Incidence, Incident Causes, and Risk Factors of Visual Impairment and Blindness in a Rural Population in India: 15-Year Follow-up of the Andhra Pradesh Eye Disease Study

Abstract

Purpose: To report 15 year(range:13-17 years) incidence rate of visual loss(blindness and visual impairment (VI)), causes and risk factors for all ages, and for those 40 years or above at baseline for participants in Andhra Pradesh Eye Disease Study(APEDS). Design: Population based cohort studyMethods: All rural participants were interviewed and underwent a comprehensive eye examination. Presenting visual acuity(PVA) was measured using a standard logarithm of minimum angle of resolution chart at 3 meters. Unaided, presenting, pinhole and best-corrected visual acuity(BCVA) were also recorded. World Health Organization(WHO) and United States of America(USA) categories of VI and blindness were used for analysis. Incident visual loss was defined as the development of, or worsening of visual loss of one or more categories.Results: At baseline, 7,771 participants were examined and in APEDS III, 5,395(69.4%) were re-examined. Using WHO categories, the crude incidence rate of any visual loss based on PVA and BCVA were 14.6 and 6.3 per 100 person-years, respectively. Using US criteria, the values were 22.6 and 10.6 per 100 person-years, respectively. More than 90% of visual loss was due to cataract and uncorrected refractive error. Using WHO categories, significant independent risk factors for the incident visual loss were increasing age, female, illiterate, past or current smoker and current use of alcohol. Using the USA definition, additional risk factor was lower level of education. Conclusions:The high incidence likely reflects poor access to eye care in this population which needs to be taken into account when planning eye care programs.

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