Abstract
PURPOSE: To determine the prevalence of under-corrected refractive error (UCRE) and its associated risk factors and patient-reported, health-related, and economic impact in a multiethnic cohort of older adults. METHODS: This study included 2592 older participants from a population-based cohort study. UCRE was defined as an improvement of at least 0.2 logMAR in best-corrected distance visual acuity from presenting distance visual acuity (PDVA) in the better-eye with PDVA worse than 20/40 (>0.3 logMAR). Patient-reported and economic outcomes, including visual functioning and healthcare expenditures, were assessed using validated questionnaires. Prevalence was weighted according to Singapore's 2020 population census, and multivariable regression models were used to analyze the risk factors of UCRE and its association with patient-reported and economic outcomes. RESULTS: The weighted prevalence of UCRE was 8%. Lower socioeconomic status (odds ratio [OR] = 2.98; P < 0.001) and greater spherical equivalent (per 0.50-D increase, OR = 1.07; P = 0.018) were associated with increased odds of UCRE, contributing 39.2% and 23.2%, respectively, of the total variance. UCRE was significantly associated with lower visual functioning scores (-5.7%; β = -0.22; P = 0.046), higher likelihood of loneliness (OR = 2.96; P = 0.015), slower gait speed (OR = 2.03; P = 0.02), and presence of sarcopenia (OR = 2.41; P < 0.001). Individuals with UCRE incurred 2.33-times higher healthcare costs (P = 0.05) compared to those without. CONCLUSIONS: One in 12 older Singaporeans had UCRE. Given the substantial adverse patient-centered and health-related impact and economic burden associated with UCRE, targeted vision screening, treatment for visual impairment, and public health education on the importance of regular eye examinations and wearing appropriate glasses are recommended to mitigate these challenges and reduce associated costs.