全球未矫正老视的老视患病率和视力损害：系统评价、荟萃分析和建模。

Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia: Systematic Review, Meta-analysis, and Modelling.

机构信息

Brien Holden Vision Institute, Sydney, Australia.

Brien Holden Vision Institute, Sydney, Australia; School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.

出版信息

Ophthalmology. 2018 Oct;125(10):1492-1499. doi: 10.1016/j.ophtha.2018.04.013. Epub 2018 May 9.

DOI:10.1016/j.ophtha.2018.04.013

PMID:29753495

Abstract

TOPIC

Presbyopia prevalence and spectacle-correction coverage were estimated by systematic review and meta-analysis of epidemiologic evidence, then modeled to expand to country, region, and global estimates.

CLINICAL RELEVANCE

Understanding presbyopia epidemiologic factors and correction coverage is critical to overcoming the burden of vision impairment (VI) from uncorrected presbyopia.

METHODS

We performed systematic reviews of presbyopia prevalence and spectacle-correction coverage. Accepted presbyopia prevalence data were gathered into 5-year age groups from 0 to 90 years or older and meta-analyzed within World Health Organization global burden of disease regions. We developed a model based on amplitude of accommodation adjusted for myopia rates to match the regionally meta-analyzed presbyopia prevalence. Presbyopia spectacle-correction coverage was analyzed against country-level variables from the year of data collection; variation in correction coverage was described best by a model based on the Human Development Index, Gini coefficient, and health expenditure, with adjustments for age and urbanization. We used the models to estimate presbyopia prevalence and spectacle-correction coverage in each age group in urban and rural areas of every country in the world, and combined with population data to estimate the number of people with near VI.

RESULTS

We estimate there were 1.8 billion people (prevalence, 25%; 95% confidence interval [CI], 1.7-2.0 billion [23%-27%]) globally with presbyopia in 2015, 826 million (95% CI, 686-960 million) of whom had near VI because they had no, or inadequate, vision correction. Global unmet need for presbyopia correction in 2015 is estimated to be 45% (95% CI, 41%-49%). People with presbyopia are more likely to have adequate optical correction if they live in an urban area of a more developed country with higher health expenditure and lower inequality.

CONCLUSIONS

There is a significant burden of VI from uncorrected presbyopia, with the greatest burden in rural areas of low-resource countries.

摘要

主题

通过系统评价和荟萃分析对流行病学证据进行研究，估算了远视眼的患病率和矫正镜的覆盖率，然后建模以扩展到国家、地区和全球的估计值。

临床意义

了解远视眼的流行病学因素和矫正镜覆盖率对于克服因未矫正远视而导致的视力损伤负担至关重要。

方法

我们对远视眼的患病率和矫正镜的覆盖率进行了系统评价。从 0 岁到 90 岁及以上的 5 岁年龄组中收集了可接受的远视眼患病率数据，并在世界卫生组织全球疾病负担区域内进行荟萃分析。我们根据近视率调整调节幅度，开发了一个与区域荟萃分析的远视眼患病率相匹配的模型。根据数据收集年份的国家层面变量，分析远视眼矫正镜的覆盖率；根据人类发展指数、基尼系数和卫生支出，建立一个基于模型的校正覆盖率，该模型还考虑了年龄和城市化因素，能够最好地描述校正覆盖率的变化。我们使用这些模型来估计世界上每个国家城乡地区每个年龄组的远视眼患病率和矫正镜的覆盖率，并结合人口数据来估计有轻度视力损伤的人数。

结果

我们估计，2015 年全球有 18 亿人（患病率为 25%；95%置信区间[CI]，17-20 亿[23%-27%]）患有远视眼，其中 8.26 亿人（95%CI，6.86-9.60 亿人）患有轻度视力损伤，因为他们没有或没有适当的视力矫正。2015 年，全球未满足的远视眼矫正需求估计为 45%（95%CI，41%-49%）。如果生活在一个更发达的国家的城市地区，有更高的卫生支出和更低的不平等，那么远视眼患者更有可能得到适当的光学矫正。