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Original Investigation
September 20, 2018

Prevalence and Associated Factors of Uncorrected Refractive Error in Older Adults in a Population-Based Study in France

Author Affiliations
  • 1Institut National de la Santé et de la Recherche Medicale (INSERM), Bordeaux Population Health Research Center, Unité Mixte de Recherché 1219, University of Bordeaux, Bordeaux, France
  • 2R&D Life and Vision Science, Essilor International, Paris, France
  • 3Sorbonne University, INSERM, Centre National de la Recherche Scientifique, Institut de la Vision, Paris, France
  • 4Department of Ophthalmology, Bordeaux University Medical Center, Bordeaux, France
JAMA Ophthalmol. Published online September 20, 2018. doi:10.1001/jamaophthalmol.2018.4229
Key Points

Questions  What is the prevalence of uncorrected refractive error and what factors are associated with these errors?

Findings  In this cross-sectional study of 707 participants 78 years and older in France, prevalence of uncorrected refractive error was 38.8%, appearing similar among participants with or without eye disease. Prevalence of uncorrected refractive error was nearly 50% among participants who were unable to attend an outpatient clinic.

Meaning  Although easily correctable, these results suggest the prevalence of uncorrected refractive error is high in this older population and that specific groups, including those with and without eye disease or unable to attend an outpatient clinic, could be targeted for preventive actions.


Importance  Uncorrected refractive error (URE) is a common cause of visual impairment, but its prevalence in groups of older adults who could be pragmatic targets for improving optical correction remains unknown.

Objectives  To estimate the prevalence of URE in older adults, particularly in those with age-related eye disease and those who are unable to attend an outpatient clinic, and to identify the factors associated with URE.

Design, Setting, and Participants  This population-based cross-sectional analysis included 707 adults 78 years or older from the Alienor Study in Bordeaux, France. Data were collected from February 12, 2011, through December 21, 2012, and analyzed from November 1, 2017, through July 7, 2018.

Main Outcomes and Measures  Uncorrected refractive error was defined as the presenting distance visual acuity in the better-seeing eye improved by at least 5 letters on the Early Treatment Diabetic Retinopathy Study chart (≥1 line on the logMAR chart) using the best-achieved optical correction. Multivariate logistic regressions were used to determine the factors associated with URE.

Results  The study population of 707 adults 78 years or older (64.8% women; mean [SD] age, 84.3 [4.4] years) had a prevalence of URE of 38.8% (95% CI, 35.2%-42.5%). Prevalence was high for participants with eye disease (range, 35.0% [95% CI, 28.4%-42.0%] to 44.1% [95% CI, 27.2%-62.1%], depending on the disease) and those without eye disease (30.1%; 95% CI, 24.0%-36.7%). Prevalence was higher in participants who were examined at home (because they could not come to the clinic) than in those examined at the clinic (49.4% [95% CI, 42.8%-55.9%] vs 33.5% [95% CI, 29.2%-37.9%]; P < .001). Having an eye examination performed at home (odds ratio [OR], 1.64; 95% CI, 1.13-2.37), living alone (OR, 0.65; 95% CI, 0.47-0.90), and having the perceptions that the ophthalmologist consultation fees are too expensive (OR, 1.94; 95% CI, 1.12-3.36) and that declining visual acuity is normal with aging (OR, 1.47; 95% CI, 1.04-2.08) were all associated with URE.

Conclusions and Relevance  These study results show that the prevalence of URE was high in this population and suggest that preventive strategies aimed at enhancing optical correction could be directed to all older adults and to specific groups by implementing at-home eye examinations for those who have difficulties attending an outpatient clinic and by focusing on those with eye disease who probably already have a regular ophthalmologic follow-up. More studies are needed to evaluate prevalence of URE in different populations and countries with various eye care systems.