Uncorrected presbyopia and its impact on the quality of life was performed as part of a community research towards strengthening the provision of optical services for Sagamu Local Government Area of Ogun State, Nigeria.
To determine the effect of uncorrected presbyopia on the quality of life of adults of 30 years old and above in Sagamu, Southwest, Nigeria.
This study consisted of the permanent resident adults of the town and village settlements within the local government.
Examination of respondents included distance visual acuity measurement with or without pinhole at 6 metres using the Snellen’s chart. Near assessment was performed at 40 centimetres with the distance correction in place if required. The semi-structured questionnaire which contained demographics and near-vision task difficulties,
The study showed that presbyopes significantly reported not being satisfied with near-vision (
The impact of reduced near vision on the quality of life in Sagamu, Nigeria, is striking and similar to findings around the world. So, any optical services plan for the local government area has to include presbyopic corrections.
In low- and middle-income countries, studies have shown that more than half of adults over the age of 30 years have presbyopia, and the majority of these do not have corrective spectacles.
Globally, few studies have been carried out to assess the impact of presbyopia on the quality of life of affected persons. The paucity of research on the prevalence of presbyopia and its impact on the quality of life in low- and middle-income countries is because of the perception that presbyopia is unimportant in locations where reading is uncommon. However, there is no evidence basis for this, and the few impact on the quality-of-life studies carried out so far had shown that presbyopia impacts greatly on the quality of life of people living in the rural areas of the developing countries as well.
The Andhra Pradesh study
In a study conducted amongst 1709 Tanzanian subjects found that compared with non-presbyopes, being presbyopic increased the odds of reporting some difficulty with near-vision tasks by twofolds, moderate difficulty by fivefolds and high difficulty by greater than eightfolds. Similarly, in a study conducted in the United States, it was discovered that presbyopia was associated with worse vision-targeted health-related quality of life compared to younger patients with emmetropia.
Furthermore, in the Zanzibar study,
In Nigeria, Bekibele
This study was designed to be part of a broad community-based one for the determination of presbyopia and refractive errors in Sagamu Local Government Area (LGA) of Ogun State, Nigeria, towards planning a comprehensive optical services for the area and the environs. There was no previous data for the LGA. Part of this study had been reported in an earlier article.
To determine the impact of uncorrected presbyopia on the quality of life of adults aged 30 years and above in Sagamu LGA of Ogun State, Nigeria.
The study was carried out in Sagamu LGA of Ogun State in Nigeria amongst adults aged 30 years and above between 17 September 2012 and 25 November 2012.
Ogun State is one of the 36 States in Nigeria and situated between latitude 6.2°N and 7.8°N and longitude 3.0°E and 5.0°E in the south-west zone of the country. Eye care services are available at the eye clinic of the Olabisi Onabanjo University Teaching Hospital (OOUTH) in the area, some private hospitals and optical clinics. The eye clinic of OOUTH is the only public institution providing eye care service to the people of the local government.
Study population consisted of the permanent residents of the town and village settlements within the local government.
All individuals aged 30 years and above who had been resident in the study area for at least 6 months were enumerated and invited to participate in the study. The exclusion criteria were those with corrected visual acuity (VA) worse than 6/60, debilitated or severely ill persons and those whose VA could not be tested.
The study was a population-based descriptive and cross-sectional study. It was conducted using a multi-stage stratified cluster random sampling technique with probability proportional to size. The sampling unit was the household which was taken to consist of all individuals who live under the same roof. The sampling details are contained in an earlier article on prevalence of presbyopia and spectacle coverage which was obtained at the same community-based dissertation research.
The minimum sample size was calculated using the Leslie Kish formula.
Each eligible individual was given an identification slip to bring to the examination centre where interviews, examinations and refractions were performed.
For the study, we used the N8 optotype (1M or 20/50 Snellen acuity) as the end point of near-vision testing. We measured near vision by placing the near chart 40 cm away from the subject. We defined people as presbyopic if both of the following were true: they were unable to read the N8 optotype with distance correction in place, or they were able to read at least one more line with the addition of a plus lens. The distance correction was determined with the aid of an autorefractor and subjective refraction using trial lenses. The degree of presbyopia was determined as the minimum amount of plus lens needed to achieve the maximum improvement in lines read to the end point (N8).
The semi-structured questionnaire which contained age, occupation, level of education, domiciliation, near-vision task difficulties, etc., was administered by the trained research assistants who were fluent in English and the local dialect. The questionnaire was translated from English to Yoruba and back-translated from Yoruba to English to ensure consistency. It was serially numbered to avoid duplication.
The data were entered and analysed using Statistical Package for Social Sciences V 16 statistical software. Near-vision tasks were then compared between those with uncorrected presbyopes and non-presbyopes. Also, their perception of quality of life for near tasks were compared.
Ethical approval was obtained from the Ethical Committee of Olabisi Onabanjo University Teaching Hospital Research (Ethical Clearance Number: OOUTH/DA:326/795) on 14 September 2012. Consent was obtained from the Medical Officer of Health of Sagamu Local Government Council. Written and/or oral informed consent was obtained from the participants prior to the interview and examination. The tenets of the Declaration of Helsinki were strictly adhered to throughout the study.
The overall prevalence of presbyopia (
Prevalence of presbyopia by gender and age group.
Age group (years) | Frequency | ||
---|---|---|---|
% | |||
30–39 | 38 | 8 | 21.1 |
40–49 | 77 | 72 | 93.5 |
50–59 | 63 | 62 | 98.4 |
60–69 | 46 | 42 | 91.3 |
70–79 | 12 | 11 | 91.7 |
≥ 80 | 3 | 3 | 100.0 |
Total | 198 | 82.8 | |
30–39 | 89 | 25 | 28.1 |
40–49 | 115 | 108 | 93.7 |
50–59 | 86 | 85 | 98.8 |
60–69 | 65 | 62 | 95.4 |
70–79 | 12 | 11 | 91.7 |
≥ 80 years | 2 | 2 | 100.0 |
Total | 293 | 79.4 |
Note:
Male age group:
Associations between presbyopia and socio-demographic factors in the 491 study participants who were presbyopic.
Characteristics | Presbyopia | |||
---|---|---|---|---|
% | ||||
30–39 | 127 | 33 | 26.0 | 0.0001 |
40–49 | 192 | 180 | 93.8 | |
50–59 | 149 | 147 | 98.7 | |
60–69 | 111 | 104 | 93.7 | |
70–79 | 24 | 22 | 91.7 | |
Above 80 | 5 | 5 | 100 | |
No formal | 108 | 98 | 90.7 | 0.0001 |
Primary school completed | 178 | 153 | 86.0 | |
Secondary school completed | 145 | 123 | 84.8 | |
Post-secondary school level | 177 | 117 | 66.1 | |
Professional | 153 | 99 | 64.7 | 0.0001 |
Non manual skilled labour | 53 | 43 | 81.1 | |
Manual skilled labour | 144 | 125 | 86.8 | |
Partially skilled labour | 198 | 170 | 85.9 | |
Unskilled labour | 21 | 20 | 95.2 | |
Unemployed | 39 | 34 | 87.2 | |
Urban | 390 | 319 | 81.8 | 0.385 |
Rural | 218 | 172 | 78.9 | |
Males | 239 | 198 | 82.8 | 0.293 |
Females | 369 | 293 | 79.2 |
There is a sharp increase in the prevalence of presbyopia from 26% in the 30–39 years age group to 93.8% in the 40–49 age group. This is followed by a steady increase in 50–59 age group before a decline in the 60–69 and 70–79 age groups.
The prevalence of presbyopia is lowest in those with post-secondary school education (66.1%), whilst it is highest in those without any formal education (90.7%). With respect to occupation, the prevalence of presbyopia is highest amongst the unskilled labourers (95.2%), whilst it is lowest amongst the professionals (64.7%).
The study showed that presbyopes are significantly more likely to require help from others because of near-vision problems. This is highlighted in
Those requiring help from others because of near-vision problems.
Action required | Presbyopia | No presbyopia | Total | |||
---|---|---|---|---|---|---|
% | % | % | ||||
Require help | 109 | 18.0 | 9 | 1.0 | 118 | 19.0 |
No help required | 382 | 63.0 | 108 | 18.0 | 490 | 81.0 |
Total | 491 | 81.0 | 119 | 19.0 | 608 | 100 |
Those reporting engaging in and having difficulty with near-vision-related tasks.
Activity | Engaging in activity | Reporting difficulty with activity | ||||||
---|---|---|---|---|---|---|---|---|
Male ( |
Female ( |
Male | Female | |||||
% | % | % | % | |||||
Reading | 205 | 85.8 | 281 | 76.2 | 181 | 88.3 | 234 | 83.3 |
Writing | 198 | 82.8 | 278 | 75.3 | 119 | 60.1 | 163 | 58.6 |
Cooking | 57 | 23.8 | 273 | 74.0 | 6 | 10.5 | 77 | 28.2 |
Sorting grain | 79 | 33.1 | 325 | 88.1 | 34 | 43.0 | 170 | 52.3 |
Threading needles | 206 | 86.2 | 354 | 95.9 | 172 | 83.5 | 282 | 79.7 |
Cutting fingernails | 168 | 70.3 | 277 | 75.1 | 81 | 48.5 | 125 | 45.1 |
Dressing children | 52 | 21.8 | 250 | 67.8 | 2 | 3.8 | 43 | 17.2 |
Harvesting | 32 | 13.4 | 34 | 9.2 | 11 | 34.4 | 11 | 32.4 |
Identifying work tools | 99 | 41.4 | 104 | 28.2 | 38 | 38.4 | 37 | 35.6 |
Recognising small objects | 188 | 78.7 | 289 | 78.3 | 120 | 63.8 | 185 | 64.0 |
Lighting/adjusting lamp | 77 | 32.2 | 131 | 35.5 | 14 | 18.2 | 34 | 26.0 |
Winnowing grains | 25 | 10.5 | 48 | 13.0 | 2 | 8.0 | 10 | 20.8 |
Note:
Comparison of difficulty in near-vision tasks between presbyopes and non-presbyopes.
Tasks | Levels of difficulty | ||||||||
---|---|---|---|---|---|---|---|---|---|
None | Little | Moderate | Severe | ||||||
% | % | % | % | ||||||
Presbyopes (379) | 7 | 1.8 | 76 | 20.1 | 178 | 47.0 | 118 | 31.1 | 0.0001 |
Non-presbyopes (107) | 64 | 59.8 | 28 | 26.2 | 10 | 9.3 | 5 | 4.7 | |
Presbyopes (374) | 107 | 28.6 | 116 | 31.1 | 104 | 27.8 | 47 | 12.6 | 0.0001 |
Non-presbyopes (108) | 88 | 81.5 | 13 | 12.0 | 5 | 4.6 | 2 | 1.9 | |
Presbyopes (248) | 171 | 69.0 | 41 | 16.5 | 20 | 8.0 | 16 | 6.5 | 0.001 |
Non-presbyopes (82) | 75 | 91.5 | 4 | 4.9 | 2 | 2.4 | 1 | 1.2 | |
Presbyopes (314) | 122 | 38.9 | 85 | 27.1 | 63 | 20.1 | 44 | 10.9 | 0.0001 |
Non-presbyopes (90) | 78 | 86.7 | 8 | 8.9 | 4 | 4.4 | 0 | 0.0 | |
Presbyope (452) | 37 | 8.2 | 63 | 13.9 | 136 | 30.1 | 216 | 47.8 | 0.0001 |
Non-presbyopes (108) | 69 | 63.9 | 21 | 19.4 | 12 | 11.1 | 6 | 5.6 | |
Presbyopes (343) | 150 | 43.7 | 106 | 30.9 | 46 | 13.4 | 41 | 12.0 | 0.0001 |
Non-presbyopes (102) | 8 | 87.3 | 10 | 9.7 | 2 | 2.0 | 1 | 1.0 | |
Presbyopes (229) | 185 | 80.8 | 18 | 7.9 | 17 | 7.4 | 9 | 3.0 | 0.003 |
Non-presbyopes (73) | 7 | 98.6 | 1 | 1.4 | 0 | 0.0 | 0 | 0.0 | |
Presbyopes (53) | 33 | 62.3 | 10 | 18.9 | 5 | 9.4 | 5 | 9.4 | 0.186 |
Non-presbyopes (13) | 11 | 84.6) | 0 | 0.0 | 2 | 15.4 | 0 | 0.0 | |
Presbyopes (153) | 85 | 55.6 | 17 | 11.1 | 32 | 20.9 | 19 | 12.4 | 0.001 |
Non-presbyopes (50) | 43 | 86.0 | 4 | 8.0 | 2 | 4.0 | 1 | 2.0 | |
Presbyopes (374) | 89 | 23.8 | 118 | 31.6 | 133 | 25.6 | 34 | 9.1 | 0.0001 |
Non-presbyopes (103) | 83 | 80.6 | 12 | 11.7 | 6 | 5.8 | 2 | 1.9 | |
Presbyopes (152) | 109 | 71.7 | 21 | 13.8 | 15 | 9.9 | 7(4.6) | 4.6 | 0.031 |
Non-presbyopes (56) | 51 | 91.0 | 3 | 5.4 | 1 | 1.8 | 1(1.8) | 1.8 | |
Presbyopes (56) | 45 | 80.4 | 3 | 5.4 | 3 | 5.4 | 5(8.8) | 8.8 | 0.435 |
Non-presbyopes (17) | 16 | 94.1 | 1 | 5.9 | 0 | 0.0 | 0(0.0) | 0.0 |
Satisfaction with near vision and general health between presbyopes and non-presbyopes.
Response of participants | Presbyopes | Non-presbyopes | |||||||
---|---|---|---|---|---|---|---|---|---|
Male | Female | Male | Female | ||||||
% | % | % | % | ||||||
Not satisfied with near vision | 37 | 18.7 | 61 | 20.8 | 2 | 4.9 | 2 | 2.6 | < 0.001 |
Not satisfied with general health | 2 | 1.0 | 18 | 6.1 | 0 | 0.0 | 1 | 1.3 | 0.087 |
Problem with family | 11 | 5.6 | 26 | 8.9 | 4 | 9.8 | 3 | 3.9 | 0.560 |
Having felt looked down upon | 14 | 7.1 | 27 | 9.2 | 4 | 9.8 | 2 | 2.6 | 0.240 |
Requiring help because of vision | 42 | 21.2 | 67 | 22.9 | 3 | 7.3 | 6 | 7.9 | 0.004 |
, Significant
This study was carried out to determine a population-based impact of uncorrected presbyopia on the quality of life of adults aged 30 years and above in Sagamu LGA of Ogun state. This is important because although some population-based studies on presbyopia have been carried out in Nigeria,
The overall prevalence of presbyopia (
There was no statistical difference between the prevalence of presbyopia between urban and rural dwellers (81.8% [urban] vs. 78.9% [rural]). This is similar to the findings of Laviers
Multivariate analysis of the risk factors for presbyopia showed that older age (odds ratio [OR] = 0.08,
More details on prevalence of presbyopia is already published.
The study showed that presbyopes are significantly more likely to require help from others because of near-vision problems as shown in
With respect to the impact on the quality of life, this study found that 78.1%, 77.8% and 40.4% of presbyopes reported moderate to severe difficulty with reading, threading needles and writing, respectively. This is consistent with the findings of Chiroma
It is also similar to the findings of the Andhra Pradesh
There was an almost three-times dependency because of near-vision impairment in presbyopes compared to non-presbyopes similar to findings previously documented by other researchers.
Presbyopes significantly reported not being satisfied with near vision (
Comparing difficulty in near-vision tasks between presbyopes and non-presbyopes as illustrated in
Also, comparing satisfaction with near vision between presbyopes and non-presbyopes (
In conclusion, the impact of reduced near vision on the quality of life in Sagamu, Ogun State, Nigeria (consisting of urban, semi-urban and rural communities) seems obvious and similar to findings in urban,
However, some limitations can be identified in this community-based study including the apparent dissimilarity between the presbyopes and non-presbyopes. The two groups are not age and sex-matched to reduce co-founders. The samples obtained from the community were just compared. This is common in all studies performed on this subject. So, a study to compare age and sex-matched groups is recommended for the future.
The contribution of Dr R.O. Musibau and Dr P.O. Abikoye, as well as that of Mrs M.C. Ogundipe during the data collection is appreciated. This work was originally part of the data obtained by one of the authors for the preparation and submission of her dissertation to the National Postgraduate Medical College of Nigeria for the award of a Fellowship in 2014.
The authors have declared that no competing interest exists.
V.O.F. made conceptual contributions and data collection, H.A.A. designed and drafted the manuscript, O.O.O. co-wrote the manuscript and also collected data, O.O.J. collected data and reviewed the manuscript and O.T.B. and T.O.O. reviewed the manuscript and analysed the data.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Data sharing is not applicable to this article.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.