Association of visual impairment with risk for future Parkinson's disease

Zhuoting Zhu; Wenyi Hu; Huan Liao; Zachary Tan; Yifan Chen; Danli Shi; Xianwen Shang; Xueli Zhang; Yu Huang; Honghua Yu; Wei Wang; Mingguang He; Xiaohong Yang

doi:10.1016/j.eclinm.2021.101189

Association of visual impairment with risk for future Parkinson's disease

EClinicalMedicine. 2021 Nov 6:42:101189. doi: 10.1016/j.eclinm.2021.101189. eCollection 2021 Dec.

Authors

Zhuoting Zhu¹, Wenyi Hu^{2

3}, Huan Liao⁴, Zachary Tan³, Yifan Chen⁵, Danli Shi⁶, Xianwen Shang¹, Xueli Zhang¹, Yu Huang¹, Honghua Yu¹, Wei Wang⁶, Mingguang He^{1

3

6}, Xiaohong Yang¹

Affiliations

¹ Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.
² Shanghai Jiaotong University, Shanghai, China.
³ Centre for Eye Research, University of Melbourne, East Melbourne, Victoria, Australia.
⁴ Neural Regeneration Group, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany.
⁵ John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁶ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Abstract

Background: Although visual dysfunction is one of the most common non-motor symptoms among patients with Parkinson's disease (PD), it is not known whether visual impairment (VI) predates the onset of clinical PD. Therefore, we aim to examine the association of VI with the future development of PD in the UK Biobank Study.

Methods: The UK Biobank Study is one of the largest cohort studies of health, enrolling over 500,000 participants aged 40-69 years between 2006 and 2010 across the UK. VI was defined as a habitual distance visual acuity (VA) worse than 0·3 logarithm of the minimum angle of resolution (LogMAR) in the better-seeing eye. Incident cases of PD were determined by self report data, hospital admission records or death records, whichever came first. Multivariable Cox proportional hazard regression models were used to investigate the association between VI and the risk of incident PD.

Findings: A total of 117,050 participants were free of PD at the baseline assessment. During the median observation period of 5·96 (IQR: 5·77-6·23) years, PD occurred in 222 (0·19%) participants. Visually impaired participants were at a higher risk of developing PD than non-VI participants (p < 0·001). Compared with the non-VI group, the adjusted hazard ratio was 2·28 (95% CI 1·29-4·05, p = 0·005) in the VI group. These results were consistent in the sensitivity analysis, where incident PD cases diagnosed within one year after the baseline assessment were excluded.

Interpretation: This cohort study found that VI was associated with an increased risk of incident PD, suggesting that VI may serve as a modifiable risk factor for prevention of future PD.

Keywords: Ageing; BMI, body mass index; CI, confidence intervals; HR, hazard ratios; IQR, interquartile range; LogMAR, logarithm of the minimum angle of resolution; NHS, National Health Service; PD, Parkinson's disease; PHQ-2, Patient Health Questionnaire-2; PPV, positive predictive value; Parkinson's disease; SD, standard deviations; VA, visual acuity; VI, visual impairment; Visual impairment.

Abstract

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