Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study

BMJ 1998;316:1643-1646 ( 30 May )

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Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study

A Reidy, senior clinical scientist, ^a D C Minassian, reader in ophthalmic epidemiology, ^b G Vafidis, consultant ophthalmologist, ^c J Joseph, consultant ophthalmologist, ^c S Farrow, professor of public health, ^d J Wu, ophthalmology research fellow, ^e P Desai, senior lecturer in ophthalmic epidemiology, ^e A Connolly, research nurse. ^c

^a Southampton General Hospital, Southampton SO16 6YD, ^b Institute of Ophthalmology, University College London, London EC1V 9EJ, ^c Central Middlesex Hospital, London NW10 7NS, ^d Middlesex University, Enfield N11 2NQ, ^e Faculty of Medicine, University of Southampton, Southampton SO9 5NH

Correspondence to: Dr Minassian

Objective: To estimate the magnitude of serious eye disorders and of visual impairment in a defined elderly populationof a typical metropolitan area in England, and to assess the frequencythey were in touch with, or known to, the eye care services.
Design: Cross sectional survey using two stage cluster random sampling.
Setting: General practices in north London.
Subjects: Random sample of people aged 65 and older, drawn from a defined population of elderly people registered with17 general practice groups.
Main outcome measures: Proportions and population prevalence estimates were determined for visual acuity, assessedwith the person's own spectacles (if any), classified into fourcategories: prevalence of cataract, age related macular degeneration,and refractive error causing visual impairment and of definiteprimary open angle glaucoma; and status of contact with eye services.
Results: 1547 of 1840 (84%) eligible people were examined. The population prevalence of bilateral visual impairment(visual acuity <6/12) was 30%, of which 72% was potentially remediable.92 of these 448 cases (21%) had visual acuity <6/60 ("blindness")in one or both eyes. Prevalence of cataract causing visual impairmentwas 30%; 88% of these people were not in touch with the eye services.The prevalence of vision impairing, age related macular degenerationwas 8% and of glaucoma (definite cases) was 3%. Three quartersof the people with definite glaucoma were not known to the eyeservices.
Conclusions: Untreated visual impairment and eye disorders affect a substantial proportion of people aged 65 yearsand older. These findings should contribute to the setting upof future strategies for preservation of sight and eye healthservices in general.

Key messages

Data have not been adequate to reliably estimate the extent of visual impairment and serious eye disease in metropolitan areas in Britain
Data from north London shows that 30% of a sample of the population aged 65 or older are visually impaired in both eyes
More than 72% of the bilateral visual impairment was potentially remediable by surgery or glasses, nearly one in three people had visually impairing cataract, and 88% of these people were not in touch with eye services
Eye problems were more prevalent in people living in relatively underprivileged areas

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