Inci Irak-Dersu MD 1, Appathurai Balamurugan, MD MPH2

1 College of Medicine, University of Arkansas Medical Sciences 2 Fay W. Boozman College of Public Health, University of

Arkansas Medical Sciences and Arkansas Department of Health

Authors have no financial interest in the subject matter of this poster.

Visual impairment is one of the major public health problems in the United States.

In 2000, there were approximately 937,000 people who were blind in the United States.

It is estimated that this number will reach to 1.6 million by 2020.

Visual impairment, regardless of its cause, is known to have impact on health-related quality of life.

The extent and nature of visual impairment and eye diseases in Arkansas has not been well described previously.

The Behavioral Risk Factor Surveillance System (BRFSS) is an annual survey conducted by 50 states and the District of Columbia to obtain state-specific information on health risk behaviors.

The survey uses a random digit dial telephone methodology designed and developed by the Centers for Disease Control and Prevention.

Disproportionate stratified random sampling is used to identify eligible participants.

Participants are non-institutionalized adults >18 years of age, and only one adult is interviewed per household.

In 2005, the BRFSS added Visual Impairment and Access to the Eye Care module to the survey to better understand visual impairment for individuals aged 40 years and older.

In this module, there are a total of 10 questions.

Participants were asked if they had been told by a health care professional that they have any eye diseases including glaucoma, cataract and age-related macular degeneration.

Participants were also asked the frequency of their visits to the eye doctor, the reasons for infrequent visits, and eye insurance status.

In addition, there were two questions about vision specific health related quality. 1) “How much difficulty, if any, do you have in recognizing a friend across the street?” 2) “How much difficulty, if any, do you have reading print in newspaper, magazine, recipe, menu, or numbers on the telephone?” Response options were “no difficulty”, “a little difficulty”, “moderate difficulty”, “extreme difficulty”, “unable to do because of eyesight”, “unable to do for other reasons”.

BRFSS data obtained from Arkansas Department of Health were analyzed to determine prevalence of glaucoma, age-related macular degeneration, and cataract by bivariate analysis and t-test was used to compare vision related quality of life between no eye disease and eye disease group.

The analytic sample consisted of 893 respondents who had one or more of the following eye diseases: glaucoma, age-related macular degeneration and cataract, and 3102 respondents who did not have any of 3 eye diseases.

The prevalence of glaucoma, age-related macular degeneration, and cataract among Arkansas survey respondents > 40 years was found to be 5.5 % (95 % CI, 4.7 – 6.3), 5.3 % (95 % CI, 4.5 - 6.0), and 13.7 % (95 % CI, 12.6 – 14.8), respectively.

The prevalence of glaucoma, age-related macular degeneration and, cataract was higher among the females and those who had an annual income under $25,000 compared to those who had an annual income more than $25,000. (Table 1)

A higher proportion of people with age-related macular degeneration could not recognize a friend across the street, and had more difficulty in reading prints (52.6% vs. 30.1% respectively) than no eye disease group. (Table 2)

Variable Glaucoma MacularDegeneration

Cataract

% 95 % CI % 95 % CI % 95 % CI

Age*

40-64 years

65-84 years

> 85 years

3.9 3.0-4.8

8.1 6.5-9.8

17.9 10.1-25.6

3.2 2.4-4.0

9.0 7.2-10.8

13.1 6.1-20.2

6.9 5.9-7.9

29.0 26.4-31.6

22.0 13.1-30.9

Gender**

Male

Female

4.3 3.1-5.4

6.6 5.5-7.6

4.1 3.0-5.2

5.9 4.9-7.0

10.8 9.2-12.4

15.6 14.1-17.0

Education***

Non-high school graduate

High school graduate

Some college

College graduate and more

7.6 5.0-10.2

5.7 4.4-7.0

4.0 2.8-5.2

5.6 3.9-7.2

6.5 3.9-9.1

5.2 3.9-6.4

5.7 4.1-7.2

4.3 2.9-5.7

15.4 12.1-18.7

14.1 12.3-16.0

13.4 11.2-15.6

12.7 10.6-14.8

*Prevalence increased by age for all 3 eye diseases.(p <0.05)** Prevalence of all 3 eye diseases was higher among females than males. (p <0.05)

*** Prevalence of all 3 eye disease was higher among respondents with annual income lower than $25,000 than other income groups. (p <0.05)

No eye disease

% 95 % CI

Glaucoma

% 95 % CI

Macular degeneration

% 95 % CI

Cataract

% 95 % CI

Difficulty in recognizing friend across the street

16.2 14.8-17.6 20.4 12.5-28.4 30.1* 21.3-38.9 18.1 14.4-17.6

Difficulty in reading

33.1 31.3-34.8 29.7 20.2-39.1 52.6* 42.6-62.6 33.4 28.8-37.9

* More respondents with macular degeneration had difficulty in seeing at distance and near than other groups. (P<0.05)

The prevalence of glaucoma and, age-related macular degeneration increased with age among Arkansas residents. This was consistent with the literature.

Vision related quality of life (VRQL) is an important indicator of overall vision health. VRQL was assessed among the survey respondents by their ability to recognize a friend across the street and read print materials. A higher proportion of Arkansans with age-related macular degeneration reported having a poor VRQL compared to those with other eye diseases and those with no eye disease.

Females and individuals with low-income were found to be at higher risk for having eye diseases. The National Health Interview Study has also showed prevalence of blindness was inversely related to education and income.

One of the limitations, BRFSS only interviews residents with home telephones, those Arkansas residents who use their cellular telephone as their main phone were not interviewed.

In addition, the prevalence of the eye diseases reported here

was an estimate based on self-reported information from survey respondents.

Prevalence of glaucoma, age-related macular degeneration, and cataract increased with age.

Age-related macular degeneration had the most impact on vision-related quality of life.

Females and individuals with low-income were at higher risk for having eye diseases.

The Eye Disease Prevalence Research Group. Causes and Prevalence of Visual Impairment among Adults in the United States. Arch Ophtahlmol.2004;122: 477-485.

BRFSS-CDC’s Behavioral Risk Factor Surveillance System. www.cdc.gov/BRFSS/

Ryskulova A, Turczyn K, Makuc DM et al. Self-Reported Age-Related Eye Diseases and Visual Impairment in the United States: Results of the 2002 National Health Interview Survey. Am J Public Health 2008; 98:454-61.