A Population-Based Assessment of Presbyopia in the State of Andhra Pradesh, South India: The Andhra Pradesh Eye Disease Study

PURPOSE: To determine the prevalence of presbyopia in the state of Andhra Pradesh in south India. METHODS: Comprehensive ocular examinations including logMAR (logarithm of the minimum angle of resolution) distance and near (presenting and best corrected) visual acuity, slit lamp biomicroscopy of the anterior segment, and dilated posterior segment examinations were performed using a standardized protocol for subjects identified through a random cluster-sampling strategy in Andhra Pradesh. Information of difficulty in performing near tasks was collected as part of a visual function questionnaire administered to all subjects. A person was defined as having presbyopia if the person required an addition of at least 1.0 D in either eye for near vision in addition to their best corrected distance correction to improve near vision to at least N8 and if they had graded lens opacities (Lens Opacities Classification System LOCS III system). RESULTS: Examined in the study were 5587 subjects 30 years of age or older (mean age 47.5+/-13.0 years). The age-, gender-, and area-adjusted prevalence of presbyopia was 55.3% (95% confidence interval CI: 54.0-56.6). One third (n=1173; 30.0%) of the 3907 subjects with presbyopia were currently using spectacles. Of the 2734 subjects with presbyopia and not using spectacles, 528 (19.3%) had moderate to severe difficulty in reading small print, and 2085 (76.3%) had moderate to severe difficulty in recognizing small objects and performing near work, including 1057 (38.6%) subjects who were unable to manage any near work. On multivariate analysis, female sex (OR: 1.4, 95% CI: 1.1-1.8), rural residence (OR: 1.5, 95% CI: 1.2-1.8), alcohol consumption (OR: 0.8, 95% CI: 0.6-0.9), nuclear opacity of the lens greater than grade 2 LOCS III (OR: 4.8, 95% CI: 1.4-16.8), myopia (OR: 1.6, 95% CI: 1.3-2.1), and hyperopia (OR: 3.6, 95% CI: 2.7-5.2) were associated with presbyopia. CONCLUSIONS: The high prevalence of presbyopia and the stated effect on performing activities related to near vision needs to be translated into programs and strategies that specifically target presbyopia.