Purpose: This study aimed to investigate the prevalence, causes, and influencing factors of vision impairment in the elderly population aged 60 years and above in Mangxin Town, Kashgar region, Xinjiang, China. Located in a region characterized by intense ultraviolet radiation and arid climatic conditions, Mangxin Town presents unique environmental challenges that may exacerbate ocular health issues. Despite the global emphasis on addressing vision impairment among aging populations, there remains a paucity of updated and region-specific data in Xinjiang, necessitating this comprehensive assessment to inform targeted interventions. Methods: A cross-sectional study was conducted from May to June 2024, involving 1,311 elderly participants (76.76% participation rate) out of a total eligible population of 1,708 individuals aged ≥60 years. Participants underwent detailed ocular examinations, including assessments of uncorrected visual acuity (UVA) and best-corrected visual acuity (BCVA) using standard logarithmic charts, slit-lamp biomicroscopy, optical coherence tomography (OCT, Topcon DRI OCT Triton), fundus photography, and intraocular pressure measurement (Canon TX-20 Tonometer). A multidisciplinary team of 10 ophthalmologists and 2 local village doctors, trained rigorously in standardized protocols, ensured consistent data collection. Demographic, lifestyle, and medical history data were collected via questionnaires. Statistical analyses, performed using Stata 16, included multivariate logistic regression to identify risk factors, with significance defined as P < 0.05. Results: The overall prevalence of vision impairment was 13.21% (95% CI: 11.37–15.04), with low vision at 11.76% (95% CI: 10.01–13.50) and blindness at 1.45% (95% CI: 0.80–2.10). Cataract emerged as the leading cause, responsible for 68.20% of cases, followed by glaucoma (5.80%), optic atrophy (5.20%), and age-related macular degeneration (2.90%). Vision impairment prevalence escalated significantly with age: 7.74% in the 60–69 age group, 17.79% in 70–79, and 33.72% in those ≥80. Males exhibited higher prevalence than females (15.84% vs. 10.45%, P = 0.004). Multivariate analysis revealed age ≥80 years (OR = 6.43, 95% CI: 3.79–10.90), male sex (OR = 0.53, 95% CI: 0.34–0.83), and daily exercise (OR = 0.44, 95% CI: 0.20–0.95) as significant factors. History of eye disease showed a non-significant trend toward increased risk (OR = 1.49, P = 0.107). Education level, income, and smoking status showed no significant associations. Conclusion: This study underscores cataract as the predominant cause of vision impairment in Mangxin Town’s elderly population, with age and sex as critical determinants. The findings align with global patterns but highlight region-specific challenges, such as environmental factors contributing to cataract prevalence. Public health strategies should prioritize improving access to cataract surgery, enhancing grassroots ophthalmic infrastructure, and integrating portable screening technologies for early detection of fundus diseases. Additionally, promoting health education on UV protection and lifestyle modifications, such as regular exercise, may mitigate risks. Future research should expand to broader regions in Xinjiang, employ advanced diagnostic tools for complex conditions like glaucoma, and explore longitudinal trends to refine intervention strategies. These efforts are vital to reducing preventable blindness and improving quality of life for aging populations in underserved areas.

Purpose: This study aimed to investigate the prevalence, causes, and influencing factors of vision impairment in the elderly population aged 60 years and above in Mangxin Town, Kashgar region, Xinjiang, China. Located in a region characterized by intense ultraviolet radiation and arid climatic conditions, Mangxin Town presents unique environmental challenges that may exacerbate ocular health issues. Despite the global emphasis on addressing vision impairment among aging populations, there remains a paucity of updated and region-specific data in Xinjiang, necessitating this comprehensive assessment to inform targeted interventions. Methods: A cross-sectional study was conducted from May to June 2024, involving 1,311 elderly participants (76.76% participation rate) out of a total eligible population of 1,708 individuals aged ≥60 years. Participants underwent detailed ocular examinations, including assessments of uncorrected visual acuity (UVA) and best-corrected visual acuity (BCVA) using standard logarithmic charts, slit-lamp biomicroscopy, optical coherence tomography (OCT, Topcon DRI OCT Triton), fundus photography, and intraocular pressure measurement (Canon TX-20 Tonometer). A multidisciplinary team of 10 ophthalmologists and 2 local village doctors, trained rigorously in standardized protocols, ensured consistent data collection. Demographic, lifestyle, and medical history data were collected via questionnaires. Statistical analyses, performed using Stata 16, included multivariate logistic regression to identify risk factors, with significance defined as P < 0.05. Results: The overall prevalence of vision impairment was 13.21% (95% CI: 11.37–15.04), with low vision at 11.76% (95% CI: 10.01–13.50) and blindness at 1.45% (95% CI: 0.80–2.10). Cataract emerged as the leading cause, responsible for 68.20% of cases, followed by glaucoma (5.80%), optic atrophy (5.20%), and age-related macular degeneration (2.90%). Vision impairment prevalence escalated significantly with age: 7.74% in the 60–69 age group, 17.79% in 70–79, and 33.72% in those ≥80. Males exhibited higher prevalence than females (15.84% vs. 10.45%, P = 0.004). Multivariate analysis revealed age ≥80 years (OR = 6.43, 95% CI: 3.79–10.90), male sex (OR = 0.53, 95% CI: 0.34–0.83), and daily exercise (OR = 0.44, 95% CI: 0.20–0.95) as significant factors. History of eye disease showed a non-significant trend toward increased risk (OR = 1.49, P = 0.107). Education level, income, and smoking status showed no significant associations. Conclusion: This study underscores cataract as the predominant cause of vision impairment in Mangxin Town’s elderly population, with age and sex as critical determinants. The findings align with global patterns but highlight region-specific challenges, such as environmental factors contributing to cataract prevalence. Public health strategies should prioritize improving access to cataract surgery, enhancing grassroots ophthalmic infrastructure, and integrating portable screening technologies for early detection of fundus diseases. Additionally, promoting health education on UV protection and lifestyle modifications, such as regular exercise, may mitigate risks. Future research should expand to broader regions in Xinjiang, employ advanced diagnostic tools for complex conditions like glaucoma, and explore longitudinal trends to refine intervention strategies. These efforts are vital to reducing preventable blindness and improving quality of life for aging populations in underserved areas.

眼底老化是年龄相关性黄斑变性(age-related macular degeneration, AMD)发生和进展的关键因素及病理基础，在组织病理学上主要表现为脉络膜毛细血管萎缩、布鲁赫膜(Bruch's membrane, BrM)增厚以及视网膜色素上皮(retinal pigment epithelium, RPE)异常。BrM增厚可由多种眼底老化沉积物聚集引起，在AMD的病理机制中具有重要作用。其中，基底薄层沉积物(basal laminar deposit, BLamD)代表了RPE基底膜的弥漫性增厚，通常作为一种正常眼底老化改变。而以酯化和未酯化胆固醇等中性脂质为主的RPE基底膜下沉积物，即基底线性沉积物(basal linear deposits, BLinD)和软性玻璃膜疣，均可参与破坏脉络膜与外层视网膜间物质交换稳态，造成外层视网膜缺血、缺氧及氧化应激，是AMD早期重要病理改变。硬性玻璃膜疣主要分布于周边视网膜，多见于正常老化眼底；表皮玻璃膜疣是RPE基底膜局灶性结节状增厚的结果，眼底表现与硬性玻璃膜疣相似，但其主要分布于后极部，数量更多且密度更高。近年来逐渐加深了对视网膜下玻璃膜疣样沉积物(subretinal drusenoid deposit, SDD)的认识和研究，其是位于RPE上方的沉积物，在AMD发病机制中亦具有深刻意义。文章就几种眼底老化相关沉积物(包括硬性玻璃膜及表皮玻璃膜疣)的病理特征和多模态影像学表现进行综述，旨在帮助认识和理解这些沉积物的眼底表现、病理特征和形成机制，以及在AMD发生及进展中的临床意义。

Fundus aging is a key factor and pathological basis for the development and progression of age-related macular degeneration (AMD), which is histopathologically characterized by choroidal capillary atrophy, Bruch’s membrane (BrM) thickening, and abnormalities of retinal pigment epithelium (RPE). BrM thickening can be induced by the aggregation of age-related fundus deposits and plays an essential role in the pathogenesis of AMD. Basal laminar deposits (BLamD) represent diffuse thickening of the basement membrane of RPE, usually considered to be a normal fundus aging. Basal linear deposits (BLinD) and soft drusen, mainly composed of neutral lipids such as esterified and unesterified cholesterol, can disrupt the homeostasis of material exchange between the choroid and the outer retina, resulting in ischemia, hypoxia, and oxidative stress in the outer retina, which are important pathological changes in the early AMD. Hard drusen is mainly distributed in the peripheral retina and is very common in aging fundus; Cuticular drusen are resulted from focal nodular thickening of the basement membrane of RPE, with similar appearance as hard drusen, but mainly distributed in the posterior pole and more numerous and denser. Recently, our understanding of subretinal drusenoid deposits (SDD), deposits above the RPE, has been gradually deepened and it also has profound significance in the pathogenesis of AMD. In this review, we presented the pathologic features and multimodal imaging of age-related fundus deposits (including hard drusen and cuticular drusen), aiming to help recognize and understand the manifestations, pathologic features, and formation mechanisms of these deposits, as well as their clinical significance in the development and progression of AMD.