臺灣博碩士論文加值系統

摘要
目的: 探討石牌地區老年人可矯正視力障礙之盛行率和危險因子, 及其與生活品質之相關。
方法: 本研究是以社區為基礎的橫斷式研究法, 於1999年7月1日至2000年12月31日間收集資料, 研究對象為石牌地區65歲或以上老年人, 資料收集包括問卷調查及眼科檢查; 問卷內容有基本人口學資料, 個人疾病史及生活品質(36-item short form survey of the Medical Outcomes Study)。眼科檢查包括表現視力及最佳矯正視力、眼壓測量、裂隙燈及眼底檢查。可矯正視力障礙之危險因子以卡方檢定作單變項分析, 並以邏輯斯回歸作多變項分析。生活品質問卷以Rand 36-Item Health Survey (version 1.0) 方法計算八個面向之分數並以Student’s t test檢定正常視力與可矯正視力障礙兩組之生活品質是否有顯著差異。
結果: 共有1361人完成問卷調查及眼科檢查, 完檢率為66.6%。可矯正視力障礙(優眼表現視力 <6/12, 經驗光矯正後優眼最佳視力 ≥6/12)有127位, 盛行率為9.6% (95% 信賴區間為8.0-11.2%), 佔所有視力障礙(無法矯正及可矯正視力障礙)的58.5%。在單變項分析中, 與可矯正視力障礙有顯著相關的危險因子有年齡、性別、中風病史、非正視眼者(遠視及近視)。高教育程度、已婚者及接受檢查時配戴看遠用眼鏡則有保護作用。多變項分析中, 年齡及非正視眼(尤其是近視))與可矯正視力障礙有顯著相關, 高教育程度及接受檢查時有配戴看遠用眼鏡有保護作用。在生活品質方面, 可矯正視力障礙組於身體功能面向與正常視力組有顯著差異。於多變項分析中, 可矯正視力障礙組在身體功能面向比正常視力組差, 且有統計上意義。
結論: 本研究發現年齡, 遠視及近視是可矯正視力障礙的相關危險因子, 經由衛教提高老年人對眼健康的重視, 定期接受眼睛檢查並了解有一部份的視力障礙是可以透過配戴眼鏡而獲得矯正的觀念是很重要的。

Objectives: To investigate the prevalence, risk factors and quality of life of correctable visual impairment in a metropolitan elderly population.
Methods: This study is a community-based cross-sectional survey of eye diseases among noninstitutionalized subjects 65 years and older in Shihpai. Elderly persons having their household registered in Shihpai district, Taipei, Taiwan were invited to participate. The study consisted of a structured questionnaire conducted at home followed by a comprehensive standardized ophthalmic examination. The questionnaire was designed to cover demographic data, personal medical history and quality of life (36-item short form survey of the Medical Outcomes Study, SF-36). Ophthalmic examination included presenting and best-corrected visual acuity, tonometry, slit-lamp biomicroscopy, direct and indirect ophthalmoscopy. Statistical methods included Chi-square analysis for evaluation of association between independent variables and correctable visual impairment. Multiple logistic regression analysis was then used to detect whether each independent variable was significantly related to correctable visual impairment after adjustment with all covariates. Scoring of the SF-36 questionnaire was performed using the Rand 36-Item Health Survey (version 1.0) method. Student’s t test was used to detect whether there was significant difference in scores between correctable visual impairment and no visual impairment in the eight scales of SF-36 separately. Multiple linear regression was then used to evaluate whether there was any significant association between the eight scales of SF-36 and correctable visual impairment after adjustment with all covariates.
Results: A total of 1361 (response rate 66.6%) participated in both the questionnaire and ophthalmic examination. The prevalence of correctable visual impairment (presenting visual acuity of better eye <6/12 and with a best-corrected visual acuity in the better eye ≥ 6/12) was 9.6% (95% confidence interval: 8.0-11.2%) and this occupied 58.5% of all types of visual impairment (correctable and non-correctable). Under univariate analysis, the very elderly (75 years and above), female, having a history of stroke and non-emmetropic eyes (myopia being at higher risk than hyperopia) were significantly related to correctable visual impairment. On the other hand, having a higher level of education, married and with distance glasses worn during examination were protective factors for correctable visual impairment. Under multiple logistic regression analysis, old age and non-emmetropia (especially myopia) were significantly related to correctable visual impairment whereas higher level of education and distance glasses worn during examination were protective. Correctable visual impairment scored significantly less than subjects with normal vision in the physical functioning scale of the SF-36 questionnaire. In multiple regression analysis, having correctable visual impairment fared significantly less in the physical functioning scale but not in the other seven scales.
Conclusions: About 10% of the elderly in Shihpai district had correctable visual impairment. The very elderly and the myopic group are at the highest risk. The impact of correctable visual impairment on quality of life in the elderly, especially in the physical functioning scale deserves further evaluation. Public education about the importance of regular ophthalmic examination and the possibility of improving visual acuity by wearing spectacles is important.

1. Olshansky SJ, Carnes BA, Cassesl CK. The aging of the human species. Sci AM 1993; 268:46-52.
2. Council for Economic Planning and Development Executive Yuan, Republic of China. 2003
3. Cornoni-Huntley JC, Foley DJ, White LR, et al. Epidemiology of disability in the oldest old: methodologic issues and preliminary findings. Health & Society 1985;63: 350-376.
4. Cornoni-Huntley JC Foley DJ, Guralnik JM. Co-morbidity analysis: a strategy for understanding mortality, disability and use of health care facilities of older people. International Journal of Epidemiology 1991;20 Suppl 1:S8-17.
5. Soldo BJ, Manton KG. Health status and services needs of the oldest old: current patterns and future trends. Health & Society 1985;63:286-319.
6. Attebo K, Ivers RQ, Mitchell P. Refractive errors in an older population. The Blue Mountains Eye Study. Ophthalmology 1999;106:1066-1072.
7. World Health Organization: Programme for the Prevention of Blindness and Deafness. Global Initiative for the Elimination of Avoidable Blindness. Geneva: WHO; 1997:1-7.
8. International Statistical Classification of Diseases and Related Health Problems, 10th rev. In: Johnson GJ, Minassian DC, Weale R, eds. The Epidemiology of Eye Disease. London: Chapman & Hall Medical 1998:8-30.
9. Dandona R, Dandona L. Refractive error blindness. Bull World Health Organ. 2001;79:237-243.
10. Tielsch JM, Sommer A. Witt K, et al. Blindness and visual impairment in an American urban population. The Baltimore Eye Survey. Arch Ophthalmol 1990;108:286-290.
11. Klein R, Klein BE, Linton KL, et al. The Beaver Dam Eye Study: visual acuity. Ophthalmology 1991;98:1310-1315.
12. Attebo K, Mitchell P, Smith W. Visual acuity and the causes of visual loss in Australia. The Blue Mountains Eye Study. Ophthalmology 1996;103:357-364.
13. Liou HL, McCarty CA, Jin CL, et al. Prevalence and predictors of undercorrected refractive error in the Victorian population. Am J Ophthalmol 1999;127:590-596.
14. Wang JJ, Mitchell P, Smith W. Vision and low self-rated health: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 2000;41:49-54.
15. Wang JJ, Mitchell P, Smith W, et al. Impact of visual impairment on use of community support services by elderly persons: the Blue Mountains Eye Study. Invest Ophthamol Vis Sci 1999;40:12-19.
16. West SK, Munoz B, Rubin GS, et al. Function and visual impairment in a population-based study of older adults. The SEE Project. Invest Ophthalmol Vis Sci 1997;38:72-82.
17. Wang JJ, Mitchell P, Simpson JM, et al. Visual Impairment, age-related cataract, and mortality. Arch Ophthalmol 2001;119:1186-1190.
18. Pokharel GP, Negrel AD, Munoz SR, et al. Refractive error study in children: results from Mechi Zone, Nepal. Am J Opthalmol 2000;129:436-444.
19. Zhao J, Pan X, Sui R, et al. Refractive error study in children: results from Shunyi District, China. Am J Ophthalmol 2000;129:427-435.
20. Maul E, Barroso, Munoz SR, et al. Refractive error study in children: results from La Florida, Chile. Am J Opthalmol 2000;129:445-454.
21. Dandona R, Dandona L, Srinivas M, et al. Refractive error in children a rural population in India. Invest Ophthalmol Vis Sci 2002;43:615-622.
22. Murthy GV, Gupta SK, Ellwein LB, et al. Refractive error in children in an urban population in New Delhi. Invest Ophthalmol Vis Sci 2002;43:623-631.
23. Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Quality of life research 1993;2:619-631.
24. Idler EI, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997;38:21-37.
25. Patrick DL, Erickson P. Health status and health policy: Quality of life in health care evaluation and resource allocation. New York: Oxford University Press, 1993.
26. Steinberg EP, Tielsch JM, Schein OD, et al. The VF-14. An index of functional impairment in patients with cataract. Arch Ophthalmol 1994;112:630-638.
27. Friedman DS, Tielsch JM, Vitale S, et al. VF-14 item specific responses in patients undergoing first eye cataract surgery: can the length of the VF-14 be reduced: Br J Ophthalmol 2002;86:885-891.
28. Wilson MR, Coleman AL, Yu F, Bing EG, Sasaki IF, Berlin K, et al. Functional Status and well-being in patients with glaucoma as measured by the medical outcomes study Short Form-36 questionnaire. Ophthalmology 1998;105:2112-6.
29. Nelson P, Aspinall P, Papasouliotis O, Worton B, O''Brien C. Quality of life in glaucoma and its relationship with visual function. J Glaucoma 2003;12:139-50.
30. Hazel CA, Petre KL, Armstrong RA, Benson MT, Frost NA. Visual function and subjective quality of life compared in subjects with acquired macular disease. Invest Ophthalmol Vis Sci 2000;41:1309-15.
31. Rose K, Harper R, Tromans C, Waterman C, Goldberg D, Haggerty C, et al. Quality of life in myopia. Br J Ophthalmol 2000;84:1031-4.
32. Scott IU, Schein OD, West S, Bandeen-Roche K, Enger C, Folstein MF. Functional status and quality of life measurement among ophthalmic patients. Arch Ophthalmol 1994;112:329-35.
33. Branch LG, Horwowitz A, Carr C. The implications for everyday life of incident self-reported visual decline among people over age 65 living in the community. Gerontologist 1989; 29:359-65.
34. Rubin GS, Roche KB, Prasada-Rao P, Fried LP. Visual impairment and disability in older adults. Optom Vis Sci 1994; 41:750-60.
35. Lee PP, Spritzer K, Hays RD. The impact of blurred vision on functioning and well-being. Ophthalmology 1997;104:390-6.
36. Javitt JC, Steinberg EP, Sharkey P, et al. Cataract surgery in one eye or both. A billion dollar per year issue. Ophthalmology 1995;102:1583-1592.
37. Claridge KG, Francis PJ, Bates AK. Should second eye cataract surgery be rationed? Eye 1995;9:47-49.
38. Cataract Management Guideline Panel, United States. Cataract in Adults: Management of Functional Impairment. Rockville (MD): Agency for Health Care Policy and Research, Public Health Service, United States Department of Health and Human Services; AHCPR Publication No. 93-0542, 1993.
39. Applegate WB, Miller ST, Elam JT, et al. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients. JAMA 1987;257:1064-1066.
40. Brenner MH, Curbow B, Javitt JC, et al. Vision change and quality of life in the elderly. Response to cataract surgery and treatment of other chronic ocular conditions. Arch Ophthalmol 1993;111:680-685.
41. Javitt JC, Brenner MH, Curbow B, et al. Outcomes of cataract surgery. Improvement in visual acuity and subjective visual function after surgery in the first, second, and both eyes. Arch Ophthmol 1993;111:686-691.
42. Mangione CM, Phillips RS, Lawrence MG, et al. Improved visual function and attenuation of declines in health-related quality of life after cataract extraction. Arch Ophthalmol 1994;112;1419-1425.
43. Damiano AM, Steinberg EP, Cassard SD, et al. Comparison of generic vs. disease-specific measure of functional impairment in patients with cataract. Med Care 1995;33(4 Suppl):AS120-130.
44. Desai P, Reidy A, Minassian DC, et al. Gains from cataract surgery: visual function and quality of life. Br J Ophthamol 1996;80:868-873.
45. Elliot DB, Patla A, Bullimore MA. Improvements in clinical functional vision and perceived visual disability after first and second eye cataract surgery. Br J Ophthalmol 1997;81:889-895.
46. Bass EB, Wills S, Scott IU, et al. Preference values for visual states in patients planning to undergo cataract surgery. Med Decis Making 1997;17:324-330.
47. Fletcher A, Gore S, Hones D. Quality of life measures in health care. II: Design, analysis, and interpretation. BMJ 1992;305:1145-1148.
48. Muldoon MF, Barger SD, Flory JD, et al. What are quality of life measurements measuring? BMJ 1998;316:542-545.
49. Foran S, Rose K Wang JJ, et al. Correctable visual impairment in an Older Population: the Blue Mountains Eye Study. Am J Ophthalmol 2002;134:712-719.
50. Bourne RRA, Dineen BP, Huq DMN, et al. Correction of refractive error in the adult population of Bangladesh: meeting the unmet need. Invest Ophthalmol Vis Sci 2004;45:410-417.
51. Dandona R, Dandona L, Kovai V, et al. Population-based study of spectacles use in southern India. Indian Journal of Ophthalmology 2002;50:145-155.
52. World Health Organization (1948). The first years of the World Health Organization, WHO, Geneva.
53. Brazier JE, Harper R, Jones NM, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992;305:160-164.
54. Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adult of working age. BMJ 1993;306:1437-1440.
55. Stadnyk K, Calder J, Rockwood K. Testing the measurement properties of the Short Form-36 Health Survey in a frail elderly population. J Clin Epidemiol 1998;51:827-835.
56. Hemingway H, Nicholson A, Stafford M, et al. The impact of socioeconomic status on health functioning as assessed by the SF-36 questionnaire: The Whitehall II Study. Am J Publ Hlth 1997;87:1484-1490.
57. Hemingway H, Stafford M, Stansfeld S, et al. Is the SF-36 a valid measure of change in population health? Results from the Whitehall II Study. BMJ 1997;315:1273-1279.
58. Bowling A, Bond M, Jenkinson C. Short Form 36 (SF-36) Health Survey questionnaire: which normative data should be used? Comparisons between the norms provided by the Omnibus Survey in Britain, the Health Survey for England and the Oxford Health Life Survey. J Publ Hlth Med 1999;21:255-270.
59. Ware JE, Kosinske M, Bayliss MS, et al. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study. Med Care 1995;33:AS264-279.
60. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-483.
61. Mchorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993;31:247-263.
62. Ware JE, Snow KK, Kosinske M, et al. SF-36 Health Survey: Manual and Interpretation Guide. Boston: New England Medical Center, Health Institute, 1993.
63. Ware JE, Kosinski M, Keller SD. SF-36 Physical and mental summary scales: A user’s manual. Boston: New England Medical Center, Health Institute, 1994.
64. Chie WC, Huang CS, Chen JH, et al. Measurement of the Quality of life during different clinical phases of breast cancer. J Formos Med Assoc 1999;98:254-60.
65. Fuh JL, Wang SJ, Lu SR, et al. Psycohmetric evaluation of a Chinese (Taiwanese) version of the SF-36 Health Survey Amongst middle-aged women from a rural community. Qual Life Res 2000;9:675-83.
66. Wang SJ, Fuh JL, Lu SR,et al. Quality of life differs among headache diagnoses: Analysis of SF-36 survey in 901 headache patients. Pain 2001; 89:285-92.
67. Fuh JL, Wang SJ, Lee SJ, et al. Quality of life and menopausal transition for middle-aged women on Kinmen island. Qual Life Res. 2003;12: 53-61.
68. Kuang TM, Hsu WM, Chou CK, et al. Impact of stereopsis on quality of life. Eye (2004; in press).
69. World Health Organization. Blindness information collected from various sources. Epidemiol Vital Stat Rep 1996;19:437-511.
70. Smeeth L. Iliffe S. Effectiveness of screening older people for impaired vision in community setting: systematic review of evidence from randomized controlled trials. BMJ 1998;316:660-663.
71. Zhao J, Jia L, Sui R, Ellwein LB. Prevalence of blindness and cataract surgery in Shunyi County, China. Am J Ophthalmol 1998:126:506-514.
72. Lau JTF, Lee V, Fan D, et al. Knowledge about cataract, glaucoma, and age related macular degeneration in the Hong Kong Chinese population. Br J Ophthalmol 2002;86:1080-1084.
73. Livingston PM, McCarty CA, Taylor HR. Knowledge, attitudes, and self care practices associated with age related eye disease in Australia. Br J Ophthalmol 1998;82:780-785.
74. Konstas AG, Maskaleris G, Gratsonidis S, et al. Compliance and viewpoint of glaucoma patients in Greece. Eye 2000;14Pt5:752-756.
75. Dandona R, Dandona L, John RK, et al. Awareness of eye diseases in an urban population in southern India. Bull World Health Organ 2001;79:96-102.
76. McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short Form Health Survey (SF-36), II: psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993;31:247-263.
77. Herzog AR, Rodgers WL. Age and response rates to interview sample survey. H Gerontol. 1988;43:5200-5205.
78. Kelsey JL, O’Brien LA, Grisso JA, et al. Issues in carrying out epidemiologic research in the elderly. Am J Epidemiol. 1989;130:857-866.
79. Tell GS, Fried LP, Hermanson B, et al. Recruitment of adults 65 years and older as participants in the Cardiovascular Health Study. Ann Epidemiol 1993;3:358-366.