Knowledge about age-related eye diseases in the general population in Germany

BMC Public Health · 6 authors, 2 centres

AI SUMMARY

FIDELITY 100%

POPULATIONAdult general population in Germany (n=1,008, demographically representative)

INTERVENTIONNot applicable (cross-sectional knowledge assessment)

COMPARISONNot applicable (no intervention group)

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AGENT 01 · STRUCTURED SUMMARY

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TL;DR

This cross-sectional study of 1,008 German adults found that knowledge about age-related eye diseases (cataract, glaucoma, AMD, diabetic eye disease) is poor, with a median of only 9 out of 16 correct answers. Knowledge was highest for cataract and lowest for AMD, and infrequent healthcare users were identified as key target groups for educational interventions. The findings highlight the need for public health campaigns to improve eye health literacy, especially for AMD.

Full summary

3,246 CHARS

**Background:** Age-related eye diseases such as cataract, glaucoma, age-related macular degeneration (AMD), and diabetic eye disease are leading causes of vision impairment and blindness worldwide. Health literacy, particularly disease-specific knowledge, is a key social determinant of health that can improve eye health outcomes. However, little is known about the level of such knowledge in the general German population. This study aimed to assess knowledge of these four conditions and identify target groups for educational interventions.

**Methods:** A 16-item knowledge instrument (4 items per condition) was developed based on literature review, expert input, and qualitative debriefings with the public. Items covered risk factors, prevention, treatment, and common misconceptions. The survey was administered online in September 2022 to 1,008 participants recruited from a panel (SurveyEngine), demographically representative of the adult German population by age and sex. Participants rated statements as true or false. Sociodemographic data, health status (EQ-5D-5L), visual difficulties, and healthcare utilization (GP and ophthalmologist visits in past 12 months) were collected. Psychometric properties were evaluated using Rasch modeling and multiple correspondence analysis (MCA). Associations with knowledge (dichotomized at median: >9 vs ≤9 correct) were analyzed using univariable and multivariable binary logistic regression.

**Key Results:** Participants (mean age 50 years, range 18-86; 49.6% female) had a median of 9 correct answers (range 2-16). Correct responses differed significantly by disease (p<0.0001): cataract median 3/4, glaucoma 2/4, diabetic eye disease 2/4, AMD 2/4. Only 27% answered all cataract items correctly, 9% for glaucoma, 1% for AMD, and 19% for diabetic eye disease. The most difficult item was AMD risk factor smoking (13.6% correct); the easiest was cataract not curable with eye drops (96.9% correct). Rasch analysis showed adequate targeting (person reliability 0.46, separation index 0.92) but one item (A3) had differential item functioning by sex (contrast 0.69, p=0.0001). MCA explained 37.6% variance in first two dimensions, supporting unidimensionality. In univariable analysis, higher knowledge was associated with older age (OR 1.014 per year, p<0.0001), retirement (OR 1.517, p=0.005), reduced general health (OR 1.222, p=0.004), GP consultation (OR 1.462, p<0.0001), and ophthalmologist consultation (OR 1.364, p<0.0001). In multivariable analysis, only GP consultation (OR 1.275, p=0.011) and ophthalmologist consultation (OR 1.256, p=0.003) remained significant.

**Clinical Implications:** Knowledge gaps about age-related eye diseases are substantial in the German general population, particularly for AMD and diabetic eye disease. Infrequent healthcare users, younger individuals, and those in good health are less knowledgeable and should be targeted by public health campaigns. Healthcare consultations (GP and ophthalmologist) are strongly associated with better knowledge, underscoring the role of healthcare contact in improving health literacy. The developed 16-item instrument may be useful for assessing and monitoring eye health knowledge in future interventions.

PICO

PPOPULATION

Adult general population in Germany (n=1,008, demographically representative)

IINTERVENTION

Not applicable (cross-sectional knowledge assessment)

OOUTCOME

Knowledge score (0-16) on cataract, glaucoma, AMD, and diabetic eye disease; associations with sociodemographic and healthcare utilization factors

STUDY TYPE

cross-sectional

SPECIALTY

ophthalmology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10851458

Knowledge about age-related eye diseases in the general population in Germany

BMC Public Health

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ABSTRACT

Abstract Background With a rising prevalence of age-related eye diseases, prevention and early diagnosis of these conditions are key goals of public eye health. Disease-related knowledge in the general public supports these goals but there is little data available. Thus, we have assessed knowledge of cataract, glaucoma, age-related macular degeneration (AMD) and diabetic eye disease in the German adult general population in a cross-sectional study and identified target groups for health education interventions. Methods Knowledge assessment content was identified based on a literature review, expert input, and a list of items was generated after a qualitative selection process. The resulting 16-item instrument (4 items per condition) was administered to 1,008 participants from a survey panel, demographically representative of the adult German population. Test properties were evaluated based on a Rasch model and multiple correspondence analysis (MCA). Binary-logistic regression analysis was performed to investigate associations with age, sex, education level, employment status, marital status, income, reported health status, visual difficulties, and recent general practitioner (GP) and ophthalmologist consultations. Results Replies were correct for a median of 9 out of 16 (range 2 – 16) items, which differed between conditions ( p < 0.0001). Most responses were correct for cataract items (median: 3 / 4) and least were correct for AMD items (median: 2 / 4). 27%, 9%, 1% and 19% of respondents replied correctly to all cataract, glaucoma, AMD and diabetic eye disease-related items, respectively. Rasch analysis suggested an adequate targeting of items and in MCA, no evidence of multidimensionality was present. Older age, being retired, decreased general health and recent GP or ophthalmology consultations were significantly associated with more knowledge about common eye conditions ( p ≤ 0.005). GP or ophthalmology consultations remained significant in a multivariable model ( p ≤ 0.011). Conclusions Knowledge gaps regarding eye health are considerable in the German general population and should therefore be addressed in educational interventions targeting the public. Special attention when designing such campaigns needs to be paid to infrequent users of the healthcare system. Knowledge of AMD seems to be poorer compared to other eye conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-024-17889-0. Keywords: Health literacy, Age-related macular degeneration, Glaucoma, Cataract, Diabetic eye disease

CITATION EXPORT

Jan Henrik Terheyden, David J Fink, Karl Mercieca et al.. Knowledge about age-related eye diseases in the general population in Germany. BMC Public Health. (2024). https://doi.org/10.1186/s12889-024-17889-0

AUTHORS

6 · 2 CENTRES

Jan Henrik Terheyden, David J Fink, Karl Mercieca, Maximilian W M Wintergerst, Frank G Holz, Robert P Finger

1Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, NRW Germany
2Department of Ophthalmology, University Hospital Mannheim & Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany