Undiagnosed age-related eye diseases prevalent in SG

About a third of older adults in Singapore have undiagnosed age-related eye diseases, according to a study.

In a cross-sectional cohort of 1,878 multiethnic individuals (mean age 72.7 years, 53.9 percent female, 48.7 percent Chinese) who participated in the PIONEER-1* study, 742 had at least one type of undiagnosed eye disease, for a weighted prevalence of 35.8 percent (95 percent confidence interval [CI], 33–38.6), reported first author Hiromi Yee from the Singapore National Eye Centre, Singapore, and colleagues in their paper. [JAMA Ophthalmol 2026;144:23-32]

Of those with undiagnosed eye disease, 650 (87.6 percent) had one condition, 87 (11.7 percent) had two conditions, and the remaining five (0.7 percent) had three conditions.

Prevalence rates differed by ethnicity, with the highest observed among Malays (46.5 percent, 95 percent CI, 41.7–51.3), followed by Indians (42.9 percent, 95 percent CI, 37.9–48) and Chinese (33.9 percent, 95 percent CI, 30.6–37.3). Prevalence was similar between men and women.

In terms of individual conditions, the weighted prevalence of being undiagnosed was 89.8 percent (95 percent CI, 80.8–95.6) for age-related macular degeneration (AMD), 89.8 percent (95 percent CI, 83–94.6 percent) for diabetic retinopathy, 40.8 percent (95 percent CI, 37.4–44.3) for cataracts, and 48.1 percent (95 percent CI, 35–61.3) for glaucoma.

Factors associated with undiagnosed eye disease included younger age (odds ratio [OR], 1.08 per year decrease, 95 percent CI, 1.06–1.10; p<0.001), use of multifocal glasses (OR, 1.75, 95 percent CI, 1.19–2.59; p=0.005), and Malay (OR, 1.71, 95 percent CI, 1.21–2.43; p=0.003) and Indian (OR, 1.43, 95 percent CI, 1–2.04; p=0.05) ethnicities (compared with Chinese).

The finding on multifocal glasses could be attributed to a lack of a comprehensive ocular health check being conducted at optical shops, as such examinations are not mandated by policy guidelines, Yee and colleagues explained. This underscores the need for “optometrists in Singapore to adopt a more proactive role in primary eye care, conducting thorough eye health assessments and facilitating appropriate referrals to secondary eye care,” they added.

Worse health outcomes

Yee and colleagues noted that compared with individuals without any eye diseases (n=488), those with undiagnosed eye disease had poorer patient-centred outcomes, including lower health-related quality of life (1.97-percent reduction in EQ-5D-5L scores; p=0.01) and vision-related quality of life as measured using the Brief Impact of Visual Impairment Questionnaire (5.67-percent reduction in the overall score, p=0.003; 4.01-percent reduction in the visual functioning domain score, p=0.01; and 4.57- reduction in the emotional domain score, p=0.01).

Furthermore, individuals with undiagnosed eye disease had more than twofold greater odds of having visual impairment in the worse eye (odds ratio [OR], 2.46, 95 percent CI, 1.68–3.61; p<0.001). 

“These adverse health outcomes were attenuated in individuals with all of their eye diseases diagnosed (n=648),” although direct healthcare expenditure was similar whether the eye disease was undiagnosed or diagnosed, according to Yee and colleagues.

“Overall, our results suggest that public health awareness and screening programs involving community optometrists and targeted toward individuals at the lower end of the older-than-60-years age spectrum and those of Malay and Indian ethnicities may be warranted to mitigate the detrimental effects of undiagnosed age-related eye diseases,” they said.

Yee and colleagues acknowledged that the study was limited by the reliance on self-reports to determine undiagnosed eye diseases, healthcare expenditure, and productivity loss.