnosis. Visually significant cataract was defined by Wisconsin Cataract Grading System and a best-corrected visual acuity <20/40 with cataract as the primary cause of vision impairment. Participants were deemed 'undiagnosed' if they had visually significant cataract and reported no prior physician diagnosis of cataract. Visual functioning (VF) was assessed with the VF-11 questionnaire validated using Rasch analysis.
  
  
  RESULTS
  Among the 925 participants with visually significant cataract, 636 (68.8%) were unaware of their cataract status. Age-standardized prevalence varied according to ethnicity, with Malays having higher rates than Chinese and Indians. Factors independently associated with having undiagnosed visually significant cataract were: Malay ethnicity, lower educational attainment, in employment, and without a history of diabetes (all P<0.05). In those with undiagnosed visually significant cataract, half had bilateral visual impairment, which was significantly associated with 24.8% poorer visual functioning compared to those with unilateral visual impairment (P<0.001).
  
  
  CONCLUSIONS
  Two-thirds of Singaporean adults with visually significant cataract were previously undiagnosed. Half of these cases had bilateral visual impairment and substantially reduced quality of life. Public health strategies targeting elderly patients, such as regular screening for visual impairment and timely referral to ophthalmologists in order to prevent progression to bilateral visual impairment when visual function is compromised are warranted.
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Chua
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
authors.forename: Blanche
authors.initials: B
authors.lastname: Lim
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|Duke-NUS Medical School, Singapore, Singapore.|Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Eva K
authors.initials: EK
authors.lastname: Fenwick
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
authors.forename: Alfred Tau Liang
authors.initials: AT
authors.lastname: Gan
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Ava Grace
authors.initials: AG
authors.lastname: Tan
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|Duke-NUS Medical School, Singapore, Singapore.|Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Ecosse
authors.initials: E
authors.lastname: Lamoureux
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|Duke-NUS Medical School, Singapore, Singapore.|Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.|Duke-NUS Medical School, Singapore, Singapore.|Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005006:Ethnicity; D005123:Eye / Q000503:physiopathology; D005128:Eye Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D014786:Vision Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D014785:Vision, Ocular / Q000502:physiology