Skip to main content
NCBI home page
Transactions of the American Ophthalmological Society logoLink to Transactions of the American Ophthalmological Society
. 1997;95:715–749.

The Hong Kong vision study: a pilot assessment of visual impairment in adults.

M R Van Newkirk
PMCID: PMC1298379  PMID: 9440191

Abstract

PURPOSE: The Hong Kong Adult Vision Pilot Study is a population based study of the distribution and determinants of eye disease in a random sample of the Chinese population age 40 and over. The present pilot study identifies the extent and causes of visual loss using methods developed in the United States and Australia. The pilot study uses the prevalence data to estimate the sample size necessary to predict the size of an effect a larger study may detect and the confidence with which that effect may be considered and the standard deviation of the Hong Kong population. The smallest detectable odds ratios were calculated based on known risk factor prevalence rates of the pilot study. METHODS: Hong Kong Chinese residents aged 40 and over in 2 random cluster sites were identified by private household census. The examinations were performed at one location and included, health history and habits, presenting and best corrected LogMar vision, Humphrey visual field and IOP measurement, dilated slit lamp, fundus examination, fundus photography and echography. RESULTS: In the two test sites, 355 people were examined of the 441 eligible residents (81% response). 76.6% of the population reported a change in vision in the last 10 years; 45% had not sought examination. 4.54% had vision less than 20/60. This was caused by: myopic choroidal degeneration (31%), cataract (19%), cataract + ARM (19%), ARMD (19%), glaucoma (6%), and corneal disease (6%). Vision loss increased significantly with age. Vision loss was more common in older women than in older men. The prevalence rates calculated from the pilot study data were used, requiring a relative precision of 95% and +/- 20% confidence interval of the prevalence rates, indicate that a sample size of 2500 would be a good number for a larger study. CONCLUSIONS: The methods developed in the United States and Australia for completing eye disease prevalence studies are applicable in Hong Kong. Vision loss is increasingly common in older people and the percent of visual impairment in Hong Kong is higher than studies in the US and Australia. As the population ages demands on the health care systems will increase. The results from this pilot warrant continuation of the study. Efforts must be directed toward prevention of visual loss.

Full text

PDF
715

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Attebo K., Mitchell P., Smith W. Visual acuity and the causes of visual loss in Australia. The Blue Mountains Eye Study. Ophthalmology. 1996 Mar;103(3):357–364. doi: 10.1016/s0161-6420(96)30684-2. [DOI] [PubMed] [Google Scholar]
  2. Attebo K., Mitchell P., Smith W. Visual acuity and the causes of visual loss in Australia. The Blue Mountains Eye Study. Ophthalmology. 1996 Mar;103(3):357–364. doi: 10.1016/s0161-6420(96)30684-2. [DOI] [PubMed] [Google Scholar]
  3. Au Eong K. G., Tay T. H., Lim M. K. Race, culture and Myopia in 110,236 young Singaporean males. Singapore Med J. 1993 Feb;34(1):29–32. [PubMed] [Google Scholar]
  4. Bailey I. L., Bullimore M. A., Raasch T. W., Taylor H. R. Clinical grading and the effects of scaling. Invest Ophthalmol Vis Sci. 1991 Feb;32(2):422–432. [PubMed] [Google Scholar]
  5. Bird A. C., Bressler N. M., Bressler S. B., Chisholm I. H., Coscas G., Davis M. D., de Jong P. T., Klaver C. C., Klein B. E., Klein R. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol. 1995 Mar-Apr;39(5):367–374. doi: 10.1016/s0039-6257(05)80092-x. [DOI] [PubMed] [Google Scholar]
  6. Bird A. C., Bressler N. M., Bressler S. B., Chisholm I. H., Coscas G., Davis M. D., de Jong P. T., Klaver C. C., Klein B. E., Klein R. An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol. 1995 Mar-Apr;39(5):367–374. doi: 10.1016/s0039-6257(05)80092-x. [DOI] [PubMed] [Google Scholar]
  7. Brechner R. J., Cowie C. C., Howie L. J., Herman W. H., Will J. C., Harris M. I. Ophthalmic examination among adults with diagnosed diabetes mellitus. JAMA. 1993 Oct 13;270(14):1714–1718. [PubMed] [Google Scholar]
  8. Brilliant L. B., Grasset N. C., Pokhrel R. P., Kolstad A., Lepkowski J. M., Brilliant G. E., Hawks W. N., Pararajasegaram R. Associations among cataract prevalence, sunlight hours, and altitude in the Himalayas. Am J Epidemiol. 1983 Aug;118(2):250–264. doi: 10.1093/oxfordjournals.aje.a113632. [DOI] [PubMed] [Google Scholar]
  9. Christen W. G., Manson J. E., Seddon J. M., Glynn R. J., Buring J. E., Rosner B., Hennekens C. H. A prospective study of cigarette smoking and risk of cataract in men. JAMA. 1992 Aug 26;268(8):989–993. [PubMed] [Google Scholar]
  10. Clayton R. M., Cuthbert J., Seth J., Phillips C. I., Bartholomew R. S., Reid J. M. Epidemiological and other studies in the assessment of factors contributing to cataractogenesis. Ciba Found Symp. 1984;106:25–47. doi: 10.1002/9780470720875.ch3. [DOI] [PubMed] [Google Scholar]
  11. Cockram C. S., Woo J., Lau E., Chan J. C., Chan A. Y., Lau J., Swaminathan R., Donnan S. P. The prevalence of diabetes mellitus and impaired glucose tolerance among Hong Kong Chinese adults of working age. Diabetes Res Clin Pract. 1993 Jul;21(1):67–73. doi: 10.1016/0168-8227(93)90099-q. [DOI] [PubMed] [Google Scholar]
  12. Congdon N. G., Quigley H. A., Hung P. T., Wang T. H., Ho T. C., Glovinsky Y. Impact of age, various forms of cataract, and visual acuity on whole-field scotopic sensitivity screening for glaucoma in rural Taiwan. Arch Ophthalmol. 1995 Sep;113(9):1138–1143. doi: 10.1001/archopht.1995.01100090064024. [DOI] [PubMed] [Google Scholar]
  13. Curtin B. J. The posterior staphyloma of pathologic myopia. Trans Am Ophthalmol Soc. 1977;75:67–86. [PMC free article] [PubMed] [Google Scholar]
  14. Dana M. R., Tielsch J. M., Enger C., Joyce E., Santoli J. M., Taylor H. R. Visual impairment in a rural Appalachian community. Prevalence and causes. JAMA. 1990 Nov 14;264(18):2400–2405. [PubMed] [Google Scholar]
  15. Ederer F., Hiller R., Taylor H. R. Senile lens changes and diabetes in two population studies. Am J Ophthalmol. 1981 Mar;91(3):381–395. doi: 10.1016/0002-9394(81)90293-2. [DOI] [PubMed] [Google Scholar]
  16. Ederer F., Krueger D. E., Mowery R. L., Connett J., Wentworth D. Lessons from the Visual Acuity Impairment Survey pilot study. Am J Public Health. 1986 Feb;76(2):160–165. doi: 10.2105/ajph.76.2.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ferris F. L., 3rd How effective are treatments for diabetic retinopathy? JAMA. 1993 Mar 10;269(10):1290–1291. [PubMed] [Google Scholar]
  18. Ferris F. L., 3rd, Kassoff A., Bresnick G. H., Bailey I. New visual acuity charts for clinical research. Am J Ophthalmol. 1982 Jul;94(1):91–96. [PubMed] [Google Scholar]
  19. Flaye D. E., Sullivan K. N., Cullinan T. R., Silver J. H., Whitelocke R. A. Cataracts and cigarette smoking. The City Eye Study. Eye (Lond) 1989;3(Pt 4):379–384. doi: 10.1038/eye.1989.56. [DOI] [PubMed] [Google Scholar]
  20. Foster A., Johnson G. J. Magnitude and causes of blindness in the developing world. Int Ophthalmol. 1990 May;14(3):135–140. doi: 10.1007/BF00158310. [DOI] [PubMed] [Google Scholar]
  21. Gregor Z., Joffe L. Senile macular changes in the black African. Br J Ophthalmol. 1978 Aug;62(8):547–550. doi: 10.1136/bjo.62.8.547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Grossniklaus H. E., Green W. R. Pathologic findings in pathologic myopia. Retina. 1992;12(2):127–133. doi: 10.1097/00006982-199212020-00009. [DOI] [PubMed] [Google Scholar]
  23. Hankinson S. E., Willett W. C., Colditz G. A., Seddon J. M., Rosner B., Speizer F. E., Stampfer M. J. A prospective study of cigarette smoking and risk of cataract surgery in women. JAMA. 1992 Aug 26;268(8):994–998. [PubMed] [Google Scholar]
  24. Harding J. J., van Heyningen R. Drugs, including alcohol, that act as risk factors for cataract, and possible protection against cataract by aspirin-like analgesics and cyclopenthiazide. Br J Ophthalmol. 1988 Nov;72(11):809–814. doi: 10.1136/bjo.72.11.809. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Ho S. C., Woo J., Lau J., Chan S. G., Yuen Y. K., Chan Y. K., Chi I. Life satisfaction and associated factors in older Hong Kong Chinese. J Am Geriatr Soc. 1995 Mar;43(3):252–255. doi: 10.1111/j.1532-5415.1995.tb07331.x. [DOI] [PubMed] [Google Scholar]
  26. Iuvone P. M., Tigges M., Stone R. A., Lambert S., Laties A. M. Effects of apomorphine, a dopamine receptor agonist, on ocular refraction and axial elongation in a primate model of myopia. Invest Ophthalmol Vis Sci. 1991 Apr;32(5):1674–1677. [PubMed] [Google Scholar]
  27. Katz J., Tielsch J. M., Quigley H. A., Javitt J., Witt K., Sommer A. Automated suprathreshold screening for glaucoma: the Baltimore Eye Survey. Invest Ophthalmol Vis Sci. 1993 Nov;34(12):3271–3277. [PubMed] [Google Scholar]
  28. Klein B. E., Klein R., Sponsel W. E., Franke T., Cantor L. B., Martone J., Menage M. J. Prevalence of glaucoma. The Beaver Dam Eye Study. Ophthalmology. 1992 Oct;99(10):1499–1504. doi: 10.1016/s0161-6420(92)31774-9. [DOI] [PubMed] [Google Scholar]
  29. Klein R., Klein B. E., Linton K. L., De Mets D. L. The Beaver Dam Eye Study: visual acuity. Ophthalmology. 1991 Aug;98(8):1310–1315. doi: 10.1016/s0161-6420(91)32137-7. [DOI] [PubMed] [Google Scholar]
  30. Klein R., Klein B. E., Moss S. E. Relation of glycemic control to diabetic microvascular complications in diabetes mellitus. Ann Intern Med. 1996 Jan 1;124(1 Pt 2):90–96. doi: 10.7326/0003-4819-124-1_part_2-199601011-00003. [DOI] [PubMed] [Google Scholar]
  31. Klein R., Wang Q., Klein B. E., Moss S. E., Meuer S. M. The relationship of age-related maculopathy, cataract, and glaucoma to visual acuity. Invest Ophthalmol Vis Sci. 1995 Jan;36(1):182–191. [PubMed] [Google Scholar]
  32. Kupfer C. Bowman lecture. The conquest of cataract: a global challenge. Trans Ophthalmol Soc U K. 1985;104(Pt 1):1–10. [PubMed] [Google Scholar]
  33. Kupfer C. Worldwide prevention of blindness. Am J Ophthalmol. 1983 Oct;96(4):543–545. doi: 10.1016/s0002-9394(14)77920-6. [DOI] [PubMed] [Google Scholar]
  34. Lee V. S., Kingsley R. M., Lee E. T., Lu M., Russell D., Asal N. R., Bradford R. H., Jr, Wilkinson C. P. The diagnosis of diabetic retinopathy. Ophthalmoscopy versus fundus photography. Ophthalmology. 1993 Oct;100(10):1504–1512. doi: 10.1016/s0161-6420(93)31449-1. [DOI] [PubMed] [Google Scholar]
  35. Leibowitz H. M., Krueger D. E., Maunder L. R., Milton R. C., Kini M. M., Kahn H. A., Nickerson R. J., Pool J., Colton T. L., Ganley J. P. The Framingham Eye Study monograph: An ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975. Surv Ophthalmol. 1980 May-Jun;24(Suppl):335–610. [PubMed] [Google Scholar]
  36. Leske M. C., Connell A. M., Kehoe R. A pilot project of glaucoma in Barbados. Br J Ophthalmol. 1989 May;73(5):365–369. doi: 10.1136/bjo.73.5.365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Leske M. C., Connell A. M., Schachat A. P., Hyman L. The Barbados Eye Study. Prevalence of open angle glaucoma. Arch Ophthalmol. 1994 Jun;112(6):821–829. doi: 10.1001/archopht.1994.01090180121046. [DOI] [PubMed] [Google Scholar]
  38. Levi L., Schwartz B. Glaucoma screening in the health care setting. Surv Ophthalmol. 1983 Nov-Dec;28(3):164–174. doi: 10.1016/0039-6257(83)90093-0. [DOI] [PubMed] [Google Scholar]
  39. Livingston P. M., Carson C. A., Stanislavsky Y. L., Lee S. E., Guest C. S., Taylor H. R. Methods for a population-based study of eye disease: the Melbourne Visual Impairment Project. Ophthalmic Epidemiol. 1994 Dec;1(3):139–148. doi: 10.3109/09286589409047222. [DOI] [PubMed] [Google Scholar]
  40. Livingston P. M., Guest C. S., Bateman A., Woodcock N., Taylor H. R. Cost-effectiveness of recruitment methods in a population-based epidemiological study: the Melbourne Visual Impairment Project. Aust J Public Health. 1994 Sep;18(3):314–318. doi: 10.1111/j.1753-6405.1994.tb00251.x. [DOI] [PubMed] [Google Scholar]
  41. McCarty C. A., Livingston P. M., Taylor H. R. Prevalence of myopia in adults: implications for refractive surgeons. J Refract Surg. 1997 May-Jun;13(3):229–234. doi: 10.3928/1081-597X-19970501-08. [DOI] [PubMed] [Google Scholar]
  42. McCarty C. A., Taylor H. R. Recent developments in vision research: light damage in cataract. Invest Ophthalmol Vis Sci. 1996 Aug;37(9):1720–1723. [PubMed] [Google Scholar]
  43. Quigley H. A. Number of people with glaucoma worldwide. Br J Ophthalmol. 1996 May;80(5):389–393. doi: 10.1136/bjo.80.5.389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Rahmani B., Tielsch J. M., Katz J., Gottsch J., Quigley H., Javitt J., Sommer A. The cause-specific prevalence of visual impairment in an urban population. The Baltimore Eye Survey. Ophthalmology. 1996 Nov;103(11):1721–1726. doi: 10.1016/s0161-6420(96)30435-1. [DOI] [PubMed] [Google Scholar]
  45. Rasmussen O. D. INCIDENCE OF MYOPIA IN CHINA: Data and theses from periodical investigations covering thirty years residence, and association with refracting and hospital centres, in a score of the larger cities. Br J Ophthalmol. 1936 Jun;20(6):350–360. doi: 10.1136/bjo.20.6.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Rohrer B., Stell W. K. Basic fibroblast growth factor (bFGF) and transforming growth factor beta (TGF-beta) act as stop and go signals to modulate postnatal ocular growth in the chick. Exp Eye Res. 1994 May;58(5):553–561. doi: 10.1006/exer.1994.1049. [DOI] [PubMed] [Google Scholar]
  47. Salive M. E., Guralnik J., Christen W., Glynn R. J., Colsher P., Ostfeld A. M. Functional blindness and visual impairment in older adults from three communities. Ophthalmology. 1992 Dec;99(12):1840–1847. doi: 10.1016/s0161-6420(92)31715-4. [DOI] [PubMed] [Google Scholar]
  48. Schaeffel F., Bartmann M., Hagel G., Zrenner E. Studies on the role of the retinal dopamine/melatonin system in experimental refractive errors in chickens. Vision Res. 1995 May;35(9):1247–1264. doi: 10.1016/0042-6989(94)00221-7. [DOI] [PubMed] [Google Scholar]
  49. Sommer A., Tielsch J. M., Katz J., Quigley H. A., Gottsch J. D., Javitt J. C., Martone J. F., Royall R. M., Witt K. A., Ezrine S. Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med. 1991 Nov 14;325(20):1412–1417. doi: 10.1056/NEJM199111143252004. [DOI] [PubMed] [Google Scholar]
  50. Sommer A., Tielsch J. M., Katz J., Quigley H. A., Gottsch J. D., Javitt J. C., Martone J. F., Royall R. M., Witt K. A., Ezrine S. Racial differences in the cause-specific prevalence of blindness in east Baltimore. N Engl J Med. 1991 Nov 14;325(20):1412–1417. doi: 10.1056/NEJM199111143252004. [DOI] [PubMed] [Google Scholar]
  51. Steinberg E. P., Tielsch J. M., Schein O. D., Javitt J. C., Sharkey P., Cassard S. D., Legro M. W., Diener-West M., Bass E. B., Damiano A. M. National study of cataract surgery outcomes. Variation in 4-month postoperative outcomes as reflected in multiple outcome measures. Ophthalmology. 1994 Jun;101(6):1131–1141. doi: 10.1016/s0161-6420(94)31210-3. [DOI] [PubMed] [Google Scholar]
  52. Tay M. T., Au Eong K. G., Ng C. Y., Lim M. K. Myopia and educational attainment in 421,116 young Singaporean males. Ann Acad Med Singapore. 1992 Nov;21(6):785–791. [PubMed] [Google Scholar]
  53. Taylor H. R., Livingston P. M., Stanislavsky Y. L., McCarty C. A. Visual impairment in Australia: distance visual acuity, near vision, and visual field findings of the Melbourne Visual Impairment Project. Am J Ophthalmol. 1997 Mar;123(3):328–337. doi: 10.1016/s0002-9394(14)70128-x. [DOI] [PubMed] [Google Scholar]
  54. Taylor H. R., Muñoz B., West S., Bressler N. M., Bressler S. B., Rosenthal F. S. Visible light and risk of age-related macular degeneration. Trans Am Ophthalmol Soc. 1990;88:163–178. [PMC free article] [PubMed] [Google Scholar]
  55. Taylor H. R., West S. K., Rosenthal F. S., Muñoz B., Newland H. S., Abbey H., Emmett E. A. Effect of ultraviolet radiation on cataract formation. N Engl J Med. 1988 Dec 1;319(22):1429–1433. doi: 10.1056/NEJM198812013192201. [DOI] [PubMed] [Google Scholar]
  56. Tielsch J. M., Katz J., Singh K., Quigley H. A., Gottsch J. D., Javitt J., Sommer A. A population-based evaluation of glaucoma screening: the Baltimore Eye Survey. Am J Epidemiol. 1991 Nov 15;134(10):1102–1110. doi: 10.1093/oxfordjournals.aje.a116013. [DOI] [PubMed] [Google Scholar]
  57. Tielsch J. M., Sommer A., Katz J., Royall R. M., Quigley H. A., Javitt J. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. 1991 Jul 17;266(3):369–374. [PubMed] [Google Scholar]
  58. Tielsch J. M., Sommer A., Katz J., Royall R. M., Quigley H. A., Javitt J. Racial variations in the prevalence of primary open-angle glaucoma. The Baltimore Eye Survey. JAMA. 1991 Jul 17;266(3):369–374. [PubMed] [Google Scholar]
  59. Tielsch J. M., Sommer A., Witt K., Katz J., Royall R. M. Blindness and visual impairment in an American urban population. The Baltimore Eye Survey. Arch Ophthalmol. 1990 Feb;108(2):286–290. doi: 10.1001/archopht.1990.01070040138048. [DOI] [PubMed] [Google Scholar]
  60. Vinding T. Age-related macular degeneration. Macular changes, prevalence and sex ratio. An epidemiological study of 1000 aged individuals. Acta Ophthalmol (Copenh) 1989 Dec;67(6):609–616. doi: 10.1111/j.1755-3768.1989.tb04392.x. [DOI] [PubMed] [Google Scholar]
  61. Wang Q., Klein B. E., Klein R., Moss S. E. Refractive status in the Beaver Dam Eye Study. Invest Ophthalmol Vis Sci. 1994 Dec;35(13):4344–4347. [PubMed] [Google Scholar]

Articles from Transactions of the American Ophthalmological Society are provided here courtesy of American Ophthalmological Society

RESOURCES