Visual Impairment in White, Chinese, Black, and Hispanic Participants from the Multi-Ethnic Study of Atherosclerosis Cohort

<div><p></p><p><i>Purpose</i>: To describe the prevalence of visual impairment and examine its association with demographic, socioeconomic, and health characteristics in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.</p><p><i>Methods</i>: Visual acuity data were obtained from 6134 participants, aged 46–87 years at time of examination between 2002 and 2004 (mean age 64 years, 47.6% male), from six communities in the United States. Visual impairment was defined as presenting visual acuity 20/50 or worse in the better-seeing eye. Risk factors were included in multivariable logistic regression models to determine their impact on visual impairment for men and women in each racial/ethnic group.</p><p><i>Results</i>: Among all participants, 6.6% (<i>n</i> = 421) had visual impairment, including 5.6% of men (<i>n</i> = 178) and 7.5% of women (<i>n</i> = 243). Prevalence of impairment ranged from 4.2% (<i>n</i> = 52) and 6.0% (<i>n</i> = 77) in white men and women, respectively, to 7.6% (<i>n</i> = 37) and 11.6% (<i>n</i> = 44) in Chinese men and women, respectively. Older age was significantly associated with visual impairment in both men and women, particularly in those with lower socioeconomic status, but the effects of increasing age were more pronounced in men. Two-thirds of participants already wore distance correction, and not unexpectedly, a lower prevalence of visual impairment was seen in this group; however, 2.4% of men and 3.5% of women with current distance correction had correctable visual impairment, most notably among seniors.</p><p><i>Conclusion</i>: Even in the U.S. where prevalence of refractive correction is high, both visual impairment and uncorrected refractive error represent current public health challenges.</p></div

Distribution of retinal outcomes and long-term (previous 2 y) and short-term (previous days) exposure estimates among 4,607 participants with complete data.

<p>Distribution of retinal outcomes and long-term (previous 2 y) and short-term (previous days) exposure estimates among 4,607 participants with complete data.</p

City-wide associations between CRAE and modeled long-term PM_2.5 concentrations after control for covariates.

<p>Notes: CRAE values presented as the residuals from a model controlled for age, sex, race/ethnicity, BMI, waist-to-hip ratio, income, education, smoking history, alcohol use, family history of cardiovascular disease, LDL, HDL, blood pressure, diabetes, glucose, physical activity, emphysema, CRP, fibrinogen, homocysteine, CRVE, and previous day PM_2.5 concentration.</p

Associations between retinal diameters and long- (previous 2 y) and short-term (previous day) exposures to fine particulate air pollution.

<p>All associations reported as µm per interquartile range of 3 µg/m³ (for long term) and 9 µg/m³ (for short term). For both long- and short-term associations, model 1 controlled for age, sex, and race/ethnicity. In our long-term analyses, model 2 also included control for BMI, waist-to-hip ratio, income, education, smoking history, alcohol use, and family history of cardiovascular disease. Model 3 of our long-term analysis and Model 2 of our short-term analysis added control for LDL, HDL, blood pressure, diabetes, glucose, physical activity, emphysema, CRP, fibrinogen, and homocysteine. In our short-term analyses, model 2 controlled for all variables in model 3 of our long-term analysis while model 3 also included city-specific trends for day of week, time, temperature, and relative humidity. Model 4 added control for the fellow vessel diameter (e.g., CRAE or CRVE) to each models 3, and the joint model included long- and short-term concentrations simultaneously with control for covariates listed in the two respective models 4.</p

Associations between retinal arteriolar diameter (CRAE) and modeled long-term PM_2.5 concentrations after control for covariates.

<p>Note: CRAE values represent residuals from full joint model (i.e., model controlled for age, sex, race/ethnicity, BMI, waist-to-hip ratio, income, education, smoking history, alcohol use, family history of cardiovascular disease, LDL, HDL, blood pressure, diabetes, glucose, physical activity, emphysema, CRP, fibrinogen, homocysteine, CRVE, and previous day PM_2.5 concentration). Data are plotted as a cubic polynomial with 3 df.</p