Korean J Ophthalmol.  2015 Dec;29(6):359-367. 10.3341/kjo.2015.29.6.359.

An Overview of Ophthalmologic Survey Methodology in the 2008-2015 Korean National Health and Nutrition Examination Surveys

• Yoon KC
• Choi W
• Lee HS
• Kim SD
• Kim SH
• Kim CY
• Park KH
• Park YJ
• Baek SH
• Song SJ
• Shin JP
• Yang SW
• Yu SY
• Lee JS
• Lim KH
• Oh KW
• Kang SW

• KMID: 2363842
• DOI: http://doi.org/10.3341/kjo.2015.29.6.359

Abstract

The Korea National Health and Nutrition Examination Survey (KNHANES) is a national program designed to assess the health and nutritional status of the noninstitutionalized population of South Korea. The KNHANES was initiated in 1998 and has been conducted annually since 2007. Starting in the latter half of 2008, ophthalmologic examinations were included in the survey in order to investigate the prevalence and risk factors of common eye diseases such as visual impairment, refractive errors, strabismus, blepharoptosis, cataract, pterygium, diabetic retinopathy, age-related macular degeneration, glaucoma, dry eye disease, and color vision deficiency. The measurements included in the ophthalmic questionnaire and examination methods were modified in the KNHANES IV, V, and VI. In this article, we provide detailed information about the methodology of the ophthalmic examinations in KNHANES in order to aid in further investigations related to major eye diseases in South Korea.

Keyword

Epidemiology; Korea National Health and Nutrition Examination Survey; Methods; Ophthalmology

MeSH Terms

*Epidemiologic Methods
Eye Diseases/*epidemiology
Humans
Nutrition Surveys/*statistics & numerical data
Ophthalmology/*methods
Prevalence
Republic of Korea/epidemiology
Risk Factors
*Surveys and Questionnaires

Figure

• 

  Fig. 1 Representative progression chart for the Korea National Health and Nutrition Examination Survey including ophthalmologic interview, visual acuity testing, slit lamp examination, IOP measurement, fundus photograph, and visual field examination. IOP = intraocular pressure; DR = diabetic retinopathy. From Yoon KC, et al. Korean J Ophthalmol 2011;25:421-33, according to the Creative Commons license [1].

• 

  Fig. 2 Diagnostic flow diagram showing use of Hardy-Rand-Rittler pseudoisochromatic plates to detect, classify, and estimate the degree of defective color vision.

Reference

1. Yoon KC, Mun GH, Kim SD, et al. Prevalence of eye diseases in South Korea: data from the Korea National Health and Nutrition Examination Survey 2008-2009. Korean J Ophthalmol. 2011; 25:421–433.

2. Park SH, Lee JS, Heo H, et al. A nationwide population-based study of low vision and blindness in South Korea. Invest Ophthalmol Vis Sci. 2014; 56:484–493.

3. Rim TH, Lee CS, Lee SC, et al. Influence of visual acuity on suicidal ideation, suicide attempts and depression in South Korea. Br J Ophthalmol. 2015; 99:1112–1119.

4. Cho GE, Lim DH, Baek M, et al. Visual impairment of Korean population: prevalence and impact on mental health. Invest Ophthalmol Vis Sci. 2015; 56:4375–4381.

5. Park Y, Shin JA, Yang SW, et al. The relationship between visual impairment and health-related quality of life in Korean adults: the Korea National Health and Nutrition Examination Survey (2008-2012). PLoS One. 2015; 10:e0132779.

6. Rim TH, Nam JS, Choi M, et al. Prevalence and risk factors of visual impairment and blindness in Korea: the Fourth Korea National Health and Nutrition Examination Survey in 2008-2010. Acta Ophthalmol. 2014; 92:e317–e325.

7. Chon B, Qiu M, Lin SC. Myopia and glaucoma in the South Korean population. Invest Ophthalmol Vis Sci. 2013; 54:6570–6577.

8. Choi JA, Han K, Park YM, Park CK. Age-related association of refractive error with intraocular pressure in the Korea National Health and Nutrition Examination Survey. PLoS One. 2014; 9:e111879.

9. Jee D, Morgan IG, Kim EC. Inverse relationship between sleep duration and myopia. Acta Ophthalmol. 2015; 06. 01. DOI: 10.1111/aos.12776.

10. Choi JA, Han K, Park YM, La TY. Low serum 25-hydroxyvitamin D is associated with myopia in Korean adolescents. Invest Ophthalmol Vis Sci. 2014; 55:2041–2047.

11. Kim EC, Morgan IG, Kakizaki H, et al. Prevalence and risk factors for refractive errors: Korean National Health and Nutrition Examination Survey 2008-2011. PLoS One. 2013; 8:e80361.

12. Lyu IJ, Kim MH, Baek SY, et al. The association between menarche and myopia: findings from the Korean National Health and Nutrition Examination, 2008-2012. Invest Ophthalmol Vis Sci. 2015; 56:4712–4718.

13. Paik JS, Jung SK, Han KD, et al. Obesity as a potential risk factor for blepharoptosis: the Korea National Health and Nutrition Examination Survey 2008-2010. PLoS One. 2015; 10:e0131427.

14. Lee DS, Han K, Kim HA, et al. The gender-dependent association between obesity and age-related cataracts in middle-aged Korean adults. PLoS One. 2015; 10:e0124262.

15. Na KS, Park YG, Han K, et al. Prevalence of and risk factors for age-related and anterior polar cataracts in a Korean population. PLoS One. 2014; 9:e96461.

16. Park YH, Shin JA, Han K, et al. Gender difference in the association of metabolic syndrome and its components with age-related cataract: the Korea National Health and Nutrition Examination Survey 2008-2010. PLoS One. 2014; 9:e85068.

17. Kim TN, Lee JE, Lee EJ, et al. Prevalence of and factors associated with lens opacities in a Korean adult population with and without diabetes: the 2008-2009 Korea National Health and Nutrition Examination Survey. PLoS One. 2014; 9:e94189.

18. Rim TH, Kim MH, Kim WC, et al. Cataract subtype risk factors identified from the Korea National Health and Nutrition Examination survey 2008-2010. BMC Ophthalmol. 2014; 14:4.

19. Rim TH, Nam J, Kim EK, Kim TI. Risk factors associated with pterygium and its subtypes in Korea: the Korean National Health and Nutrition Examination Survey 2008-2010. Cornea. 2013; 32:962–970.

20. Lee WJ, Sobrin L, Lee MJ, et al. The relationship between diabetic retinopathy and diabetic nephropathy in a population-based study in Korea (KNHANES V-2, 3). Invest Ophthalmol Vis Sci. 2014; 55:6547–6553.

21. Jee D, Han Kd, Kim EC. Inverse association between high blood 25-hydroxyvitamin D levels and diabetic retinopathy in a representative Korean population. PLoS One. 2014; 9:e115199.

22. Park YH, Shin JA, Han JH, et al. The association between chronic kidney disease and diabetic retinopathy: the Korea National Health and Nutrition Examination Survey 2008-2010. PLoS One. 2015; 10:e0125338.

23. Rim TH, Byun IH, Kim HS, et al. Factors associated with diabetic retinopathy and nephropathy screening in Korea: the Third and Fourth Korea National Health and Nutrition Examination Survey (KNHANES III and IV). J Korean Med Sci. 2013; 28:814–820.

24. Byun SH, Ma SH, Jun JK, et al. Screening for diabetic retinopathy and nephropathy in patients with diabetes: a nationwide survey in Korea. PLoS One. 2013; 8:e62991.

25. Park YM, Ko SH, Lee JM, et al. Glycaemic and haemoglobin A1c thresholds for detecting diabetic retinopathy: the fifth Korea National Health and Nutrition Examination Survey (2011). Diabetes Res Clin Pract. 2014; 104:435–442.

26. Yang JY, Kim NK, Lee YJ, et al. Prevalence and factors associated with diabetic retinopathy in a Korean adult population: the 2008-2009 Korea National Health and Nutrition Examination Survey. Diabetes Res Clin Pract. 2013; 102:218–224.

27. Jee D, Lee WK, Kang S. Prevalence and risk factors for diabetic retinopathy: the Korea National Health and Nutrition Examination Survey 2008-2011. Invest Ophthalmol Vis Sci. 2013; 54:6827–6833.

28. Park SJ, Lee JH, Woo SJ, et al. Five heavy metallic elements and age-related macular degeneration: Korean National Health and Nutrition Examination Survey, 2008-2011. Ophthalmology. 2015; 122:129–137.

29. Kim EC, Han K, Jee D. Inverse relationship between high blood 25-hydroxyvitamin D and late stage of age-related macular degeneration in a representative Korean population. Invest Ophthalmol Vis Sci. 2014; 55:4823–4831.

30. Kim EC, Cho E, Jee D. Association between blood cadmium level and age-related macular degeneration in a representative Korean population. Invest Ophthalmol Vis Sci. 2014; 55:5702–5710.

31. Park SJ, Lee JH, Woo SJ, et al. Age-related macular degeneration: prevalence and risk factors from Korean National Health and Nutrition Examination Survey, 2008 through 2011. Ophthalmology. 2014; 121:1756–1765.

32. Cho BJ, Heo JW, Shin JP, et al. Epidemiological association between systemic diseases and age-related macular degeneration: the Korea National Health and Nutrition Examination Survey 2008-2011. Invest Ophthalmol Vis Sci. 2014; 55:4430–4437.

33. Cho BJ, Heo JW, Shin JP, et al. Association between reproductive factors and age-related macular degeneration in postmenopausal women: the Korea National Health and Nutrition Examination Survey 2010-2012. PLoS One. 2014; 9:e102816.

34. La TY, Cho E, Kim EC, et al. Prevalence and risk factors for age-related macular degeneration: Korean National Health and Nutrition Examination Survey 2008-2011. Curr Eye Res. 2014; 39:1232–1239.

35. Cho BJ, Heo JW, Kim TW, et al. Prevalence and risk factors of age-related macular degeneration in Korea: the Korea National Health and Nutrition Examination Survey 2010-2011. Invest Ophthalmol Vis Sci. 2014; 55:1101–1108.

36. Hwang HS, Lee SB, Jee D. Association between blood lead levels and age-related macular degeneration. PLoS One. 2015; 10:e0134338.

37. Seo S, Lee CE, Kim DW, et al. Prevalence and risk factors of superior segmental optic hypoplasia in a Korean population: the Korea National Health and Nutrition Examination Survey. BMC Ophthalmol. 2014; 14:157.

38. Jang HD, Kim DH, Han K, et al. Relationship between intraocular pressure and parameters of obesity in Korean adults: the 2008-2010 Korea National Health and Nutrition Examination Survey. Curr Eye Res. 2015; 40:1008–1017.

39. Chun YH, Han K, Park SH, et al. Insulin resistance is associated with intraocular pressure elevation in a non-obese Korean population. PLoS One. 2015; 10:e112929.

40. Kim DW, Kim YK, Jeoung JW, et al. Prevalence of optic disc hemorrhage in Korea: the Korea National Health and Nutrition Examination Survey. Invest Ophthalmol Vis Sci. 2015; 56:3666–3672.

41. Oh E, Yoo TK, Hong S. Artificial neural network approach for differentiating open-angle glaucoma from glaucoma suspect without a visual field test. Invest Ophthalmol Vis Sci. 2015; 56:3957–3966.

42. Kim YH, Jung SW, Nam GE, et al. High intraocular pressure is associated with cardiometabolic risk factors in South Korean men: Korean National Health and Nutrition Examination Survey, 2008-2010. Eye (Lond). 2014; 28:672–679.

43. Kim MJ, Kim MJ, Kim HS, et al. Risk factors for open-angle glaucoma with normal baseline intraocular pressure in a young population: the Korea National Health and Nutrition Examination Survey. Clin Experiment Ophthalmol. 2014; 42:825–832.

44. Kim MJ, Park KH, Kim CY, et al. The distribution of intraocular pressure and associated systemic factors in a Korean population: the Korea National Health and Nutrition Examination Survey. Acta Ophthalmol. 2014; 92:e507–e513.

45. Yoo TK, Oh E, Hong S. Is vitamin D status associated with open-angle glaucoma? A cross-sectional study from South Korea. Public Health Nutr. 2014; 17:833–843.

46. Kim NR, Park HJ, Suh YJ, et al. Heritabilities of intraocular pressure in the population of Korea: the Korean National Health and Nutrition Examination Survey 2008-2009. JAMA Ophthalmol. 2014; 132:278–285.

47. Lin SC, Singh K, Lin SC. Association between body levels of trace metals and glaucoma prevalence. JAMA Ophthalmol. 2015; 133:1144–1150.

48. Um SB, Kim NH, Lee HK, et al. Spatial epidemiology of dry eye disease: findings from South Korea. Int J Health Geogr. 2014; 13:31.

49. Na KS, Han K, Park YG, et al. Depression, stress, quality of life, and dry eye disease in Korean women: a population-based study. Cornea. 2015; 34:733–738.

50. Ahn JM, Lee SH, Rim TH, et al. Prevalence of and risk factors associated with dry eye: the Korea National Health and Nutrition Examination Survey 2010-2011. Am J Ophthalmol. 2014; 158:1205–1214.e7.

51. Kweon S, Kim Y, Jang MJ, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol. 2014; 43:69–77.

52. Jin YH. A new logMAR vision chart: Jin's vision chart. J Korean Ophthalmol Soc. 1997; 38:2036–2044.

53. Van Herick W, Shaffer RN, Schwartz A. Estimation of width of angle of anterior chamber: incidence and significance of the narrow angle. Am J Ophthalmol. 1969; 68:626–629.

54. Chylack LT Jr, Leske MC, McCarthy D, et al. Lens opacities classification system II (LOCS II). Arch Ophthalmol. 1989; 107:991–997.

55. Tan DT, Chee SP, Dear KB, Lim AS. Effect of pterygium morphology on pterygium recurrence in a controlled trial comparing conjunctival autografting with bare sclera excision. Arch Ophthalmol. 1997; 115:1235–1240.

56. Bird AC, Bressler NM, Bressler SB, et al. An international classification and grading system for age-related maculopathy and age-related macular degeneration: the International ARM Epidemiological Study Group. Surv Ophthalmol. 1995; 39:367–374.

57. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs: an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology. 1991; 98:5 Suppl. 786–806.

58. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of diabetic retinopathy: XIV. Ten-year incidence and progression of diabetic retinopathy. Arch Ophthalmol. 1994; 112:1217–1228.

59. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology. 1998; 105:1801–1815.

60. Foster PJ, Buhrmann R, Quigley HA, Johnson GJ. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002; 86:238–242.

61. Cole BL, Lian KY, Lakkis C. The new Richmond HRR pseudoisochromatic test for colour vision is better than the Ishihara test. Clin Exp Optom. 2006; 89:73–80.