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Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 51-53

Prospective clinical study to find out epidemiology of presbyopia in a prepresbyopic population (age group 34–40 years)

1 Department of Ophthalmology, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
2 Regional Institute of Ophthalmology, IGIMS, Patna, Bihar, India

Date of Submission06-Jun-2018
Date of Acceptance21-Jun-2018
Date of Web Publication21-Aug-2019

Correspondence Address:
Deepak Mishra
Assistant Professor, Department of Ophthalmology, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcor.jcor_53_18

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Background: Several studies have been carried out regarding the epidemiology of presbyopia at or after 40 years of age. Now a day we find the need of presbyopic glasses before the age of 40 years, so we plan this study in pre-presbyopic age group. Aim: To find out epidemiology of presbyopia in a pre-presbyopic age group (age 34-40 years). Settings and Design: A prospective clinical study was done on two thousand two hundred and ninety-six patients at two tertiary care centres in India. Duration of study was three years and eight months. Materials and Methods: The degree of presbyopia was determined as minimum amount of plus lens needed to achieve maximum improvement in lines read to the end point (N8). Patients were divided in 3 groups, group 1 (age 34-36), group 2 (age 36-38) and in group 3 (age 38-<40). A detailed epidemiological profile and systemic history were noted in the prescribed Performa. Statistical Analysis Used: Data was analyzed by SPSS software 16. Results: Maximum (43.7%) number of patients was in group 3.In the study females predominated over males and maximum (51.9%) patients were from middle socioeconomic status. We found that 53.6 % were from urban area. 39.6 % patients had accepted that near vision problem affected their daily work efficiency and quality of life. Conclusion: This study shows occurrence of presbyopia in pre-presbyopic age group. So we recommend patients should be screened and treated before the age of 40 years for presbyopia to reduce burden of avoidable visual impairments and for improvement in quality of life.

Keywords: Epidemiology, North India, premature presbyopia

How to cite this article:
Mishra D, Bhushan P, Singh M K, Makkar B, Sinha B P, Bhaskar G. Prospective clinical study to find out epidemiology of presbyopia in a prepresbyopic population (age group 34–40 years). J Clin Ophthalmol Res 2019;7:51-3

How to cite this URL:
Mishra D, Bhushan P, Singh M K, Makkar B, Sinha B P, Bhaskar G. Prospective clinical study to find out epidemiology of presbyopia in a prepresbyopic population (age group 34–40 years). J Clin Ophthalmol Res [serial online] 2019 [cited 2022 Jul 1];7:51-3. Available from: https://www.jcor.in/text.asp?2019/7/2/51/264893

Presbyopia is the decline in accommodation that diminishes the ability of the eye to focus on near objects secondary to aging.[1] Usually, this process becomes perceptible beyond 40 years of age. Multiple theories have been proposed to explain the pathophysiology of presbyopia. Some common ones are changes in the shape, size, and mechanical characteristics of the lens as well as the function of the ciliary muscle.[2],[3] Presbyopia affects a large number of people and is easily treated by spectacles. It is known that premature presbyopia can be a result of associated refractive errors, systemic conditions like anemia, cardiovascular diseases, myasthenia, multiple sclerosis, and several other causes. Some other causes such as inadvertent use of alcohol, antidepressants, antihistamines, and antispasmodics also exist.[4] Few ocular diseases such as glaucoma or trauma, removal or damage to lens, zonules, or ciliary muscle, and laser photocoagulation of retina may also lead to early presbyopia.[1],[4],[5],[6] These have been studied in Western countries. Studies in the Indian subcontinent are lacking; this study is an attempt to estimate the epidemiological trends of premature presbyopia in Northern India.

  Material and Methods Top

It was a multicenter prospective clinical study done at two tertiary care centers of North India. The study was approved by the Institutional Ethics Committee and written consent was obtained before enrolment in the study group. Sample size was calculated by the WHO formula given by Lwanga and Lemeshow[7] keeping confidence interval 95%, the duration of the study was 48 months. Comprehensive ocular examinations were performed of by two ophthalmologists out of whom one worked at both tertiary center and trained optometrists of 10-year experience. Each center had its own set of optometrists.

Ocular examinations included measurement of distance and near visual acuity and best-corrected visual acuity. The optometrists performed objective refraction with a streak retinoscope and further refined it with subjective refraction. The ocular examinations including assessment of pupillary reaction, slit-lamp biomicroscopy for anterior segment abnormalities, measurement of intraocular pressures with a Goldman applanation tonometer, central corneal thickness, and gonioscopy for angles of the anterior chamber were done by the ophthalmologists. Slit-lamp biomicroscopy with 90D lens was done to rule out any abnormality in the fundus. Blood hemoglobin examination was done to all patients having near vision problem in the selected age group.

Inclusion criteria

Patients in the age group of 34 to <40 years were sent for refraction to the optometrists and those who required only plus lenses for presbyopia were included without any other accompanying refractive error. It was natural to expect such a correction to be less than what is expected from a normal presbyopic of 40 and above age group, the minimal plus lens that was required to provide clear near vision to such a patient was to be recorded.[8]

Exclusion criteria

Patients having ocular disorders such as glaucoma, uveitis, lental sclerosis (lens opacification classification was used for grading), patients with diabetes, pregnancy, or on drugs such as aspirin and sulfonamides which are known to affect ciliary spasm.

Patients were divided into three groups, Group 1 (age 34 to <36), Group 2 (age 36 to <38), and in group 3 (age 38 to <40). A detailed epidemiological profile such as age, gender, caste, locality (rural/urban), education, monthly family income, occupation, type of house, duration of near work, questionnaire about near vision problem, and last refraction/doctors visit and systemic history were noted in the prescribed pro forma. Verification of age of patients was done by date of birth, age of the first child, age of marriage, etc. Modified BG Prasad classification was used for classification of socioeconomic status. In the statistical data/presentation, lower- and upper-middle class were combined in a single group as middle, similarly lower- and upper-lower class were into lower class. Data were analyzed by SPSS software version 16 IBM.

  Results Top

Total number of patients visited to both centers' outpatient department during the study duration were 3,08,960. A total of 2800 patients were fulfilled the inclusion and exclusion criteria, but only 2296 patients were enrolled in the study after giving their written consent and fulfilling the inclusion and exclusion criteria's. A total of 1102 (i.e., 48%) were from one center and the rest 1194 patients (i.e., 52%) were from other center. Prevalence of presbyopia in prepresbyopic age group was = 0.74%. It was observed that maximum number of patients (n = 1004, 43.7%) belonged to the age group 3 followed by group 2 (n = 786, 34.2%) and group 1 (n = 506, 22%). The gender-wise distribution showed that female's patients (n = 1309, 57%) were more than males (n = 987, 43%). Females were higher in numbers in group 1 and 2, whereas males were more in group 3. Nearly half of the cases (n = 1100, 47.9%) were from middle socioeconomic status followed by 30.7% (n = 704) from low and 21.4% (n = 491) from higher socioeconomic status. About 53.6% (n = 1230) of patients were from urban and 46.4% (n = 1065) from rural areas. Total number patients having refractive error were 53964. Prevalence of total patients refracted was 17.5%. Within the 6-month duration, 905 (39.4%) were consulted for eye checkup previously for glasses prescriptions and it was given by ophthalmologist and optometrist. About 18.2% (n = 418) of patients were using spectacles for presbyopia, whereas 21.2% (n = 487) had used spectacles but were not currently using them. About 41% (n = 941) patients having presbyopia were doing near work job in his/her daily life >6 h. The mean power correction showed a linear correlation with increasing age of the patients [Figure 1]. Males were found to have significantly (P = 0.03) better acceptance of spectacles than female in all groups. Common reason for not wearing glass was don't need it despite having reading problems (n = 895, 39%) and cosmetic problem (n = 620, 27%) followed by forgot to bring spectacles with them to their workplace [Figure 2]. About 39.6% (n = 909) patients had accepted that near vision problem affected their daily work efficiency and quality of life [Figure 3]. About 18.6% (n = 427) patients of presbyopia had hemoglobin level <11 mg/dl.

  Discussion Top

The prevalence of presbyopia in a population-based study was found to be 62%, with prevalence increasing with age.[8] In a study in Southern India, the prevalence of presbyopia was 55% in people aged 30 years and older whereas Duarte et al.[9] in Brazil estimated the prevalence of presbyopia in 3000 adults of 30 years. Similar to our study, age-adjusted data showed the higher prevalence among women than men.[10] Our study reported a female preponderance as there were 57% female patients and 43% male patients, but Bernice and Soetan reported that males had higher degrees of early presbyopic errors than females which is contrary to our study.[11] Our study had a female preponderance perhaps as the females bear more stresses in our society as compared to males including multiparity, child raising, anemia, and other household stresses. Weale has also reported a female preponderance in his study.[1]

We found that patients were doing near work job in his/her daily life >6 h and from the urban area were more prone to presbyopia. Similarly, Kamali et al. found that secondary education and residence in town (as opposed to a village) were also significantly associated with a higher prevalence of presbyopia.[12]
Figure 1: Mean dioptric power in different groups

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Figure 2: Reasons for not wearing spectacles

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Figure 3: Effect of presbyopia on daily work and quality of life

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About 18.6% patients of presbyopia had hemoglobin level <11 mg/dl. Anemia and poor nutritional status are also associated with early onset of presbyopia. Gary L has also reported an association between poor nutrition and early onset of presbyopia.[13]

The association of presbyopia and hemoglobin values is also shown in a study done in Ghana. This study indirectly explained that presbyopia is more common in multiparous and anemic patients.[14]

Since near vision was needed for the study, farmer, cooking food, and many more daily life activity and professional work, so it affects the quality of life and economy. A previous study showed that presbyopia was associated with substantial negative effects on health-related quality of life in a US population.[15] Major limitations of our study are that we identify the age of the patients by indirect methods or memory based by asking their ages, age of first children, age at time of marriage, etc., and patients with refractive error but requiring additional number for reading were not included in the study.

  Conclusion Top

Prevalence of presbyopia is much higher than reported worldwide. This study shows 0.7% prevalence of presbyopia in prepresbyopic age group. Hence, we recommend patients should be screened before the age of 40 years to reduce burden of avoidable visual impairments, improve the quality of life, and economy of patients.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Weale RA. Epidemiology of refractive errors and presbyopia. Surv Ophthalmol 2003;48:515-43.  Back to cited text no. 1
Schachar RA. The mechanism of accommodation and presbyopia. Int Ophthalmol Clin 2006;46:39-61.  Back to cited text no. 2
Charman WN. The eye in focus: Accommodation and presbyopia. Clin Exp Optom 2008;91:207-25.  Back to cited text no. 3
Werner DL, Press JL. Clinical Pearls in Refractive Care. Boston: Butterworth Heinemann; 2002. p. 145.  Back to cited text no. 4
Jain IS, Ram J, Gupta A. Early onset of presbyopia. Am J Optom Physiol Opt 1982;59:1002-4.  Back to cited text no. 5
Pointer JS. The presbyopic add. III. Influence of the distance refractive type. Ophthalmic Physiol Opt 1995;15:249-53.  Back to cited text no. 6
Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1991.  Back to cited text no. 7
Burke AG, Patel I, Munoz B, Kayongoya A, McHiwa W, Schwarzwalder AW, et al. Population-based study of presbyopia in rural Tanzania. Ophthalmology 2006;113:723-7.  Back to cited text no. 8
Duarte WR, Barros AJ, Dias-da-Costa JS, Cattan JM. Prevalence of near vision deficiency and related factors: A population-based study. Cad Saude Publica 2003;19:551-9.  Back to cited text no. 9
Nirmalan PK, Krishnaiah S, Shamanna BR, Rao GN, Thomas R. A population-based assessment of presbyopia in the state of Andhra Pradesh, South India: The Andhra Pradesh eye disease study. Invest Ophthalmol Vis Sci 2006;47:2324-8.  Back to cited text no. 10
Bernice O, Soetan O. Emmanuel risk factors for early presbyopia in Nigerians. Niger J Surg Sci 2006;16:7-11.  Back to cited text no. 11
Kamali A, Whitworth JA, Ruberantwari A, Mulwanyi F, Acakara M, Dolin P, et al. Causes and prevalence of non-vision impairing ocular conditions among a rural adult population in SW Uganda. Ophthalmic Epidemiol 1999;6:41-8.  Back to cited text no. 12
Gary L. Care of the patient with presbyopia. Optom Clin Pract Guidel 2006;1:3-5.  Back to cited text no. 13
Morny FK. Correlation between presbyopia, age and number of births of mothers in the Kumasi area of Ghana. Ophthalmic Physiol Opt 1995;15:463-6.  Back to cited text no. 14
McDonnell PJ, Lee P, Spritzer K, Lindblad AS, Hays RD. Associations of presbyopia with vision-targeted health-related quality of life. Arch Ophthalmol 2003;121:1577-81.  Back to cited text no. 15


  [Figure 1], [Figure 2], [Figure 3]

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