Min Jae Kang; Tyler Hyungtaek Rim; Sung Soo Kim

doi:10.3341/jkos.2016.57.8.1287

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Kang, Rim, Kim, and The Epidemiologic Survey Committee in the Korean Ophthalmological Society: Prevalence and Risk Factors for Undercorrected Refractive Errors among South Korean: KNHANES 2008–2012

Original Article

J Korean Ophthalmol Soc 2016;57(8):1287-1293.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.8.1287

Prevalence and Risk Factors for Undercorrected Refractive Errors among South Korean: KNHANES 2008–2012

Min Jae Kang, MD¹, Tyler Hyungtaek Rim, MD, MBA², Sung Soo Kim, MD, PhD¹; The Epidemiologic Survey Committee in the Korean Ophthalmological Society

¹Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Address reprint requests to Tyler Hyungtaek Rim, MD, MBA Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea Tel: 82-31-900-0094, Fax: 82-31-900-0049 E-mail: awaitingyourfeedback@gmail.com

Received 4 May 2016 Revised 11 June 2016 Accepted 2 August 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To assess the prevalence and risk factors of undercorrected refractive error in South Korea.

Methods

We analyzed 36,162 participants for estimating prevalence using the Korean National Health and Nutrition Examination Survey (KNHANES, 2008–2012). Undercorrected refractive error was defined as an improvement of at least 2 lines in best corrected visual acuity compared with the presenting visual acuity in the right eye. Proportion of undercorrected refractive error by occupation was presented, and associated sociodemographic factors were evaluated by multivariable logistic regression.

Results

The prevalence of undercorrected refractive error among all participants and among adults was 8.5% (n/N, 6,954/36,162) and 18.8% (n/N, 3,980/19,884), respectively. The proportion of undercorrected refractive error was higher among those with did not wear spectacles or contact lenses (23.1%) than among spectacle or contact lens wearers (8.1%). The proportion of participants who gained more than four or more lines of best corrected visual acuity was 7.2% (n = 2,606) for the all age group. In terms of occupation, farming, fishing, and forestry occupations (22.8%, 570/2,499) and laborer (20.2%, 497/2,457) were more likely to have undercorrected refractive error. Age groups of 10s, 70s, or 80s (30s as a reference group), female sex, lower income, lower education level, and living without a spouse were associated with undercorrected refractive error.

Conclusions

People of older age, female sex, and lower socioeconomic status were more likely to have undercorrected refractive error. This suggests that a public-health approach is needed for preventing visual impairment via proper vision correction.

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Keywords: Korean National Health and Nutrition Examination Survey (KNHANES), Low vision, South Korea, Uncorrected refractive error, Undercorrected refractive error

References

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Table 1.

Prevalence rates of undercorrected refractive error (n = 36,162)

Variables	All			Spectacle or contact lens wearers			Non-spectacle or Non– contact lens wearers
Variables	N	n	Prevalence % (95% CI)	N	n	Prevalence %(95% CI)	N	n	Prevalence %(95% CI)
Age group (years)
5–9	2,665	451	16.5 (14.8–18.3)	356	81	20.4 (16.2–25.3)	2,302	368	15.8 (14.0–17.8)
10–18	4,578	1,164	25.8 (24.1–27.5)	2,026	319	15.9 (13.9–18.1)	2,546	843	33.4 (31.0–35.8)
19–29	3,621	683	18.8 (17.3–20.3)	1,602	115	6.4 (5.2–8.0)	2,011	565	27.9 (25.7–30.3)
30–39	5,414	676	12.5 (11.5–13.7)	1,998	48	2.6 (1.8–3.5)	3,412	626	18.5 (16.9–20.2)
40–49	5,360	752	14.4 (13.2–15.6)	1,502	88	5.5 (4.2–7.1)	3,849	662	17.8 (16.4–19.4)
50–59	5,291	875	16.7 (15.5–18.0)	1,002	66	6.0 (4.5–7.9)	4,282	807	19.2 (17.8–20.7)
60–69	4,859	1,143	23.5 (21.9–25.2)	845	86	9.8 (7.7–12.6)	4,000	1,049	26.3 (24.4–28.2)
70–79	3,592	994	28.1 (26.3–30.0)	784	107	13.4 (10.7–16.6)	2,800	886	32.3 (30.2–34.5)
≥80	782	216	28.3 (24.5–32.6)	168	33	22.0 (14.7–31.7)	611	183	30.3 (25.8–35.1)
≥65	6,747	1,820	27.5 (26.1–29.0)	1,403	192	14.3 (12.0–16.9)	5,324	1,623	31.1 (29.5–32.7)
≥40	19,884	3,980	18.8 (18.0–19.6)	4,301	380	7.7 (6.7–8.7)	15,542	3,587	22.1 (21.1–23.0)
Overall	36,162	6,954	18.5 (17.9–19.2)	10,283	943	8.1 (7.4–8.9)	25,813	5,989	23.1 (22.3–23.8)

CI = confidence interval; N = total participants; n = number of subjects with undercorrected refractive error.

Table 2.

Distribution of the number of lines gained on the log MAR chart after refraction

Population	Number of lines gained	Total (n, %)	Spectacle or contact lens wearers (n, %)	Non-spectacle or Non-contact lens wearers (n, %)
Whole	0	26,975 (74.6)	8,862 (86.2)	18,074 (70.0)
	1	2,068 (5.7)	447 (4.4)	1,616 (6.3)
	2	2,753 (7.6)	546 (5.3)	2,199 (8.5)
	3	1,760 (4.9)	262 (2.6)	1,494 (5.8)
	4	2,606 (7.2)	166 (1.6)	2,430 (9.4)
	Total	36,162 (100.0)	10,283 (100.0)	25,813 (100.0)
Men	0	12,666 (78.4)	4,450 (88.8)	8,198 (73.7)
	1	745 (4.6)	161 (3.2)	581 (5.2)
	2	1,083 (6.7)	225 (4.5)	853 (7.7)
	3	706 (4.4)	110 (2.2)	595 (5.4)
	4	965 (6.0)	64 (1.3)	898 (8.1)
	Total	16,165 (100.0)	5,010 (100.0)	11,125 (100.0)
Women	0	14,309 (71.6)	4,412 (83.7)	9,876 (67.2)
	1	1,323 (6.6)	286 (5.4)	1,035 (7.1)
	2	1,670 (8.4)	321 (6.1)	1,346 (9.2)
	3	1,054 (5.3)	152 (2.9)	899 (6.1)
	4	1,641 (8.2)	102 (1.9)	1,532 (10.4)
	Total	19,997 (100.0)	5,273 (100.0)	14,688 (100.0)

Values are presented as n (%) unless otherwise indicated.

n = number of subjects.

Table 3.

Undercorrected refractive error and occupation (n = 35,626)

Occupation	N	n	%
Working
Administrator, Management	434	49	11.3
Professional	2,959	399	13.5
Business and financial operations occupations	2,213	305	13.8
Service and related occupations	1,556	283	18.2
Sales and related occupations	1,974	342	17.3
Farming, fishing, and forestry occupations	2,499	570	22.8
Installation, maintenance, and repair occupations	1,326	196	14.8
Technicians	1,268	151	11.9
Laborer	2,457	497	20.2
Soldier	59	4	6.8
Not working
Age under 19 years	7,243	1,615	22.3
Not needed	2,038	412	20.2
Studying	740	140	18.9
Retire	664	104	15.7
Health problems	3,292	884	26.9
Unemployed	1,628	329	20.2
Child-care/patients-care	2,628	422	16.1
Other	582	127	21.8
Unknown	66	12	18.2
Total	35,626	6,841	19.2

N = total number of each group; n = number of subjects with undercorrected refractive error.

Table 4.

Factors associated with undercorrected refractive error-univariable and multivariable logistic regression

Variables	Unadjusted	p-value	Adjusted	p-value
Variables	OR (95% CI)	p-value	OR (95% CI)	p-value
Age (years)
5–9	1.37 (1.17–1.62)	<0.01	1.17 (0.96–1.43)	0.11
10–18	2.42 (2.13–2.76)	<0.01	2.09 (1.77–2.48)	<0.01
19–29	1.61 (1.40–1.85)	<0.01	1.59 (1.38–1.83)	<0.01
30–39	1 (reference)		1 (reference)
40–49	1.17 (1.02–1.34)	0.02	1.09 (0.95–1.26)	0.22
50–59	1.40 (1.22–1.60)	<0.01	1.25 (1.08–1.45)	<0.01
60–69	2.14 (1.86–2.47)	<0.01	1.77 (1.51–2.08)	<0.01
70–79	2.73 (2.38–3.12)	<0.01	2.10 (1.77–2.49)	<0.01
≥80	2.76 (2.23–3.41)	<0.01	2.07 (1.59–2.68)	<0.01
Sex
Men	1 (reference)		1 (reference)
Women	1.39 (1.30–1.48)	<0.01	1.35 (1.26–1.44)	<0.01
Monthly house income
Lowest quintile	1 (reference)		1 (reference)
2nd–4th quintile	0.72 (0.66–0.79)	<0.01	0.95 (0.86–1.05)	0.28
Highest quintile	0.61 (0.55–0.68)	<0.01	0.84 (0.74–0.95)	<0.01
Education
Elementary school	1 (reference)		1 (reference)
Middle school	0.88 (0.80–0.98)	0.01	0.99 (0.88–1.10)	0.80
High school	0.66 (0.60–0.72)	<0.01	0.91 (0.81–1.03)	0.15
University or higher	0.52 (0.47–0.57)	<0.01	0.80 (0.69–0.92)	<0.01
Residential area
Urban	1 (reference)		1 (reference)
Rural	1.13 (1.01–1.26)	0.03	1.03 (0.92–1.16)	0.61
Spouse
With	1 (reference)		1 (reference)
Without	1.55 (1.40–1.71)	<0.01	1.14 (1.00–1.29)	0.04

OR = odd ratio; CI = confidence interval.

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