| 摘要(英) | Abstract
An Epidemiological Study of Visual Impairment
and Visual Function Related Quality of Life
among The Elderly.
(Total Pages 178 )
AUTHOR： Chang, Hsueh-Hui
SUPERVISOR：Dr. Li, Chung-Yi
DEGREE： Master of Science in Public Health
Dept of Public Health, College of Medicine, Fu-Jen Catholic University
KEY WORD： elderly, vision, visual function, screening, quality of life, cross-sectional study, epidemiology
BACKGROUND AND PURPOSE: The prevalence of visual impairment increases as a result of the growth of elderly population and changes of disease pattern. Many elderly people do not receive timely and appropriate eye treatment since they are not examined. This study was conducted to characterize and compare the prevalence rates of visual impairment and scores of visual function related quality of life (VFRQOL) among the elderly people living in four districts with different ways of living in Hisn-Chu County. Further analyses were also performed to explore demographic characteristics and disease histories that could significantly predict visual capability and VFRQOL. Results from this study may be of help to the health policy toward eye care of the elderly, community health research, and policy formulation.
METHODS: This study used a cross-sectional design. Using a stratified random sampling technique, we selected a total of 2,006 elderly participants aged 65 and more and lived in four townships (Jhubei, Guansi, Emei, and Wufong) of Hsin-Chu County. Each study participant received an eye screening for visual impairment and was administered a questionnaire for VFRQOL. A total of 1,392 study participants completed the interview, representing a response rate of 69.4%. Instrument used in this study included the Snellen E chart, the simplified visual acuity card, and the 25-item Visual Function Questionnaire (VFQ-25). The study participants whose presenting visual acuity of the better eye was worst than 6/12 were classified as subjects with visual impairment. The study also calculated the total score and sub-scale scores of VFQ-25 to indicate an individual’s VFRQOL. Percentage and mean were calculated for description of categorical and continuous variables, respectively. Statistical testing was performed with various techniques including Chi-square test, One-way analysis of variance, logistic regression (calculation of odds ratios), and linear regression (calculation of the difference in score).
RESULTS: The highest and lowest prevalence rate of visual impairment was observed in Emei and Guansi, respectively. Among the VFQ-25 sub-scales, the highest score was noted for “color vision” irrespective of the study township (average score was 93.1, the highest and lowest township-specific score was noted for Jhubei (97.4) and Wufong (82.8), respectively). The lowest sub-scale specific score was observed for “general health” (average score of 33.0) with the highest and lowest township-specific score noted for Guansi (37.6) and Jhubei (30.4). Results from multivariate analyses indicated that prevalence of visual impairment was significantly associated with township of living, age, diabetes, and eye disorder, but not with gender, education, marital status, living condition, body mass index (BMI), and histories of hypertension and hyperlipidemia. Additionally, the total score of VFQ-25 can be significantly predicted by the factors including visual impairment, township of living, age, gender, education, marital status, BMI, and disease histories of hypertension, diabetes, and eye disorders, but was unrelated to living condition and hyperlipidemia. Moreover, visual impairment, township of living, and eye disorders were factors that can significantly predict scores of all VFQ-25 subs-scales; and age was also a significant predictor for all VFQ-25 subs-scales except “driving”. As compared to the healthy subjects, the study participants with visual impairment tended to experience a significantly reduced VFQ-25 total score and scores of all sub-scales. The largest and smallest difference associated with visual impairment was “driving” (14.4) and “general health” (5.5). Overall, there was a significant difference in VFQ-25 score between four townships, and the elderly in Wefong township had the least total score and scores of nearly all sub-scales except for “general health” for which the elderly in Jhubei township experienced the least score.
CONCLUSION: We found that the prevalence of visual impairment was significantly associated with township of living, age, diabetes, and eye disorder. Additionally, visual impairment, township of living, and eye disorders were factors that can significantly predict scores of all VFQ-25 subs-scales. In the future, community visual health care should deliver its visual screen program to the elderly people who are older, living in rural, with the history of diabetes, and eye disorder. Moreover, visual health care and visual health education should also be further enforced. Besides, after adjustment for the demographic characteristics, the history of disease, and visual impairment, we still noted a significant geographic variation in the score of VFRQOL. Future studies should aim to explore the specific factors that may be responsible for such geographic variation.
KEY WORDS: elderly, vision, visual function, screening, quality of life, cross-sectional study, epidemiology
|
|---|
| 參考文獻 | 中文部分
內政統計資訊服務網：主要國家65歲以上人口占總人口比率。2004 June 6th (cited 2005 June 26) Available from: URL: http://www.moi.gov.tw /stat。
內政部社會司：身心障礙等級，行政規則，身心障礙福利相關法規。2003 (cited 2005 June 26) Available from: http://sowf.moi.gov.tw/05/new05. htm
文良彥等：終結白內障消除霧化的視覺。台北市：宏欣文化事業有限公司，2004。
史麗珠：台灣地區老年性白內障之流行病學研究，台灣大學公共衛生學研究所博士論文，1996。
杞昭安：視覺障礙老人安養問題之研究。特殊教育研究學刊2001;20:147-169。
林隆光：學幼童視力及立體感篩檢工作手冊。教育部。2004 November 19th (cited 2005 June 26)Available from: URL: http://www.edu.tw/EDU_ WEB/EDU_MGT/PHYSICAL/EDU7663001/health/931119150334.doc
林隆光：學童視力保健。台北市，健康文化事業股份有限公司，2001。
林隆光等：臺北縣金山鄉中老年人視力障礙狀態之調查。慈濟醫學2001;13:75-79。
林嘉理：先天與後天性色盲。財團法人尹書田紀念醫院，書田泌尿科眼科診所。2005 May 20th (cited 2005 June 26) Available from: URL: http://www.shutien.org.tw/0117_011.htm
姚開屏： 簡介與評論常用的一般性健康相關生活品質量表兼談對未來研究的建議。測驗年刊2000;47:111-38。
姚開屏：健康相關生活品質概念與測量原理之簡介。台灣醫界2002; 6:183-192。
施永豐：色盲乎? --色覺異常。健康世界1998; 147:101-5。
洪柏廷等：淺說青光眼—預防、診療、保健的介紹。台北市，宏欣文化事業有限公司，2004。
馬偕紀念醫院眼科：青光眼簡介。2002 November 13th (cited 2005 June 26)Available from: URL: http://www2.mmh.org.tw/oph/glaucoma.htm
張朝凱等：看見清楚與美麗：眼科疾病的治療保健與雷射近視手術。台北市，宏欣文化事業有限公司，2005。
莊文信：中大調查發現本港五分一老人有視力障礙。2002 November 13th(cited 2005 June 26)Available from: URL: http://www.cuhk.edu.hk/ipro /pressrelease/990416c.htm
陳慕師：糖尿病友發生視力障礙的原因。糖尿病家族2002;4:4-7。
朝陽科技大學：視野及視量測畫面。人因工程實驗室。2000 July 12th (cited 2005 June 26) Available from: URL: http://www.cyut.edu.tw/~hcchen /%B9%EA%C5%E7%B3%E6%A4%B8/%B5%F8%B3%A5%A4%CE%B5%F8%A4O%B6q%B4%FA.htm
程景煜等：台灣地區老人視力與眼及現況。中華民國眼科醫學會主編：中老年視覺問題診療指引手冊(2003)。台中市：行政院衛生署國民健康局，2003。
黃秀蕙等：新竹縣老人視覺功能與生活品質的社區性研究(2005)。台中：行政院衛生署國民健康局2005;13-15。
新竹縣衛生局：保健課。91-93年老人視篩統計.xls，2004。
新竹縣衛生局：新竹縣各鄉鎮市歷年（70-93）人口數及93年老年人口比較。2003 August 8th (cited 2005 June 26) Available from: URL:http://www.hsinchu.gov.tw/_upload/staticpaper/138/新竹縣各鄉鎮70-93年人口數.xls
新竹縣衛生局：新竹縣醫療資源分佈概況(95.02).xls。2006 March 20th (cited 2006 March 23) Available from: URL http://www.hsinchu.gov.tw/_upload/staticpaper/883/新竹縣醫療資源分佈概況(95.02).xls
褚仁遠等人：眼病學。第一版。中國：人民衛生出版社，2005。
蔡景耀等：社區老人視力障礙盛行率及其相關因子。北市醫學雜誌2004;1:344-51。
蔡景耀等：臺北市與馬祖地區老人視力障礙盛行率與原因的社區性研究。中華民國眼科醫學會雜誌2003;42:178-86。
英文部分
Agresti A. Categorical data analysis: New York: John Wiley & Sons; 1990.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression.Arch Gen Psychiatry 1961;4:561-71.
Bellan L. Why are patients with no visual symptoms on cataract waiting lists? Can J Ophthalmol 2005;40:433-8.
Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981;19:787-805.
Bernth-Petersen P. A change in indications for cataract surgery? A 10 year comparative epidemiologic study. Acta Ophthalmol 1981;59:206-10.
Blyth C, Still H. Binomial confidence intervals. J Am Stat Assoc 1983;78:108-16.
Booth-Kewley S, Friedman HS. Psychological predictors of heart disease: a quantitative review. Psychol Bull 1987;101:343-62.
Bremond-Gignac D, Tixier J, Missotten T, Laroche L, Beresniak A. Evaluation of the quality of life in ophthalmology. Presse Med 2002;19;31:1607-12.
Brown MM, Brown GC, Sharma S, Landy J, Bakal J. Quality of life with visual acuity loss from diabetic retinopathy and age-related macular degeneration. Arch Ophthalmol 2002;120:481-4.
Cahill MT, Banks AD, Stinnett SS, Toth CA. Vision-related quality of life in patients with bilateral severe age-related macular degeneration. Ophthalmology 2005;112:152-8.
Carabellese C, Appollonio I, Rozzini R, Bianchetti A, Frisoni GB, Frattola L, Trabucchi M. Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc 1993;41:401-7.
Chen JH, Xu L, Hu AL, Sun BC, Li JJ, Ma K, Xia CR, Cui TT, Zheng YY, Li YB, Zhang RX, Yang H, Sun XY, Zou Y, Wang Y, Ma BR. Prevalence of low vision and blindness in defined populations in rural and urban areas in Beijing. Zhonghua Yi Xue Za Zhi 2003;83:1413-8.
Chia EM, Wang JJ, Rochtchina E, Smith W, Cumming OR, Mitchell P. Impact of Bilateral Visual Impairment on Health-Related Quality of Life: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 2004;45:71-6.
Cid-Ruzafa J, Damian-Moreno J. [Disability evaluation: Barthel's index]. Rev Esp Salud Publica 1997;71:127-37.
Cole SR, Beck RW, Moke PS, Gal RL, Long DT. The National Eye Institute Visual Function Questionnaire: experience of the ONTT. Optic Neuritis Treatment Trial. Invest Ophthalmol Vis Sci 2000;41:1017-21.
Cusick M, SanGiovanni JP, Chew EY, Csaky KG, Hall-Shimel K, Reed GF, Caruso RC, Ferris FL 3rd. Central visual function and the NEI-VFQ-25 near and distance activities subscale scores in people with type 1 and 2 diabetes. Am J Ophthalmol 2005;139:1042-50.
Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Schott AM, HausheOR E, Meunier PJ, Breart G. Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 1996;348:145-9.
de Boer MR, de Vet HC, Terwee CB, Moll AC, Volker-Dieben HJ, van Rens GH. Changes to the subscales of two vision-related quality of life questionnaires are proposed. J Clin Epidemiol 2005;58:1260-8.
de Boer MR, Pluijm SM, Lips P, Moll AC, Volker-Dieben HJ, Deeg DJ, van Rens GH. Different aspects of visual impairment as risk factors for falls and fractures in older men and women. J Bone Miner Res 2004;19:1539-47.
Desai P, Reidy A, Minassian DC, Vafidis G, Bolger J. Gains from cataract surgery: visual function and quality of life. Br J Ophthalmol 1996;80:868-73.
Dimitrov PN, Mukesh BN, McCarty CA, Taylor HR. Five-year incidence of bilateral cause-specific visual impairment in the Melbourne Visual Impairment Project. Invest Ophthalmol Vis Sci 2003;44:5075-81
Duh EJ, Aiello LP. Basic Pathobiology of the eye and its complications. Ellenberg & Rifkin's Diabetes Mellitus: New York: McGraw-Hill; 2002.
Elliott DB, Hurst MA, Weatherill J. Comparing clinical tests of visual function in cataract with the patient's perceived visual disability. Eye 1990;4 :712-7
Evans JR, Fletcher AE, Wormald RP, Ng ES, Stirling S, Smeeth L, Breeze E, Bulpitt CJ, Nunes M, Jones D, Tulloch A. Prevalence of visual impairment in people aged 75 years and older in Britain: results from the MRC trial of assessment and management of older people in the community. Br J Ophthalmol 2002 ;86:795-800.
Friedman DS, Tielsch JM, Vitale S, Bass EB, Schein OD, Steinberg EP. 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;86:885-91.
Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ 1993;306:1440-4.
Granger CV, Hamilton BB, Linacre JM, Heinemann AW, Wright BD. Performance profiles of the functional independence measure. Am J Phys Med Rehabil 1993;72:84-9.
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
Hinds A, Sinclair A, Park J, Suttie A, Paterson H, Macdonald M. Impact of an interdisciplinary low vision service on the quality of life of low vision patients. Br J Ophthalmol 2003;87:1391-6.
Hsu WM, Cheng CY, Liu JH, Tsai SY, Chou P. Prevalence and causes of visual impairment in an elderly Chinese population in Taiwan: the Shihpai Eye Study. Ophthalmology 2004;111:62-9.
Iliffe S, Kharicha K, Harari D, Swift C, Gillmann G, Stuck A. Self-reported visual function in healthy older people in Britain: an exploratory study of associations with age, sex, depression, education and income. Fam Pract 2005;22:585-90.
Ivers RQ, Norton R, Cumming RG, Butler M, Campbell AJ. Visual impairment and risk of hip fracture. Am J Epidemiol 2000;152:633-9.
Jampel HD, Friedman DS, Quigley H, Miller R. Correlation of the binocular visual field with patient assessment of vision. Invest Ophthalmol Vis Sci 2002;43:1059-67.
Kaplan RM, Atkins CJ, Timms R. Validity of a quality of well-being scale as an outcome measure in chronic obstructive pulmonary disease. J Chronic Dis 1984;37:85-95.
Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist 1970;10:20-30.
Keeffe JE, Lovie-Kitchin JE, Maclean H, Taylor HR. A simplified screening test for the identification of individuals with diminished vision in developing countries. Rev Panam Salud Publica 1998;3:220-6.
Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil 1987;1: 6-18.
Klein BE, Klein R, Lee KE, Cruickshanks KJ. Associations of performance-based and self-reported measures of visual function. The Beaver Dam Eye Study. Ophthalmic Epidemiol 1999;6:49-60.
Landis JR, Koch GG. The agreement of observer agreement for Categorical data. Biometrics 1977;33:159-74.
Lavery JR, Gibson JM, Shaw DE, Rosenthal AR. Vision and the visual acuity in an elderly population. Ophthalmic Physiol Opt 1988;8:390-3.
Lee BL, Gutierrez P, Gordon M, Wilson MR, Cioffi GA, Ritch R, Sherwood M, Mangione CM. The Glaucoma Symptom Scale. A brief index of glaucoma-specific symptoms. Arch Ophthalmol 1998;116:861-6.
Lindblad AS, Clemons TE. Responsiveness of the National Eye Institute Visual Function Questionnaire to progression to advanced age-related macular degeneration, vision loss, and lens opacity. Arch Ophthalmol 2005 ;123:1207-14.
Liu JH, Cheng CY, Chen SJ, Lee FL. Visual impairment in a Taiwanese population: prevalence, causes, and socioeconomic factors. Ophthalmic Epidemiol 2001;8:339-50.
Lukkarinen H, Hentinen M. Assessment of quality of life with the Nottingham Health Profile among patients with coronary heart disease. J Adv Nurs 1997;26:73-84.
Lundstrom M, Brege KG, Floren I, Lundh B, Stenevi U, Thorburn W. Cataract surgery and quality of life in patients with age related macular degeneration. Br J Ophthalmol 2002;86:1330-5.
Lundstrom M, Fregell G, Sjoblom A. Vision related daily life problems in patients waiting for a cataract extraction. Br J Ophthalmol 1994;78:608-11.
Mahoney FI, Barthel DW. Functional evaluation: The Barthel index. Maryland State Medical Journal 1965;14:61-5.
Mangione CM, BeORy S, Spritzer K, Janz NK, Klein R, Owsley C, Lee PP. Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire: results from focus groups with visually impaired persons. Arch Ophthalmol 1998;116:227-33.
Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD. National Eye Institute Visual Function Questionnaire Field Test Investigators: Development of the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). Arch Ophthalmol 2001;119:1050-8.
Mangione CM, Phillips RS, Seddon JM, Lawrence MG, Cook EF, Dailey R, Goldman L. Development of the 'Activities of Daily Vision Scale'. A measure of visual functional status. Med Care 1992;30:1111-26.
Mangione CM. Version 2000. The National Eye Institute 25-Item. Visual Function Questionnaire (VFQ-25). NEI VFQ-25 Scoring Algorithm – August 2000(cited 2005 June 26). Available from: URL: http://www.nei.nih.gov/resources/visionfunction/manual_cm2000.pdf
Massof RW, Rubin GS: Visual function assessment questionnaires. Surv Ophthalmol 2001;45:531-48.
McDowell I, Jenkinson C. Development standards for health measures. J Health Serv Res Policy 1996;1:238-46
Negrel AD, Minassian DC, Sayek F. Blindness and low vision in southeast Turkey. Ophthalmic Epidemiol 1996;3:127-34.
NEI. National Eye Health Education Program (NEHEP): Communication Plan: A Glaucoma Public Education Program. 1994. November (cited 2005 June 26).Available from: http://www.nei.nih.gov/nehep/plans/glaucplan.asp
Neugarten BL, Havighurst RJ, Tobin SS. The measurement of life satisfaction. J Gerontol 1961;16:134-43.
Nordmann JP, Auzanneau N, Ricard S, Berdeaux G. Vision related quality of life and topical glaucoma treatment side effects. Health Qual Life Outcomes 2003;1:75.
Pacheco-Cutillas M, Edgar DF, Sahraie A. Acquired colour vision defects in glaucoma—their detection and clinical significance. Br J Ophthalmol 1999;83:1396–402
Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-9.
Reidy A, Minassian DC, Vafidis G, Joseph J, FaORow S, Wu J, Desai P, Connolly A. Prevalence of serious eye disease and visual impairment in a north London population: population based, cross sectional study. BrMJ 1998;316:1643-6.
Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP. Global data on visual impairment in the year 2002. Bull World Health Organ 2004;82:844-51.
Rovner BW, Zisselman PM, Shmuely-Dulitzki Y. Depression and disability in older people with impaired vision: a follow-up study. J Am Geriatr Soc 1996;44:181-4.
Rowe S, MacLean CH, Shekelle PG .Preventing Visual Loss From Chronic Eye Disease in Primary Care. JAMA 2004;291:1487-95.
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.
Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32:705-14.
Skevington SM, Lotfy M, O'Connell KA; WHOQOL Group. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004;13:299-310.
Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, Legro MW, Diener-West M, Bass EB, Damiano AM, et al. National study of cataract surgery outcomes. Variation in 4-month postoperative outcomes as reflected in multiple outcome measures. Ophthalmology 1994;101:1131-40; discussion 1140-1.
Submacular Surgery Trials Research Group. Health- and vision-related quality of life among patients with ocular histoplasmosis or idiopathic choroidal neovascularization at enrollment in a randomized trial of submacular surgery: Submacular Surgery Trials Report No. 5. Arch Ophthalmol 2005;123:78-88.
Taylor HR, Keeffe JE, Vu HT, Wang JJ, Rochtchina E, Pezzullo ML, Mitchell P. Vision loss in Australia. Med J Aust 2005;182:565-8.
Taylor HR. Refractive Error. Eye Care for the Community. 2005 Oct 7 th (cited 2005 June 26). Available from: URL: http://iris.medoph.unimelb.edu.au /eyecarecommunity/refractive.html
Toprak AB, Eser E, Guler C, Baser FE, Mayali H. Cross-validation of the Turkish version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ 25). Ophthalmic Epidemiol 2005;12:259-69.
Tsai CY, Woung LC, Chou P, Yang CS, Sheu MM, Wu JR, Chuang TL, Tung TH. The current status of visual disability in the elderly population of Taiwan. Jpn J Ophthalmol 2005;49:166-72.
Tsai SY, Chi LY, Cheng CY, Hsu WM, Liu JH, Chou P. The impact of visual impairment and use of eye services on health-related quality of life among the elderly in Taiwan: the Shihpai Eye Study. Qual Life Res 2004;13:1415-24.
Uy HS, Munoz VM. Comparison of the potential acuity meter and pinhole tests in predicting postoperative visual acuity after cataract surgery. J Cataract Refract Surg. 2005;31:548-52.
van der Pols JC, Bates CJ, McGraw PV, Thompson JR, Reacher M, Prentice A, Finch S. Visual acuity measurements in a national sample of British elderly people. Br J Ophthalmol 2000;84:165-70.
Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992;30:473-83.
Ware JE Jr. Conceptualizing disease impact and treatment outcomes. Cancer 1984;53:2316-23.
Watt WS. How Visual Acuity Is Measured. 2004 Nov 7th (cited 2005 June 26).Available from: URL: http://www.mdsupport.org/library/acuity.html
WHO. Prevention of Blindness & Deafness, Geneva, 4-5 September 2003. 2005 May 3th (cited 2005 June 26). Available from: URL: http://whqlibdoc. who.int/hq/2003/WHO_PBL_03.91.pdf#search='Prevention%20of%20Blindness%20%26%20Deafness%2C%20Geneva%2C%2045%20September%202003.'
WHO. The World Health Organization Quality of Life Assessment (WHOQOL): development and general psychometric properties. Soc Sci Med 1998;46:1569-85.
WHO. VISION 2020 action plans to combat blindness. 2004a. Oct 22 th (cited 2005 June 26).Available from: URL: http://www.who.int/ncd/ vision2020_ actionplan/contents/2.1.htm
WHO. VISION 2020 slides.pdf. 2004b. Oct 14 th (cited 2005 June 26). Available from: URL: http://www.v2020.org/toolkit/documents/ VISION% 202020%20slides.PDF
Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 1995;273:59-65.
Wittenberg S. Pinhole eyewear systems: a special report. J Am Optom Assoc. 1993;64:112-6.
Wormald RP, Wright LA, Courtney P, Beaumont B, Haines AP. Visual problems in the elderly population and implications for services. BrMJ 1992;304:1226-9.
Xu L, Li J, Cui T, Hu A, Zheng Y, Li Y, Sun B, Ma B, Jonas JB. Visual acuity in northern China in an urban and rural population: the Beijing Eye Study. Br J Ophthalmol 2005;89:1089-93.
Zainal M, Ismail SM, Ropilah AR, Elias H, Arumugam G, Alias D, Fathilah J, Lim TO, Ding LM, Goh PP. Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996. Br J Ophthalmol 2002;86:951-6.
|
|---|
