Hindawi
Journal of Ophthalmology
Volume 2019, Article ID 1717464, 10 pages
https://doi.org/10.1155/2019/1717464
Research Article
Prevalence, Causes, and Factors Associated with Visual
ImpairmentandBlindnessamongRegisteredPensioners inGhana
Benjamin D. Nuertey ,1,2 Kwesi Nyan Amissah-Arthur,3 Joyce Addai,4 Victor Adongo,1
Augustine D. Nuertey,5 Clement Kabutey,6 Isaac Asimadu Mensah,1
and Richard Bekoe Biritwum2
1Tamale Teaching Hospital, Tamale P. O. Box TL 16, Tamale, Ghana
2Community Health Department, School of Public Health, University of Ghana, Korle-Bu, Ghana
3Ophthalmology Unit, Department of Surgery, Korle Bu Teaching Hospital, College of Health Sciences,
School of Medicine and Dentistry, University of Ghana, Accra, Ghana
4Korle-Bu Teaching Hospital, Korle-Bu, Ghana
5St Francis Xavier Hospital, Assin Fosu, Ghana
6Nursing and Midwifery Training College, Koforidua, Ghana
Correspondence should be addressed to Benjamin D. Nuertey; ben.nuertey@gmail.com
Received 13 May 2019; Accepted 9 September 2019; Published 7 October 2019
Academic Editor: Takayuki Baba
Copyright © 2019 Benjamin D. Nuertey et al. *is is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Purpose. To determine the prevalence, causes, and factors associated with presenting visual impairment and blindness among
pensioners. Design. A nationwide cross-sectional study. *is study was part of the analysis on data obtained in the pensioners’
medical survey conducted among members of the National Pensioners Association in Ghana. Method. (i) Setting: it was a
multicenter study involving thirteen centers throughout Ghana with a center in each regional capital. (ii) Study population: the
study involved 4813 pensioners. (iii) Observation procedures: data were captured through the use of questionnaires, physical
examinations including eye examinations, and urine and blood sample analysis. (iv) Main outcome measure: presenting visual
impairment and blindness (as defined by the WHO ICD-10 classification). Results. *e overall prevalence of blindness among
pensioners in Ghana was 3.8% (95% CI� 3.2–4.4), while the prevalence of moderate and severe visual impairment was 21.7% (95%
CI� 20.5–23.0). *e prevalence of blindness was lowest in the 60–65-year-old age group (2.1% (95% CI� 1.3–2.8)) and highest in
the above 80-year-old age group (12.2% (95% CI� 6.6–17.8)). Cataract was the leading cause of blindness (62.4%) and moderate
and severe visual impairment (55.7%). Factors significantly associated with blindness and visual impairment include educational
status, vegetarianism, arthritis, and having proteins in urine. Conclusion. *ere is a high prevalence of visual impairment and
blindness among the pensioners in Ghana. Sadly, the greatest cause was cataract, which is correctable. Increase in formal
education status will be important in the prevention of blindness and visual impairment.
1. Introduction years and above, the global prevalence of blindness was
estimated at 1.9% with moderate and severe vision im-
Visual impairment due to any cause is a major cause of pairment (MSVI, <6/18–3/60) estimated at 10.4%with about
significant morbidity, and it affects many globally [1]. In the 31 million of global 36 million blind people within this age
year 2010, it was estimated that 285 million people were group [4, 5]. However, with the introduction of the global
visually impaired worldwide, of which 39 million were blind initiative to eliminate avoidable blindness (vision 2020: the
and 246 million had low vision [2]. It was estimated that, right to sight), many agree that the initiative is in the right
without intervention, the prevalence of blindness might direction to reduce the prevalence of avoidable blindness
reach 76 million by the year 2020 [3]. In the elderly, aged 50 [6, 7]. In theWHOAfrica region, the prevalence of blindness
2 Journal of Ophthalmology
in the year 2010 was estimated as 7300 per million of which However, participants from nearby rural areas of each of the
81.7% was among those aged 50 years and above [2, 8]. In study sites also took part in the study. All the studies took
Ghana, the World Health Organization (WHO) Study on place in thirteen sites across the country Ghana, with at least
global AGEing and adult health (SAGE) wave one which was one site per the ten regions of Ghana.
conducted between 2007 and 2010, estimated the prevalence
of low vision among adults 50 years or more to be 12.9% [9].
However, population-based studies in sections of the 2.3. Study Population and Eligibility Criteria. *e study
country among those aged 40 years and over had reported subjects were pensioners, and the majority of the pensioners
blindness prevalence ranging from 1.2% to 4.4%, with one were qualified as elderly as defined by the United Nations
study reporting a visual impairment prevalence of 17.1% classification of 60 years and above [19]. *ere were some
[10, 11]. *e current findings from the Ghana blindness and participants below 60 years who retired before the man-
visual impairment study 2015 show that 19.12% of those datory retirement age of 60 years due to disability and other
aged 80 and above are blind [12]. reasons thereby, qualifying as pensioner. All pensioners who
*ere were varied underlying causes of visual impair- were members of the National Pensioners Association were
ment and blindness. It was estimated in the year 2010 that eligible as participants of the study. Within the study period,
about 65% of blindness and 76% of the people with mod- 4813 members of the National Pensioners Association
erate/severe visual impairment worldwide were from pre- presented for the medical screening.*e participant must be
ventable causes [13]. Recent studies reported cataract as the a member of the National Pensioners Association and must
leading cause of blindness worldwide [14–16]. *e leading be a resident in Ghana.
cause of visual impairment, however, was uncorrected re-
fractive error [1, 2]. Regardless of its cause, visual impair- 2.4. Sample Size and Sampling Method. *e aim was to
ment or blindness was associated with reduced quality of life screen all the members of the National Pensioners Asso-
[17]. ciation within and around the study sites.*e estimated total
*e aim of this study was to determine the current number of eligible pensioners in and around the study sites
prevalence, causes, and factors associated with visual im- was about 5000. Of these 4813 pensioners took part in the
pairment and blindness among pensioners in Ghana. *is study.
study used the current WHO ICD 10th revision recom-
mendation of presenting visual acuity in the best eye to
classify study participants. *e study reported on the 2.5. Definitions and Eye Examinations. *e Snellen chart in
prevalence, causes, and factors associated with blindness and standard good illumination was used at a distance of sixmeters
visual impairment. to measure the visual acuity. *e tumbling “E” chart was usedin instances that the pensioner had no formal education. Mild
or no visual impairment was defined in this study as pre-
2. Method senting distance visual acuity in the better eye equal to or better
than 6/18 (20/70, 3/10, 0.3), which was consistent with the
2.1. Study Design. A cross-sectional study was conducted WHO ICD-10 category zero. Moderate visual impairment was
with study participants from all ten regions of Ghana. defined as presenting distance visual acuity in the better eye
Members of the National Pensioners Association (NPA) worse than 6/18 but better or equal to 6/60 (20/200, 1/10, 0.1)
took part in the survey. It involved questionnaire interviews corresponding to category 1 of the ICD-10H54 categorization.
and physical examinations as well as laboratory examina- Severe visual impairment was defined in the study as pre-
tions of urine and blood samples collected from study senting distance visual acuity in the better eye worse than 6/60
participants. *e survey was conducted as part of a regis- but better or equal to 3/60 (20/400, 1/20, 0.05) corresponding
tration exercise for all members of the National Pensioners to category 2 of the WHO ICD-10 H54 categorization.
Association for the start of a Pensions Medical Scheme Moderate visual impairment and severe visual impairment
(PMS) [18]. *e scheme was aimed as a top-up health in- were put together in the final analysis of this study and termed
surance scheme for the members of the National Pensioners moderate and severe visual impairment (MSVI).
Association. It is suggested that the medical scheme would Blindness corresponding to category 3, 4, and 5 in the
finance health care expenses of members of the National ICD-10 H54 categorization was put together in this study
Pensioners Association in instances where the health care and termed blindness. Blindness was therefore defined as
claim is outside the coverage of the National Health In- presenting distance visual acuity worse than 3/60. Addi-
surance Scheme (NHIS). It was a nationwide exercise that tionally, examination of the anterior and posterior segments
took place from April to December 2014. Members of the using a direct ophthalmoscope was performed. For other
National Pensioners Association converged at the regis- causes of visual impairment and blindness, we used the
tration/medical screening centers within the days of the definitions from the 10th revision of International Statistical
screening. Classification of Diseases, injuries, and causes of death (ICD-
10).
2.2. Study Sites. *e study took place in thirteen sites of
which ten were in the regional capitals of the ten regions of 2.6. Study Materials and Data Capture Tool. Study ques-
Ghana, West Africa. *e study settings were mainly urban. tionnaires recorded sociodemographic data of participants.
Journal of Ophthalmology 3
*e past medical history of participants was collected. As *e board further monitored each step of the data col-
was information on allergies, alcohol consumption, smok- lection process. *e content of the medical screening ex-
ing, exercise, and diet. *ere was a physical examination ercise was developed in extensive consultation with the
form attached, which was used to capture data of the executives of the National Pensioners Association. *e
physical examination conducted by medical officers. Weight study followed the tenets of the Declaration of Helsinki.
was measured with a weighing scale and height with a Consent was voluntary, and each study participant had the
stadiometer. Blood pressure was measured using a stan- right to withdraw at any stage of the study process. Ut-
dardized and validated electronic sphygmomanometer with termost privacy and confidentiality were maintained. No
appropriate cuff sizes. Visual acuity was checked using a compensation or payments were made to any study par-
Snellen chart and the tumbling “E” chart. Blood sample was ticipants. *e results of the physical examination were
taken, and a glucometer was used to measure the random carefully explained to all participants and were counselled
blood sugar. Blood sample was collected into a serum on healthy lifestyle in old age. Personalized results of the
separator bottle and transported to a laboratory for mea- study were sent to each participant in a sealed envelope to
surement of serum cholesterol using automated and stan- be given to his or her physician for further explanation.
dardized techniques. Data files were password protected. Hard copy data were
stored in locked file cabinets, and access was limited to the
principal investigator.
2.7. Data Collection. Trained research assistants filled the
questionnaire based on the response of the study partici-
pants. *e weight was measured to the nearest one-kilo- 3. Results
gram, while the height to the nearest one-millimeter.
Random blood sugar was measured using a glucometer. 3.1. Background Characteristics of the Study Participants.
Medical officers perform physical examination, while the eye Table 1 displays the background characteristics of the study
team checked the vision and carried out the comprehensive participants. Sixty-nine percent of the study participants
eye examinations. Personalized reports of the medical were males, while 31% were females. *e median age of the
screening were sent to each participant. study participants was 66 (interquartile range� 7) years.
2.8. Data Processing and Analysis. *e data generated in the 3.2. Prevalence of Presenting Blindness and Presenting Visual
research were entered into EPIDATA 3.1 and exported into ImpairmentamongPensioners inGhana. Table 2 displays the
STATA/MP 11.0 (copyright 2004–2009) for analysis. *e prevalence of moderate and severe visual impairment
primary outcome in the study was presenting visual im- (MSVI) and the prevalence of blindness among study
pairment and blindness. With regard to social class, the participants. *e overall prevalence of blindness among
participants’ previous occupation was classified under var- pensioners in Ghana was 3.8% (95% CI� 3.2–4.4), while the
ious social class headings according to the Registrar Gen- prevalence of moderate to severe visual impairment was
eral’s occupational classification of England and Wales [20]. 21.7% (95% CI� 20.5–23.0). *us, overall 256 per 1000
*e background characteristics of the respondents were pensioners were either blind or visually impaired. *e
obtained by cross tabulation. Causes of the visual impair- prevalence of blindness and visual impairment was worse in
ment and blindness were tabulated based on the findings of males. *us, 22.6% (95% CI� 21.1–24.1) of the males were
the comprehensive eye exam. Causes with smaller fre- moderately and severely visually impaired (MSVI), whereas
quencies and in instances with indeterminate causes were 19.7% (95% CI� 17.6–21.8) of the females were MSVI.
grouped together and termed “others.” Logistic regression Similarly, 4.5% (95% CI� 3.8–5.2) of the males were blind
was used to analyze the factors associated with blindness and compared with 2.4% (95% CI� 1.5–3.2) among the females.
visual impairment. First, the association between each of the Generally, there was an increasing prevalence of
potential factors and visual impairment/blindness was ex- blindness and moderate and severe visual impairment with
amined ignoring other variables.*is analysis was important increasing age.*e prevalence of blindness was lowest in the
because it gave a fair idea as to which of the variables were below 65-year-old age group, thus 2.1% (95% CI� 1.3–2.8)
strong predictors/related to visual impairment/blindness. and highest in the above 80-year-old group (12.2% (95%
Second, to construct a model with factors that were in- CI� 6.6–17.8)). Similarly, the prevalence of moderate and
dependently associated with visual impairment/blindness, severe visual impairment (15.2% (95% CI� 12.4–17.0)) was
and each of the independent variable was a candidate lowest in the below 65-years age group and highest in the 80
provided that the P value was 0.05 or less. A P value of 0.05 years and above group (39.7% (95% CI� 31.3–48.1)). *e
or less was considered statistically significant. With regards prevalence of pensioners in Ghana who were either blind or
to the causes of moderate and severe visual impairment or MSVI was 173 per 1000 in the below 65-years age group, and
blindness, multiple response analysis was carried out to rank it increased with increasing age to as high as 519 per 1000 in
the causes, and the results were tabulated as such. the 80 years and above group. *e prevalence of blindness
and MSVI generally decreases with increasing highest ed-
ucational status. Pensioners who had no formal education
2.9. Ethical Considerations. Review and approval was ob- had the highest prevalence of blindness and MSVI among
tained from the National Pensioners Association board. the study participants.
4 Journal of Ophthalmology
Table 1: Background characteristics of study participants.
Proportion by sex
Participant characteristics Female n (%) Male n (%) All participants N (column %)
All participants 1,482 (31.0) 3,300 (69.0) 4,782 (100)
Age in years
60–65 704 (50.5) 960 (31.4) 1,664 (37.3)
66–69 461 (33.1) 1,056 (34.5) 1,517 (34.0)
70–74 166 (11.9) 627 (20.5) 793 (17.8)
75–79 50 (3.6) 295 (9.7) 345 (7.7)
≥80 14 (1.0) 123 (4.0) 137 (3.1)
Current marital status
Never married 36 (2.6) 40 (1.3) 76 (1.7)
Married 556 (40.3) 2,679 (88.0) 3,235 (73.1)
Widow/widower 511 (37.1) 200 (6.6) 711 (16.1)
Divorced 157 (11.4) 63 (2.1) 220 (5.0)
Separated 119 (8.6) 62 (2.0) 181 (4.1)
Body mass index (by WHO BMI
cutoff/classification)
Underweight 34 (2.4) 232 (7.6) 266 (6.0)
Normal 393 (28.0) 1,743 (56.8) 2,136 (47.8)
Overweight 492 (35.1) 848 (27.6) 1,340 (30.0)
Obese 483 (34.5) 246 (8.0) 729 (16.3)
Highest formal educational status
None 70 (5.4) 423 (15.1) 493 (12.0)
Primary 517 (39.7) 1,116 (39.9) 1,633 (39.4)
Secondary 195 (15.0) 434 (15.5) 629 (15.4)
Tertiary 452 (34.7) 724 (25.9) 1,176 (28.7)
Vocational 68 (5.2) 100 (3.6) 168 (4.1)
Known diabetic status
Not a diabetic 1,167 (86.0) 2,745 (91.4) 3,910 (89.7)
Known diabetic 190 (14.0) 258 (8.6) 448 (10.3)
Known hypertension status
Not a hypertensive 531 (38.3) 1,785 (58.6) 2,316 (52.2)
Known hypertensive 857 (61.7) 1,262 (41.4) 2,119 (47.8)
*e prevalence of MSVI and blindness among pen- other causes of MSVI were retinal diseases (4.1%), age-re-
sioners without any formal education was 31.7% (95% lated macular degeneration (3.1%), cornea opacities (1.5%),
CI� 27.5–35.9) and 7.5% (95% CI� 5.1–9.9), respectively. optic nerve-related causes (1.1%), and other causes ac-
*e prevalence of MSVI and blindness among pensioners counting for 3.0%.
with tertiary education as highest educational status was
16.5% (95% CI� 14.3–18.7) and 2.8% (95% CI� 1.9–3.8), 3.4. Causes of Presenting Blindness among Pensioners in
respectively. Ghana. Table 4 displays the causes of blindness among
Table 3 displays the age and sex specific prevalence of pensioners in Ghana. Uncorrected cataract accounted for
blindness and MSVI among the study participants. *e more than half of all the causes of blindness among the
prevalence of blindness in the males was higher than that pensioners. 62.4% of the presenting blindness was attrib-
among the female pensioners across the various age groups. utable to cataract. *e second most common cause of
*e prevalence of blindness among male pensioners aged blindness among pensioners in Ghana was glaucoma ac-
less than 65 years was 2.8 (95% CI� 1.7–3.9), whereas the counting for 12.9%. Retinal diseases followed with 4.8%.
prevalence among female pensioners for the same age group Age-related macular degeneration (3.2%), cornea opacities
was 1.1 (95% CI� 0.3–1.8). (2.7%), phthisis bulbi (2.7%), optic nerve related (2.2%), and
others accounting for 9.1%.
3.3. Causes of Presenting Moderate and Severe Visual Im-
pairment (MSVI). Table 4 displays the results of a multiple 3.5. Combined Causes of Presenting Visual Impairment and
response analysis of the causes of moderate to severe visual Blindness among Pensioners in Ghana. *e leading cause of
impairment. *e leading cause of MSVI was cataract. It visual impairment classified as MSVI and blindness put
accounted for about 55.7% of all the causes of MSVI. *is together was cataract accounting for 52.3%. Refractive error
was followed by refractive error accounting for 22.9%. (19.4%) and glaucoma (9.2%) also formed part of the top
Glaucoma was ranked the third highest cause of presenting three causes of combined MSVI and blindness among the
MSVI among the pensioners accounting for 8.6% of all the pensioners in Ghana. *e other causes of the combined
causes of MSVI. Cataract surgery was fairly common. *e MSVI and blindness included retinal diseases (4.2%), cornea
Journal of Ophthalmology 5
Table 2: Prevalence of presenting blindness and visual impairment among pensioners in Ghana.
Mild or no visual impairment Moderate to severe visualimpairment Blindness
n (%) 95% CI n (%) 95% CI n (%) 95% CI
Overall 3,300 (74.4) 73.1–75.7 964 (21.7) 20.5–23.0 170 (3.8) 3.2–4.4
Sex
Male 2,236 (72.9) 71.3–74.5 693 (22.6) 21.1–24.1 138 (4.5) 3.8–5.2
Female 1,062 (80.0) 75.8–80.2 268 (19.7) 17.6–21.8 32 (2.4) 1.5–3.2
Age (years)
<65 1,323 (82.7) 80.1–84.6 243 (15.2) 12.4–17.0 33 (2.1) 1.3–2.8
65–69 1,153 (78.2) 76.1–80.3 283 (19.2) 17.2–21.2 39 (2.64) 1.8–3.4
70–74 507 (66.1) 62.7–69.5 218 (28.4) 25.2–31.6 42 (2.5) 3.9–7.1
75–79 182 (54.8) 49.5–60.2 118 (35.5) 30.4–40.7 32 (9.6) 6.5–12.8
≥80 63 (48.1) 39.5–56.7 52 (39.7) 31.3–48.1 16 (12.2) 6.6–17.8
Highest formal
educational status
None 291 (60.8) 56.3–65.1 152 (31.7) 27.5–35.9 36 (7.5) 5.1–9.9
Primary 1,180 (74.8) 72.7–80.0 342 (21.7) 19.7–23.7 55 (3.5) 2.6–4.4
Secondary 466 (76.5) 73.1–79.9 123 (20.2) 17.0–23.4 20 (3.3) 1.9–4.7
Tertiary 915 (80.7) 78.4–83.0 187 (16.5) 14.3–18.7 32 (2.8) 1.9–3.8
Vocational 129 (80.6) 74.5–86.8 29 (18.1) 12.1–24.1 2 (1.3) 0.5–3.0
Body mass index WHO
classification
Underweight 152 (60.6) 54.5–44.4 86 (34.3) 28.4–40.2 13 (5.2) 2.4–7.9
Normal 1,493 (71.7) 69.7–73.6 491 (23.6) 21.8–25.4 99 (4.7) 3.8–5.7
Overweight 1,023 (78.7) 76.5–80.9 243 (18.7) 16.6–20.8 34 (2.6) 1.7–3.5
Obese 558 (79.8) 76.9–82.8 122 (17.5) 14.6–20.3 19 (2.7) 1.5–3.9
Current smoking status
Nonsmoker 3,008 (80.0) 73.6–76.3 853 (21.3) 20.0–22.5 151 (3.8) 3.2–4.4
Smoker 66 (69.6) 60.2–78.8 23 (24.2) 15.5–32.9 6 (6.3) 1.4–11.2
Known diabetic status
Nondiabetic 2,826 (74.8) 73.4–76.2 808 (21.4) 20.1–22.7 144 (3.8) 3.2–4.4
Diabetic 330 (76.4) 72.3–80.4 83 (19.2) 15.5–22.9 19 (4.4) 2.5–6.3
Region of residence
Central 97 (58.1) 50.6–65.6 55 (32.9) 25.8–40.0 15 (9.0) 4.6–13.3
Upper West 218 (66.9) 61.8–72.0 82 (25.2) 20.4–29.9 26 (8.0) 5.0–10.9
Ashanti 937 (85.1) 83.0–87.2 123 (11.2) 9.3–13.0 41 (3.7) 2.6–4.8
Northern 218 (66.7) 61.5–71.8 87 (26.6) 21.8–31.4 22 (6.7) 4.0–9.4
Upper East 156 (59.1) 53.1–65.0 96 (36.4) 30.5–42.2 12 (4.6) 2.0–7.1
Brong-Ahafo 210 (75.8) 70.8–80.9 55 (19.9) 15.1–24.6 12 (4.3) 1.9–6.7
Western 415 (64.6) 60.9–68.3 208 (32.4) 28.7–36.0 19 (3.0) 1.6–4.3
Volta 346 (71.8) 67.8–75.8 126 (26.1) 22.2–30.1 10 (2.1) 0.8–3.3
Eastern 345 (87.6) 84.2–90.8 41 (10.4) 7.4–13.4 8 (2.0) 0.6–3.4
Greater Accra 313 (82.6) 78.8–86.4 62 (16.4) 12.6–20.0 4 (1.1) 0.03–2.0
Table 3: Age and sex specific prevalence of blindness and visual impairment among pensioners in Ghana.
Mild or no visual impairment Moderate to severe visual Blindness
Sex stratified by age impairment
n (%) 95% CI n (%) 95% CI n (%) 95% CI
Males stratified by age
in years
<65 758 (81.5) 79.0–84.0 146 (15.7) 13.4–18.0 26 (2.8) 1.7–3.9
65–69 807 (78.6) 76.0–81.1 191 (18.6) 16.2–21.0 29 (2.8) 1.8–3.8
70–74 407 (66.3) 62.5–70.0 174 (28.3) 24.8–31.9 33 (5.4) 3.6–7.2
75–79 156 (54.7) 48.9–60.5 99 (34.7) 29.2–40.3 30 (10.5) 7.0–14.1
≥80 59 (50.0) 40.9–59.1 46 (40.0) 30.1–47.8 13 (11.0) 5.3–16.7
Females stratified by age
in years
<65 565 (84.5) 81.7–87.2 97 (14.5) 11.8–17.2 7 (1.1) 0.3–1.8
65–69 345 (77.4) 73.4–81.2 91 (20.4) 16.7–24.2 10 (2.2) 0.9–3.6
70–74 100 (65.4) 57.8–72.9 44 (28.8) 21.6–36.0 9 (5.9) 2.1–9.6
75–79 26 (55.3) 40.9–69.7 19 (40.4) 26.2–54.6 2 (4.3) 1.6–10.1
≥80 4 (30.7) 4.6–56.9 6 (46.2) 17.9–74.4 3 (23.1) 0.7–46.9
6 Journal of Ophthalmology
Table 4: Causes of presenting moderate and severe visual impairment (MSVI) and presenting blindness among pensioners in Ghana.
Visual impairment among pensioners Presenting blindness
Rank
Causes N (%) Causes N (%)
1 Cataract 579 (55.7) Cataract 116 (62.4)
2 Refractive errors 238 (22.9) Glaucoma 24 (12.9)
3 Glaucoma 89 (8.6) Retinal disease 9 (4.8)
4 Retinal disease 43 (4.1) Age-related macular degeneration 6 (3.2)
5 Age-related macular degeneration 32 (3.1) Cornea opacities 5 (2.7)
6 Cornea opacities 16 (1.5) Phthisis bulbi 5 (2.7)
7 Optic nerve related 11 (1.1) Optic nerve related 4 (2.2)
8 Others 31 (3.0) Others 17 (9.1)
opacities (1.7%), optic nerve related (1.2%), phthisis bulbi model B adjusted for age, sex, and highest educational status.
(0.4%), and other causes accounting for 3.9%. Formal education was protective against BMSVI in the ad-
Factors associated with blindness and moderate and severe justed analysis compared with no formal education. Primary
visual impairment among pensioners in Ghana. education was associated with 30% reduced risk of BMSVI
In the unadjusted analysis, the odds of blindness and (0.7, 95% CI� 0.5–0.9). Similarly, secondary education as the
moderate and severe visual impairment among the males highest formal educational status was also associated with a
were 1.3 (95% CI� 1.1–1.5) times that among the females as reduced risk of BMSVI (0.7, 95% CI� 0.5–0.9).
shown in Table 5. Blindness and moderate and severe visual Tertiary education and vocational/technical education as
impairment (BMSVI) increased with increasing age such that highest formal education was associated with reduced risk of
the odds of BMSVI in pensioners aged 80 years and above BMSVI (0.6, 95% CI� 0.4–0.7) and (0.5, 95% CI� 0.3–0.8),
were about 5.2 (95% CI� 3.5–7.5) times the odds of BMSVI respectively. Also, in the adjusted analysis, the odds of
among the pensioners below 65 years. Also, increasing highest BMSVI were high in the underweight WHO BMI classifi-
educational status was associated with reduced risk of BMSVI. cation group (1.5, 95% CI� 1.1–1.9), whereas it was reduced
*e odds of BMSVI among pensioners with no formal ed- in the WHO overweight group (0.8, 95% CI� 1.0–0.9).
ucation were 2.7 (95% CI� 1.7–4.1) times the odds of BMSVI Vegetarians were 1.9 (95% CI� 1.2–3.0) times more asso-
among the pensioners with the highest educational status as ciated with BMSVI compared to nonvegetarians. Pensioners
tertiary or vocational/technical training. having a history of arthritis were associated with BMSVI in
Body mass index was associated with BMSVI. Compared the adjusted analysis (AOR� 1.2, 95% CI� 0.5–1.5) com-
with the pensioners with normal BMI, being obese was pared to pensioners with no such history. Urine proteins
associated with lower risk of presenting BMSVI (0.6, 95% were associated with BMSVI. Pensioners with trace urine
CI� 0.5–0.9), whereas underweight was associated with an proteins were 1.3 (95% CI� 1.1–1.9) times more likely to be
increased risk (1.7, 95% CI� 1.3–2.2) of being blind and blind and moderately or severely visually impaired com-
moderately or severely visually impaired. Vegetarians were pared with those with normal urine proteins. Also pen-
1.8 (95% CI� 1.2–2.8) times likely to be blind and mod- sioners with urine proteins greater than 30mg/dl or
erately or severely visually impaired compared to non- 0.3mmol/L were 1.5 (95% CI� 0.5–1.0) times more likely to
vegetarians. Social class was another factor associated with have BMSVI.
BMSVI.*e social class Vmade up of unskilled according to
the Registrar General social class classification was most 4. Discussion
associated with BMSVI (1.9, 95% CI� 1.3–3.6) compared to
the professional group. Other factors like arthritis was Age has been a significant factor that influenced the de-
marginally associated with BMSVI (1.2, 95% CI� 1.0–1.4). velopment of visual impairment and blindness. Age has been
Raised serum lipids were associated with lower odds of described as an important related factor in eye disease [21].
BMSVI among the pensioners. Raised triglyceride (0.7, 95% More than half (519 per 1000) of all pensioners above the age
CI� 0.5–1.0), low-density lipoprotein (0.8, 95% CI� 0.6– of 80 in Ghana have a visual impairment with 122 per 1000
0.9), and total cholesterol (0.8, 95% CI� 0.6–0.9) were as- pensioners 80 years and above blind. *e above statistics is
sociated with reduced odds of BMSVI compared to having worrisome since majority of causes of blindness and visual
normal levels of triglyceride, low-density lipoprotein, and impairment in Ghana were from preventable causes.
total cholesterol, respectively. According to findings from the Ghana blindness and visual
Having proteins in the urine was associated with BMSVI. impairment study 2015, more than half of blindness in
Positive urine protein was associated with 1.5 (95% Ghana was caused by cataract [12].
CI� 1.2–1.9) times the odds of BMSVI compared with the *e prevalence of blindness and MSVI generally de-
odds of having normal urine protein. Table 5 displays the creased with increasing highest educational status. Pen-
findings from the logistic regression. sioners who had no formal education had the highest
prevalence of blindness and MSVI among the study par-
ticipants. Education and occupation have been used as proxy
3.6. Adjusted Analysis. *e adjusted odds ratios are dis- for socioeconomic status [22] which has been linked with
played in Table 6. Model A adjusted for age and sex, while visual impairment [23, 24]. It has been shown that people
Journal of Ophthalmology 7
Table 5: Factors associated with blindness and moderate and severe visual impairment among pensioners in Ghana.
Crude odds ratio 95% confidence interval P value
Sex
Male 1.3 1.1–1.5 <0.0005
Female — —
Age in years
<65 — —
65–69 1.3 1.1–1.6 <0.0001
70–74 2.5 2.0–3.0
75–79 4.0 3.1–5.1
≥80 5.2 3.5–7.5
Highest formal education
No formal education 2.7 1.7–4.1 <0.0001
Primary 1.4 0.9–2.1
Secondary 1.3 0.8–2.0
Tertiary 1.0 0.7–1.5
Vocational - —
Body mass index WHO classification
Underweight 1.7 1.3–2.2 <0.0001
Normal — —
Overweight 0.7 0.6–0.8
Obese 0.6 0.5–0.9
Vegetarian
Nonvegetarian
Vegetarian 1.8 1.2–2.8 <0.001
History of arthritis
No arthritis
Had arthritis 1.2 1.0–1.4 <0.05
Social class by previous occupation
I (professional) — — <0.0001
II (managerial/technical) 1.1 0.8–1.5
III (N; skilled nonmanual) 1.0 0.7–1.3
III (M; skilled manual) 1.3 0.9–1.8
IV (partly skilled) 1.6 1.4–2.1
V (unskilled) 1.9 1.3–2.6
Serum triglyceride level
Normal
Raised 0.7 0.5–1.0 <0.05
Serum Ldl level
Normal
Raised 0.8 0.6–09 <0.05
Serum total cholesterol level
Normal
Raised 0.8 0.6–0.9 <0.05
Urine proteins
Negative — — <0.0005
Trace 1.3 1.1–1.7
Positive (+, ++, +++, ++++) 1.5 1.2–1.9
from high social classes have a stronger health care-seeking cataract that keeps rising due to population growth [21]. It
behavior [25]. *e economic empowerment of pensioners has been estimated that close to 90% of all cases of cataract
with higher educational status means that they may be more globally is from developing countries; however, most of the
likely to seek and undertake early treatment for eye con- research into cataract are in the United States and the
ditions. In such circumstances, they were less likely to have European countries [21].
presented at the study with MSVI and blindness due to prior Cataract is ranked as the leading cause of blindness and
intervention. visual impairment [14], a situation that was also observed in
More than half of all blindness and visual impairment in Ghana. Glaucoma was ranked the second leading cause of
this study can be directly linked to cataract. Cataract is the blindness among the pensioners in Ghana and the third
leading cause of blindness worldwide, and it is a multifac- leading cause of MSVI among the pensioners. Increasing age
torial disease associated with several factors [26]. Cataract was strongly associated with the risk of being blind and
still remains a public health problem because of lack of moderately or severely visually impaired. Age above 80 years
skilled personnel and facilities to adequately handle cases of was associated with about five times the odds of being
8 Journal of Ophthalmology
Table 6: Factors associated with blindness andmoderate and severe visual impairment among pensioners in Ghana adjusting for age and sex
in model (A) and adjusting for age, sex, and highest educational status in model B.
∗Model A #Model B
AOR∧ 95% CI+ P value AOR∧ 95% CI+ P value
Highest formal education
No formal education —
Primary 0.7 0.5–0.9 <0.001
Secondary 0.7 0.5–0.9 <0.005
Tertiary 0.6 0.4–0.7 <0.001
Vocational 0.5 0.3–0.8 <0.005
Body mass index WHO classification
Underweight 1.5 1.1–1.9 <0.05 1.5 1.1–2.1 0.006
Normal — —
Overweight 0.8 0.6–0.9 <0.005 0.8 0.7–1.0 0.06
Obese 0.8 0.6–1.0 <0.05 0.8 0.6–1.0 0.9
Vegetarian
Nonvegetarian — —
Vegetarian 1.9 1.2–3.0 <0.005 1.9 1.2–3.0 0.009
History of arthritis
No arthritis — —
Had arthritis 1.2 1.0–1.5 <0.05 1.3 1.1–1.6 0.008
Urine proteins
Negative — — —
Trace 1.3 1.1–1.7 <0.5 1.5 1.2–1.9 0.002
Positive (+, ++, +++, ++++) 1.5 1.2–1.9 <0.005 1.5 1.1–1.9 0.003
∗Model A: adjusting for age and sex. #Model B: adjusting for age, sex, and highest educational status. AOR̂: adjusted odds ratio. 95% CI+: 95% confidence
interval.
BMSVI compared to that of the pensioners below 65 years. studies to ascertain the nature of the proteinuria if it is of
Several years of study on aging and vision have demon- infective or renal pathology.
strated the effects of aging and vision, which is true for *is study was done in pensioners; given the de-
almost all people from all nations including Ghana [27]. mographic of workers in Ghana, particularly those who have
Globally, causes of blindness included age-related macular retired, there are more males in employment and sub-
degeneration, glaucoma, corneal opacities, uncorrected re- sequently more males in the pensioner category. *is could
fractive errors, and diabetic retinopathy [13]. In Ghana, the also explain the higher prevalence of visual impairment in
leading causes of blindness are from correctable causes such men than women, contrary to previous meta-analysis of
as cataract [12]. Causes of visual impairment included various worldwide studies that revealed higher proportion of
cataract, diabetic retinopathy, and age-related macular worldwide blindness in women than in men.
degeneration. Limitations encountered in this study were that not all
Nutritional factors were significantly associated with pensioners were members of the National Pensioners As-
BMS visual impairment. Firstly, body mass index was found sociation. Also, a significant proportion of pensioners whose
to be related with blindness and moderate and severe visual previous work was in the informal sector were not members
impairment. *ose within the WHO BMI underweight of the National Pensioners Association and such, the
category were about 50% more likely to be blind and prevalence of blindness and visual impairment may be
moderately and severely (BMS) visually impaired. Also, underestimated by this study. *e setting of the study was
analyzing the crude odds ratio, raised total cholesterol, mainly urban. Also, majority of the elderly people who had
raised low-density lipoprotein, and raised triglyceride levels no formal education were not members of the National
were negatively associated with being BMS visually im- Pensioners Association [29] and as such, the prevalence of
paired. Finally, vegetarians were about twice likely to be BMS blindness obtained as 3.8% and the prevalence of visual
visually impaired compared to nonvegetarians. We can impairment, which was estimated as 21.7%, may be lower
attribute nutritional causes to play a significant role in the than what really persist among the elderly population in
development of visual impairment in the elderly. Ghana. *is is because pensioners without any formal ed-
Pensioners who were diagnosed as having any form of ucation were more likely to beMSVI or blind compared with
arthritis were more likely to be BMS visually impaired, and any category of elderly who had some formal education [30].
this may be due to the use of steroids for treating rheumatoid *e authors recommend that the Eye Care Secretariat of
arthritis [28]. the Ghana Health Service should include a strategy for
Also, obesity was found to confer less risk against the identifying pensioners with visual impairment and prioritize
development of BMS visual impairment. We also noted that their care. *ere will have to be a deliberate plan to seek out
having proteins in the urine was associated with presenting these individuals using the social security system to identify
BMS visual impairment in the elderly. *is requires further them. Given the relatively young population of the country,
Journal of Ophthalmology 9
there will also have to be a strategy to forecast the increase in British Journal of Ophthalmology, vol. 98, no. 5, pp. 612–618,
pensioner numbers over the next few decades as well as 2014.
make provision for their eye care needs. Also, the role of the [9] R. Biritwum, G. Mensah, A. Yawson, and N. Minicuci, “Study
National Health Insurance Scheme (NHIS) and access to on global AGEing and adult health (SAGE),” Wave 1: the
preventive eye care services in Ghana need a critical review Ghana National Report, World Health Organization, Geneva,
because no one should theoretically be cataract blind. Switzerland, 2013.
*is study shows that even though there is provision for [10] J. Guzek, F. Anyomi, S. Fiadoyor, and F. Nyonator, “Prevalenceof blindness in people over 40 years in the volta region of
cataract surgery under the National Health Insurance Ghana,”GhanaMedical Journal, vol. 39, no. 2, pp. 55–62, 2006.
Scheme of Ghana, there is a high prevalence of visual im- [11] D. Budenz, J. Bandi, K. Barton, W. Nolan, and L. Herndon,
pairment and blindness due to cataract, which appears to be “Blindness and visual impairment in an urban West African
worse in men of lower educational status. population: the tema eye survey,” Ophthalmology, vol. 119,
no. 11, pp. 1744–1753, 2012.
Data Availability [12] B. Wiafe, A. Quainoo, and P. Antwi, Ghana Blindness and
Visual Impairment Study 2015, Ghana Health Service Oper-
*e data used to support the findings of this study are ation Eyesight Universal, Accra, Ghana, 2015.
available from the corresponding author upon request. [13] R. R. Bourne, G. A. Stevens, and R. A.White, “Causes of vision
loss worldwide, 1990–2010: a systematic analysis,”Ae Lancet
Conflicts of Interest Global Health, vol. 1, no. 6, pp. e334–e339, 2013.[14] S. Flaxman, R. Bourne, and S. Resnikoff, “Global causes of
*e authors declare that they have no conflicts of interest. blindness and distance vision impairment 1990–2020: a
systematic review and meta-analysis,” Ae Lancet Global
Health, vol. 5, no. 12, pp. 1221–1234, 2017.
Authors’ Contributions [15] Y.-C. Liu, M. Wilkins, T. Kim, B. Malyugin, and J. S. Mehta,
BDN, KNAA, JA, VA, ADN, CK, IAM, and RBK designed “Cataracts,”AeLancet, vol. 390, no. 10094, pp. 600–612, 2017.[16] M. Khairallah, R. Kahloun, R. Bourne et al., “Number of
the study; BDN analyzed the data; BDN and KNAA drafted people blind or visually impaired by cataract worldwide and in
the manuscript; and all authors read the manuscript, made world regions, 1990 to 2010,” Investigative Opthalmology &
significant contribution, and approved the final manuscript. Visual Science, vol. 56, no. 11, pp. 6762–6769, 2015.
[17] J. H. Seland, J. R. Vingerling, C. A. Augood et al., “Visual
Acknowledgments impairment and quality of life in the older european pop-
ulation, the EUREYE study,” Acta Ophthalmologica, vol. 89,
*e authors acknowledge the support of the members of the no. 7, pp. 608–613, 2011.
National Pensioners Association for their contribution in [18] B. D. Nuertey, A. I. Alhassan, A. D. Nuertey et al., “Prevalence
making this a success. of obesity and overweight and its associated factors among
registered pensioners in Ghana; a cross sectional studies,”
References BMC Obesity, vol. 4, no. 1, p. 26, 2017.
[19] United Nations Population Fund Help Age International,
[1] J. Keeffe and S. Resnikoff, “Prevalence and causes of vision Ageing in the Twenty-First Century: A Celebration and a
impairment and blindness: the global burden of disease,” in Challenge, United Nations Population Fund Help Age New,
Essentials in Ophthalmology [Internet], R. Khanna, G. Rao, New York, NY, USA, 2012.
and S. Marmamula, Eds., Springer, Cham, Switzerland, [20] D. Rose, D. Pevalin, and K. O’Reilly, Ae National Statistics
pp. 7–20, 2019. Socio-Economic Classification: Origins, Development and Use,
[2] D. Pascolini and S. P. Mariotti, “Global estimates of visual Palgrave Macmillan, New York, NY, USA, 2005.
impairment: 2010,” British Journal of Ophthalmology, vol. 96, [21] E. Prokofyeva, A. Wegener, and E. Zrenner, “Cataract
no. 5, pp. 614–618, 2012. prevalence and prevention in Europe: a literature review,”
[3] L. Pizzarello, A. Abiose, and T. Ffytche, “Vision 2020: the right Acta Ophthalmologica, vol. 91, no. 5, pp. 395–405, 2013.
to sight: a global initiative to eliminate avoidable blindness,” [22] R. Dandona and L. Dandona, “Socioeconomic status and
Archives of Ophthalmology, vol. 122, no. 4, pp. 615–620, 2004. blindness,” British Journal of Ophthalmology, vol. 85, no. 12,
[4] M. Zetterberg, “Age-related eye disease and gender,” 2001.
Maturitas, vol. 83, pp. 19–26, 2016. [23] A. Tafida, F. Kyari, M. M. Abdull et al., “Poverty and blindness
[5] R. R. A. Bourne, S. R. Flaxman, T. Braithwaite et al., “Mag- in Nigeria: results from the national survey of blindness and
nitude, temporal trends, and projections of the global prev- visual impairment,” Ophthalmic Epidemiology, vol. 22, no. 5,
alence of blindness and distance and near vision impairment: pp. 333–341, 2015.
a systematic review and meta-analysis,” Ae Lancet Global [24] J. Ramke, A. B. Zwi, A. Palagyi, I. Blignault, and C. E. Gilbert,
Health, vol. 5, no. 9, pp. e888–e897, 2017. “Equity and blindness: closing evidence gaps to support
[6] A. Foster and S. Resnikoff, “*e impact of vision 2020 on universal eye health,”Ophthalmic Epidemiology, vol. 22, no. 5,
global blindness,” Eye, vol. 19, no. 10, pp. 1133–1135, 2005. pp. 297–307, 2015.
[7] N. Muhammad and M. Adamu, “Making a difference with [25] V. Kuuire, E. Bisung, and A Rishworth, “Health-seeking
vision 2020: the right to sight? Lessons from two states of behaviour during times of illness: a study among adults in a
North Western Nigeria,” Nigerian Journal of Clinical Practice, resource poor setting in Ghana,” Journal of Public Health,
vol. 17, no. 6, 2014. vol. 38, no. 4, pp. e545–e553, 2016.
[8] K. Naidoo, S. Gichuhi, M.-G. Basáñez et al., “Prevalence and [26] M. Yang, J. Zhang, S. Su et al., “Allelic interaction effects of
Causes of Vision Loss in Sub-saharan Africa: 1990–2010,” DNA damage and repair genes on the predisposition to age-
10 Journal of Ophthalmology
related cataract,” PLoS One, vol. 13, no. 4, Article ID e0184478,
2018.
[27] C. Owsley, “Aging and vision,”Vision Research, vol. 51, no. 13,
pp. 1610–1622, 2011.
[28] J. J. Wang, E. Rochtchina, A. G. Tan, R. G. Cumming,
S. R. Leeder, and P. Mitchell, “Use of inhaled and oral cor-
ticosteroids and the long-term risk of cataract,” Ophthal-
mology, vol. 116, no. 4, pp. 652–657, 2009.
[29] B. D. Nuertey, J. Addai, A. D. Nuertey, C. Kabutey,
V. Adongo, and I. A. Mensah, “Prevalence and factors as-
sociated with self-reported pensioners in Ghana,” Post-
graduate Medical Journal of Ghana, vol. 8, no. 1, pp. 38–46,
2019.
[30] J. M. Tielsch, A. Sommer, J. Katz, H. Quigley, and S. Ezrine,
“Socioeconomic status and visual impairment among urban
Americans,”Archives of Ophthalmology, vol. 109, no. 5, p. 637,
1991.
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