Visual impairment and quality of life: gender differences in the elderly in Cuenca, Spain

To estimate the prevalence of visual impairment (VI) in a population sample of older adults of the province of Cuenca, Spain and to evaluate the impact of VI on health-related quality of life (HRQOL) in this population group.

Cross-sectional observational study of the cohort of all persons over the age of 64 years from an urban area and rural nucleus of the province of Cuenca, Spain. Sociodemographic data were obtained and the VF-14 and SF-12 questionnaires were administered in an interview. One ophthalmologist evaluated the visual acuity (VA) and the presence of lens opacities, glaucoma, diabetic retinopathy, and age-related maculopathy. Prevalence of VI and blindness was defined according to the WHO criteria (0.5 log MAR or= 1.2 log MAR) and the European criteria (0.3 log MAR or= 1 log MAR) in the better eye.

The study enrolled 1155 people out of a total of 1435 who were invited to participate (response rate 80.5%). The prevalence of VI and blindness according to the WHO criteria was 6.3 and 2%, respectively. Using the European criteria, the prevalence of VI was 21.1 and 2.4% the prevalence of blindness. The prevalence of VI was greater in older subjects (p < 0.0001); no significant gender-related differences were observed. The mean VF-14 score and means of the Physical Composite Score (PCS) and Mental Composite Score (MCS) of the SF-12 were lower in women than in men for all categories of visual acuity. The mean VF-14 score diminished as the degree of VI increased in all the pathologies studied, except glaucoma. The mean PCS score differed significantly by categories of VI, cataract, and diabetic retinopathy. The mean MCS score only differed with the degree of impairment of diabetic retinopathy.

The prevalence of VI was among the highest reported until now in adults over 64 years old and increased with age. The deterioration in quality of life related to visual function increased with increased degree of VI for all the pathologies studied (cataract, diabetic retinopathy, age-related maculopathy) except glaucoma. The HRQOL was consistently worse in women than in men for all categories of deterioration of visual acuity.