May 25, 2014
The Straits Times
By Janice Tai and Joan Chew
Not being able to see well, or at all, is worse than suffering from diabetes, obesity, hypertension and high cholesterol levels. Malays and Indians here are also more afflicted by visual problems than Chinese. These were the findings of a first-of-its-kind study involving more than 10,000 Singaporeans aged between 40 and 80.
It compared the loss of quality of life that poor eyesight brings with that of other chronic conditions, and could possibly guide policymakers working on programmes to tackle eye diseases.
Published in the top eye research journal Ophthalmology last month, the study - which culled data from three other population- based eye studies - found that for every 100,000 people here, the burden of visual impairment for the Chinese was equivalent to 512 healthy people dying every year. The impact was even greater for Malays and Indians, with the figure calculated at 707 and 609 respectively.
Hypertension is second on the list, and its burden is equivalent to 506 Chinese, 599 Indians and 698 Malays dying annually out of every 100,000 people.
The local study also found visual impairment to be associated with anxiety or depression in Indians, but not in Chinese and Malays. The study by researchers and doctors from the National University of Singapore (NUS) and the Singapore Eye Research Institute (Seri) did not find out why this was so.
Principal investigator Assistant Professor Luo Nan from NUS' Saw Swee Hock School of Public Health suggested that it could be due to factors such as social support and economic status. Study co-investigator Marcus Ang, an associate consultant with cornea service at the Singapore National Eye Centre, was not surprised by the findings.
He said that while conditions such as diabetes and hypertension may lead to life-threatening complications, patients may otherwise be symptom-free and can go about their daily activities normally. But eye issues can affect a person's day-to-day living, even making simple tasks such as putting on clothes difficult to perform. He said: "This may lead to feelings of sadness when they are unable to do things they used to enjoy."
Doctors expect an ageing population to lead to more people living with visual impairment. After all, four of the top five causes of blindness here - cataract, glaucoma, age-related macular degeneration, refractive errors such as short-sightedness, and diabetic retinopathy - are linked to ageing.
Dr Ang has observed that patients delay treatment for visual problems, especially those who see poorly with one eye but can still see with the other. It is why Seri is conducting studies to understand Asian patients' health-seeking behaviour, he said.
Prof Luo's team is also studying the economic costs of visual impairment through another study of 1,000 people. Both doctors said they hope primary care doctors can also step in to treat symptoms of visual impairment, since they are already caring for patients with chronic medical conditions.
Housewife Moddiappah Sellamah, 77, was part of the Singapore Indian Eye Study which was analysed for this large-scale eye study. Her daughter, 60-year-old Vaiyapuri Nallamal, said Madam Sellamah is healthy except for the cataracts she has been suffering from over the last two years.
The cataracts, which do not require surgery yet, have caused her to mistake people on the streets and board the wrong bus. Madam Nallamal said the elderly woman, who has an independent streak, "will never admit that her eyes are not good" and it can get exasperating for the family when she insists that the numbers and colours she sees are correct.
Dr Ang said people who experience blurred vision or other visual symptoms should see a doctor for a proper evaluation. Some eye diseases such as glaucoma do not cause symptoms in the early stages, so people with risk factors such as a family history of the disease should still go for eye screenings.
