Elsevier

Ophthalmology

Volume 115, Issue 5, May 2008, Pages 802-807
Ophthalmology

Original article
Visual Acuity and Mortality in a Chinese Population: The Tanjong Pagar Study

https://doi.org/10.1016/j.ophtha.2007.04.066Get rights and content

Objective

To examine the relationship between visual acuity and mortality in a Chinese population.

Design

Population-based cohort study.

Participants

Chinese persons in Singapore ages 40 to 79 years at baseline examination.

Methods

The Tanjong Pagar Study in Singapore examined 1232 persons (response rate, 71.8%) at the baseline examination in 1997 and 1998. Participants had measurements of presenting and best-corrected visual acuity (VA) using standardized protocols. Mortality data were obtained from the National Death Registry, which linked subjects who had died since the baseline examination. Cause of death was determined from the International Classification of Diseases 9 codes. Analysis was performed on 1225 (99.4%) participants with VA data.

Main Outcome Measure

All-cause mortality.

Results

By December 31, 2004 (median follow-up, 6.8 years), 126 persons had died. Participants with presenting VA in the better eye worse than 20/40 (logarithm of the minimum angle of resolution [logMAR] score, 0.3) had a significantly higher mortality rate (hazard ratio [HR], 2.9; 95% confidence interval [CI], 1.4–6.3, adjusting for age, gender, hypertension, diabetes, smoking, heart attack, stroke, and income) as compared with participants with VA of 20/20 (logMAR, 0.0). Associations were similar for best-corrected VA in the better eye (HR, 2.7; 95% CI, 1.4–5.5). Among clinic participants with logMAR VA measurements, each 1-line difference in presenting VA (logMAR gain, 0.10) was associated with a 4-fold increased risk of mortality (HR, 4.4; 95% CI, 1.9–10.2).

Conclusions

In this Chinese population in Singapore, visual impairment was associated independently with an increased risk of mortality.

Section snippets

Study Population and Procedures

The Tanjong Pagar Study was a population-based survey of eye diseases among Chinese adults living in Singapore conducted between October, 1997, and August, 1998.10, 11 The study was approved by the ethics committee of the Singapore National Eye Center and was carried out in accordance with the tenets of the World Medical Association's Declaration of Helsinki. Written informed consent was obtained from all participants. Detailed population selection and methodology were described previously.10,

Results

Table 1 shows the baseline characteristics of participants according to their better-eye presenting VA status. Persons with poorer presenting VA tended to be females, to have cataract or to have undergone cataract surgery, and to have undercorrected refractive error, regardless of age.

By December 31, 2004 (median follow-up, 6.8 years), 126 persons from the baseline cohort had died. After adjusting for age and gender, systemic correlates of mortality include hypertension (HR, 1.7; 95% CI,

Discussion

Our study demonstrates the relationship of presenting and best-corrected VA with mortality in an urban Chinese population in Singapore. We showed that persons with presenting VA worse than 20/20 (logMAR, 0.0) had a 3-fold higher risk of death as compared with persons with normal vision (VA, 20/20 or better), independent of other predictors of mortality. The risk of death increased 4-fold for every 1-line decrease of presenting VA. After best correction, persons with VA worse than 20/40 (logMAR,

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    • Cited by (0)

    Manuscript no. 2006-1149.

    Supported by the National Medical Research Council, Singapore, and British Council for the Prevention of Blindness, London, United Kingdom.

    The authors have no proprietary interests related to the article.

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    Copyright © 2008 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.