Journal of Clinical and Diagnostic Research. 2020 Jan, Vol-14(1): NC05-NC09 5 5 DOI: 10.7860/JCDR/2020/42998.13441 Original Article Ophthalmology Section Visual Impairment among Older Adults in Selangor State of Malaysia: The Grand Challenge Project INTRODUCTION The world’s elderly population is rising due to decline in fertility and increased longevity. Globally, there is approximately 9% elderly (aged ≥65) in 2019 and is expected to reach 12% in 2030 and 16% in 2050 [1]. The same phenomenon occurred in Malaysia as well. Population census showed an increment of Malaysian elderly from 6.3% in 2017 to 6.5% in 2018 and is expected to reach more than 7.0% in 2020 [2]. With aging of population, prevalence of VI is expected to increase as well [2]. Study in Malaysia also found that the increasing prevalence of VI with age was statistically significant [3,4]. It should be a concern as VI will affect the quality of life, physically, psychologically, environmental, and also social aspects [5-7]. Bourne RRA et al., reported the prevalence of VI worldwide differ according to the severity of VI [8]. Mild VI (VA 6/12 to 6/18 inclusive) was reported to be about 2.57%, moderate and severe VI (VA 6/18 to 3/60 inclusive) 2.95%, and blindness (VA less than 3/60) 0.49% among the world population of 7.33 billion [8]. Bourne RR et al., also found that 78% of the total number of VI was comprised of those aged 50 years and above [8]. Stevens GA et al., reported higher prevalence of VI in developing countries as compared to developed countries [9]. The prevalence of VI and blindness among population in USA aged 40 years and above was 2.14% and 0.68%, respectively [10]. Another developed country, Canada, showed a higher prevalence of VI, which was 5.7% among residents aged 45 to 85-year-old [11]. Study of VI among Singaporean population aged 40 to 80 years revealed a 26.87% low vision and a 1.09% blindness [12]. In Indonesia, it was 18.6% among residents aged 50 years and above [13]. National Eye Survey II (NES II) conducted in 2018 found 5.5% with moderate VI, 0.9% with severe VI and 1.2% blindness among Malaysian elderly population [14]. However, previous study at Sepang reported a 18.9% VI and a 2.9% blindness among residents aged 40 years and above [4]. Previous study on VI in Asia has found that VI could be influenced by demographic and socio-economic factors. Aging, low educational level and household income, systemic diseases including hypertension and diabetes as well as smoking were the common risk factors for VI [11,15-18]. However, there was limited information on risk factors of VI among Malaysian population especially in the elderly population. Moreover, previous study on VI only focused on specific regions in Selangor and unable to demonstrate its prevalence for the whole state of Selangor population [4,19,20]. Therefore, this study was carried out to determine the prevalence and risk factors of VI among older adults in Selangor by using correlation and regression analysis. This study also aimed to determine the status of VA and refractive error among older adults in Selangor. MATERIALS AND METHODS This was a cross-sectional study involving Malaysian older adults who participated in the population-based longitudinal study on neuroprotective model for healthy longevity (Towards Useful Aging (TUA) Project) [21]. The TUA study recruited Malaysian older adults aged 60 and above. In this study, 12 places randomly selected from in the state of Selangor (Keramat, Klang, Tanjung Sepat, Kuala Langat, Tanjung Karang, Kuala Selangor, Petaling Jaya, Kelana MOHD HARIMI ABD RAHMAN 1 , KEE QIU TING 2 , ZAINORA MOHAMMED 3 , NORLIZA MOHAMAD FADZIL 4 , SUZANA SAHAR 5 , MAHADIR AHMAD 6 Keywords: Ageing, Elderly, Epidemiology, Prevalence, Refractive error, Vision ABSTRACT Introduction: The increased prevalence of Visual Impairment (VI) in the elderly is in tandem with the increase of its populations in Malaysia. Aim: This study was aimed to determine the prevalence and risk factors of VI among older adults in Selangor, Malaysia as it is one of the highly populated states in the country. Materials and Methods: A total of 230 adults aged 60 years and above from the longitudinal study on neuroprotective model for healthy longevity (TUA) took part in this study from August 2018 to May 2019. Information on socio-demographic, smoking status and health condition were obtained through interview. Habitual distance Visual Acuity (VA) was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Refractive error was determined using retinoscopy technique followed by subjective refraction. Subjects’ height and weight were measured for their Body Mass Index (BMI). Descriptive statistics were used to determine the prevalence of VI and status of refractive error. Pearson correlation was used to determine correlation between household income and VI whereas Kendall’s Tau-b was used to determine correlation between age, educational level and smoking status with VI. Multivariate logistic regression was carried out to determine the risk factors of VI. Results: Analysis was performed on 201 subjects (29 were excluded due to incomplete data) and the mean±SD VA for better eye was 0.23±0.20 logMAR. Overall, emmetropia has the highest percentage (37.3%), followed by hyperopia (34.3%) and myopia (28.4%). This study found that the prevalence of VI among older adults in Selangor was 27.3%. Pearson correlation showed significant correlation between monthly household income with VI. Kendall Tau-b showed a significant correlation between age, educational level and smoking status with VI. Multivariate logistic regression shows significant association between age older than 80-year-old with VI. Conclusion: The prevalence of VI among the elderly in Selangor was notably high (27.3%) and greater age is associated with VI.