Concurrent vision and hearing impairment associated with cognitive dysfunction in a population aged 85+ years: the Ural Very Old Study.

OBJECTIVE: To assess the prevalence of vision impairment, hearing impairment and dual sensory impairment (DSI) as combination of vision and hearing impairment, in association with cognitive dysfunction in a population aged 85+ years. METHODS: The cross-sectional population-based Ural Very Old Study, conducted in rural and urban Bashkortostan, Russia, between 2017 and 2020, included a detailed ocular and systemic examination with assessment of moderate to severe vision impairment (MSVI)/blindness (best-corrected visual acuity <6/18), moderate to severe hearing loss (MSHL) and cognitive function. SETTING: A rural and urban area in Bashkortostan, Russia. PARTICIPANTS: Out of 1882 eligible individuals aged 85+ years, 1526 (81.1%) individuals participated. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of vision, hearing and DSI and cognitive dysfunction. RESULTS: The study included 731 (47.9%) individuals (mean age 88.1±2.7 years; median 87 years, range 85-98 years) with measurements of MSVI/blindness, MSHL and cognitive function. The prevalence of MSVI/blindness, MSHL, DSI and dementia were 51.8% (95% CI 48.2% to 55.5%), 33.1% (95% CI 29.7% to 36.5%), 20.5% (95% CI 17.8% to 23.5%) and 48.2% (95% CI 44.5% to 51.8%), respectively. Lower cognitive function score was associated with lower visual acuity (p<0.001) and higher hearing loss score (p=0.03), after adjusting for older age (p=0.001), rural region of habitation (p=0.003), lower educational level (p<0.001) and higher depression score (p<0.001). Higher dementia prevalence was associated with higher MSHL prevalence (OR 2.18 95% CI 1.59 to 2.98; p<0.001), higher MSVI/blindness prevalence (OR 2.09, 95% CI 1.55 to 2.81; p<0.001) and higher DSI prevalence (OR 2.80, 95% CI 1.92 to 4.07; p<0.001). CONCLUSIONS: In this very old, multiethnic population from Russia, DSI (prevalence 20.5%), as compared with hearing impairment (OR 2.18) and vision impairment alone (OR 2.09), had a stronger association (OR 2.80) with dementia. The findings show the importance of hearing and vision impairment, in particular their combined occurrence, for dementia prevalence in an old population.

The prevalence of dry eye in a very old population.

PURPOSE: To assess the prevalence of dry eye disease (DED) and Meibomian gland dysfunction (MGD) in a very old population. METHODS: The Ural Very Old Study (UVOS), a population-based cohort study performed in rural and urban Bashkortostan/Russia, included 1526 (81.1%) out of 1882 eligible individuals aged 85+ years. The participants underwent a detailed medical and ophthalmological examination including Schirmer´s test, slit-lamp based assessment of the Meibomian glands and an interview. RESULTS: The study included 1493 (97.8%) individuals with available information about DED (mean age: 88.3 ± 2.9 years). Schirmer´s test was ≤5 mm in 388 individuals (34.3%; 95% confidence interval (CI): 31.5, 37.1), and the mean score of subjective dry eye symptoms was 7.52 ± 2.14 (median: 6; range: 6-18; 95%CI: 7.41, 7.63). An MGD grade 1, 2, 3 and 4 was diagnosed in 367 (31.4%), 309 (26.4%), 89 (7.6%) and 39 (3.3%) eyes, respectively. The prevalence of DED diagnosis definition #2 (dry eye score ≥8, Schirmer´s test ≤5 mm) and definition #4 (dry eye score ≥7, Schirmer test ≤5 mm, MGD grade 1+), were 164/1132 (14.5%; 95%CI: 12.4, 16.5), and 167/1131 (14.8%; 95%CI: 12.7, 16.8), respectively. In multivariate analysis, higher DED prevalence was associated with female sex (odds ratio (OR): 2.36; 95%CI: 1.18, 4.71; p = 0.02), rural region of habitation (OR: 2.72; 95%CI: 1.10, 6.70; p = 0.03), longer axial length (OR: 1.30; 95%CI: 1.04,1.62; p = 0.02), higher hearing loss score (OR: 1.03; 95%CI: 1.01, 1.05; p = 0.001) and lower self-reported salt consumption (OR: 0.64; 95%CI: 0.54, 0.75; p < 0.001). CONCLUSIONS: In this population-based recruited very old study sample aged 85+ years, higher DED prevalence (dry eye score ≥8, Schirmer´s test <5 mm; mean: 14.5%) and MGD prevalence (any grade:68.8%) was associated with female sex, rural region of habitation, longer axial length, higher hearing loss score and lower salt consumption.

Axial length and its associations in the Ural Very Old Study.

To assess the distribution of axial length as surrogate for myopia and its determinants in an old population, we performed the Ural Very Old Study as a population-based cohort study. Out of 1882 eligible individuals aged 85 + years, the Ural Very Old Study performed in an urban and rural region in Bashkortostan/Russia included 1526 (81.1%) individuals undergoing ophthalmological and medical examinations with sonographic axial length measurement. Biometric data were available for 717 (47.0%) individuals with a mean age of 88.0 ± 2.6 years (range 85-98 years; 25%). Mean axial length was 23.1 ± 1.1 mm (range 19.37-28.89 mm). Prevalences of moderate myopia (axial length 24.5-< 26.5 mm) and high myopia (axial length ≥ 26.5 mm) were 47/717 (6.6%; 95% CI 4.7, 8.4) and 10/717 (1.4%; 95% CI 0.5, 2.3), respectively. In multivariable analysis, longer axial length was associated (coefficient of determination r2 0.25) with taller body height (standardized regression coefficient beta:0.16;non-standardized regression coefficient B: 0.02; 95% confidence interval (CI) 0.01, 0.03; P < 0.001), higher level of education (beta: 0.12; B: 0.07; 95% CI 0.02, 0.11; P = 0.002), and lower corneal refractive power (beta: - 0.35; B: - 0.23; 95% CI - 0.28, - 0.18; P < 0.001). Higher prevalence of moderate myopia, however not of high myopia, was associated with higher educational level (OR 1.39; 95% CI 1.09, 1.68; P = 0.007) and lower corneal refractive power (OR 0.77; 95% CI 0.63, 0.94; P = 0.01). In this old study population, prevalence of moderate axial myopia (6.6% versus 9.7%) was lower than, and prevalence of high axial myopia (1.4% versus 1.4%) was similar as, in a corresponding study on a younger population from the same Russian region. Both myopia prevalence rates were higher than in rural Central India (1.5% and 0.4%, respectively). As in other, younger, populations, axial length and moderate myopia prevalence increased with higher educational level, while high myopia prevalence was independent of the educational level.

Prevalence Factors Associated With Vision Impairment and Blindness Among Individuals 85 Years and Older in Russia.

Importance: Visual performance is important for quality of life. However, vision impairment among adults 85 years and older has not been intensively examined. Objective: To assess the prevalence of mild vision impairment (VI), moderate to severe vision impairment, and blindness and the factors associated with these conditions among a population 85 years and older. Design, Setting, and Participants: The Ural Very Old Study was a population-based cohort study conducted in rural and urban areas in Bashkortostan, Russia from 2017 to 2020. Among 1882 eligible individuals 85 years and older, 1526 participants (81.1%) were enrolled. Exposures: Ophthalmologic, physical, and mental examinations. Main Outcomes and Measures: Prevalence of vision impairment and blindness based on best-corrected visual acuity (BCVA; measured using modified Early Treatment of Diabetic Retinopathy Study charts) in the better eye or both eyes. Mild vision impairment was defined as BCVA worse than 6/12 to 6/18, and moderate to severe VI was defined as BCVA worse than 6/18 but equal to or better than 3/60. Blindness was defined as BCVA worse than 3/60. Results: Among 1526 participants, 1149 individuals (75.3%; 846 women [73.6%]; mean [SD] age, 88.2 [2.8 years]) had available BCVA measurements and were included in the present analysis. Mild vision impairment was present in 114 individuals (9.9%; 95% CI, 8.2%-11.7%), moderate to severe VI in 562 individuals (48.9%; 95% CI, 46.0%-51.8%), and blindness in 68 individuals (5.9%; 95% CI, 4.6%-7.3%). Factors associated with moderate to severe VI were cataracts (324 individuals [57.7% of those with moderate to severe VI and 28.2% of total population; 95% CI, 25.6%-30.8%]), secondary cataracts (4 individuals [0.7% of those with moderate to severe VI and 0.3% of total population; 95% CI, 0%-0.7%]), age-related macular degeneration (78 individuals [13.9% of those with moderate to severe VI and 6.8% of total population; 95% CI, 5.3%-8.3%]), glaucoma (45 individuals [8.0% of those with moderate to severe VI and 3.9% of total population; 95% CI, 2.8%-5.0%]), corneal opacifications (26 individuals [4.6% of those with moderate to severe VI and 2.3% of total population; 95% CI, 1.4%-3.1%]), myopic maculopathy (13 individuals [2.3% of those with moderate to severe VI and 1.1% of total population; 95% CI, 0.5%-1.7%]), and nonglaucomatous optic nerve damage (4 individuals [0.7% of those with moderate to severe VI and 0.3% of total population; 95% CI, 0%-0.7%]). Factors associated with blindness were cataracts (33 individuals [48.5% of those with blindness and 2.9% of total population; 95% CI, 1.9%-3.8%]), age-related macular degeneration (15 individuals [22.1% of those with blindness and 1.3% of total population; 95% CI, 0.7%-2.0%]), glaucoma (7 individuals [10.3% of those with blindness and 0.6% of total population; 95% CI, 0.2%-1.1%]), myopic maculopathy (3 individuals [4.4% of those with blindness and 0.3% of total population; 95% CI, 0%-0.6%]), and corneal opacifications (2 individuals [2.9% of those with blindness and 0.2% of total population; 95% CI, 0%-0.4%]). Higher moderate to severe VI prevalence was associated with older age (odds ratio [OR], 1.19; 95% CI, 1.11-1.28; P < .001), higher blood pressure (OR, 1.01; 95% CI, 1.00-1.02; P = .03), lower hand grip force (OR, 0.88; 95% CI, 0.83-0.95; P < .001), lower score on the Mini-Mental State Examination (OR, 0.95; 95% CI, 0.92-0.98; P < .001), lower prothrombin index (OR, 0.93; 95% CI, 0.89-0.97; P < .001), lower refractive error (OR, 0.91; 95% CI, 0.85-0.97; P = .006), and lower prevalence of previous cataract surgery (OR, 0.48; 95% CI, 0.33-0.68; P < .001). Conclusions and Relevance: In this cohort study of individuals 85 years and older, the prevalence of moderate to severe VI and blindness was relatively high. Cataracts were the main reversible condition associated with vision loss, and age-related macular degeneration, glaucoma, and myopic maculopathy were the main irreversible conditions. Because a higher prevalence of moderate to severe VI was associated with lower cognitive function and physical strength, improvement of vision through increases in cataract surgery and measures to prevent and treat irreversible conditions may help to improve cognitive function and physical strength.