Module 7: Presbyopia: Universal Age-Related Visual Impairment

The Global Burden of Presbyopia

Presbyopia (far sightedness) affects most adults over the age of 40. The condition results from age-related loss of elasticity in the eye’s crystalline lens and its capsule, which leads to refractive error. Eyeglasses can be used to correct this, allowing patients to focus on nearby objects. In developing countries, however, eyeglasses are often unavailable or unaffordable, which makes uncorrected distance refractive error the “most common cause of vision impairment and the second most common cause of blindness in the world.”(1)(2)

Though the global burden of presbyopia is widespread across all nations, avoidable vision impairment resulting from uncorrected presbyopia is concentrated almost entirely in the developing world.

“It is estimated that there were 1.04 billion people globally with presbyopia in 2005, 517 million of whom had no spectacles or inadequate spectacles. Of these, 410 million were prevented from performing near tasks in the way they required. Vision impairment from uncorrected presbyopia predominantly exists (94%) in the developing world.”(3)

In summary, the recent studies of presbyopia in developing countries converge around the following conclusions:(4),(5),(6)

1. More than half of adults over the age of 30 have presbyopia.

2. Women have both a higher prevalence of, and more severe, presbyopia.

3. The majority of those with presbyopia do not have corrective eyeglasses.

Presbyopia and Quality of Life

Presbyopia has significant effects on quality of life, particularly in the developing world, making corrective spectacles a necessity. Those with functional presbyopia report higher dissatisfaction with their general health, difficulty in carrying out daily tasks, and increased problems with family relationships, increased feelings of being “looked down upon.”(7) Women are affected disproportionately, due to increased prevalence and severity of presbyopia among women and because presbyopia makes tasks traditionally performed by females such as sewing, knitting, and cooking in poor light very difficult. It is also of note that uncorrected presbyopia impedes efforts to improve adult literacy, which is associated with higher life quality.(8)

The Need for Continual, Comprehensive Eye Care

Because presbyopia is a progressive condition, patients will continually need to renew their eyeglasses prescriptions as they age.(9) Long-term access to eye care is thus essential to treating far sightedness. Additionally, people with presbyopia are at higher risk for developing permanently sight-threatening conditions such as glaucoma and diabetic eye disease, making comprehensive eye care all the more essential.(10)

“Presbyopic correction can play an important role in the development of an integrated eye care system. The need for spectacles for presbyopia is already a major driver encouraging people to seek eye cae, especially in developing countries. Having the capacity to provide a solution to presbyopic problems will encourage even more people to seek care, and it allows for a more integrated model of eye care than vertical approaches such as those using cataract case finders.”(11)

Footnotes

(1) Holden, B.A., Fricke, T.R., Ho, S.M., Song, R., Schlenther, G., Cronjé, S., Burnett, A., Papas, E., Naidoo, K.S. and Frick, K.D. “Global Vision Impairment Due to Uncorrected Presbyopia.” Archives of Ophthalmology. 126.12 (2008): 1731-1739.

(2) Sherwin, J.C., Keeffe, J.E., Kuper, H., Islam, F.M.A., Muller, A., and Mathenge, W. “Functional Presbyopia in a Rural Kenyan Population: The Unmet Presbyopic Need.” Clinical & Experimental Ophthalmology. 36.3 (2008): 245-251.

(3) Holden, B.A., Fricke, T.R., Ho, S.M., Song, R., Schlenther, G., Cronjé, S., Burnett, A., Papas, E., Naidoo, K.S. and Frick, K.D. “Global Vision Impairment Due to Uncorrected Presbyopia.” Archives of Ophthalmology. 126.12 (2008): 1731-1739.

(4) Patel, I. and West, S.K. “Presbyopia: Prevalence, Impact, and Interventions.” Community Eye Health. 20.63 (2007): 40-41.

(5) Holden, B.A., Fricke, T.R., Ho, S.M., Song, R., Schlenther, G., Cronjé, S., Burnett, A., Papas, E., Naidoo, K.S. and Frick, K.D. “Global Vision Impairment Due to Uncorrected Presbyopia.” Archives of Ophthalmology. 126.12 (2008): 1731-1739.

(6) Patel, I., Munoz, B., Burke, A.G., Kayongoya, A., Mchiwa, W., Schwarzwalder, A.W., and West, S.K. “Impact of Presbyopia on Quality of Life in a Rural African Setting.” Ophthalmology. 113.5 (2006): 728-734.

(7) Patel, I., Munoz, B., Burke, A.G., Kayongoya, A., Mchiwa, W., Schwarzwalder, A.W., and West, S.K. “Impact of Presbyopia on Quality of Life in a Rural African Setting.” Ophthalmology. 113.5 (2006): 728-734.

(8) Ibid.

(9) “Refraction Training Manual: Presbyopia.” 2007. International Centre for Eye Health. www.cehjournal.org. Accessed on 14 January 2009.

(10) Holden, B.A., Fricke, T.R., Ho, S.M., Song, R., Schlenther, G., Cronjé, S., Burnett, A., Papas, E., Naidoo, K.S. and Frick, K.D. “Global Vision Impairment Due to Uncorrected Presbyopia.” Archives of Ophthalmology. 126.12 (2008): 1731-1739.

(11) Ibid.