Visual impairment among hypertensive patients in resource-limited settings: evidence from Southern Ethiopia

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In low- and middle-income countries such as Ethiopia, where visual health problems are increasingly severe, understanding the burden of VI among hypertensive patients is critical to inform prevention and treatment strategies. Objective This study aimed to determine visual impairment among hypertensive patients in resource-limited settings: evidence from Southern Ethiopia Methods A multicenter, institution-based cross-sectional study was conducted among 423 randomly selected hypertensive patients. Sociodemographic and clinical data, including blood pressure and intraocular pressure, were collected. Comprehensive ocular assessments—visual acuity, perimetry, color vision testing, slit-lamp evaluation, and fundus examination—were performed. Data were analyzed using SPSS version 26, with logistic regression identifying factors associated with VI. A p-value < 0.05 was considered statistically significant. Results The overall prevalence of VI was 39.7% (n = 168; 95% CI: 27.1–37.1), with 38.7%, 44.1%, and 11.9% of patients showing mild, moderate, and severe impairment, respectively. Complete blindness was observed in 5.4% of participants. Cataract (36.3%) and glaucoma (25%) were the leading causes of VI. Significant predictors included history of ocular trauma (AOR = 3.84, 95% CI: 1.7–8.71, P = 0.001), hypertension duration ≥ 5 years (AOR = 3.73, 95% CI: 2.32–5.99, P = 0.001), and alcohol intake (AOR = 2.27, 95% CI: 1.12–4.59, P = 0.023). Conclusion Nearly two-fifths of hypertensive patients in southern Ethiopia were visually impaired, primarily due to cataract. Ocular trauma, prolonged hypertension, and alcohol use were key predictors, highlighting the need for early detection, integrated eye care, and targeted public health interventions in resource-limited settings. Hypertension Visual impairment Glaucoma Cataract Southern Ethiopia Figures Figure 1 Figure 2 Background Visual impairment (VI), ranging from mild loss to complete blindness, is defined as a presenting distance visual acuity of the better eye worse than 6/12 ( 1 ). The leading causes of VI include uncorrected refractive errors, cataract, age-related macular degeneration, glaucoma, diabetic retinopathy, corneal opacity, and trachoma, many of which are associated with hypertension (HTN) ( 1 – 7 ). Hypertensive retinopathy, characterized by retinal vascular damage, develops in the later stages of hypertension ( 2 ). Arteriolar constriction, vascular wall changes, cotton-wool spots, yellow hard exudates, and optic disc edema, identifiable by fundoscopic examination, are common manifestations that may result in VI. Globally, at least 2.2 billion people are affected by VI, with 26.3 million in Africa alone, and up to half of these cases are preventable ( 1 , 8 ). Ethiopia ranks among countries with the highest rates of blindness (1.6%) and low vision (3.7%), of which approximately 80% are preventable or treatable ( 9 , 10 ). Studies in China ( 11 ), Taiwan ( 12 ), India ( 13 ), Sri Lanka ( 14 ), Malaysia ( 15 ), and Nigeria ( 2 ) have consistently identified hypertension as a leading diagnosis among visually impaired populations. VI significantly impacts individuals’ quality of life, causing disability, cognitive decline, poor mental health, reduced productivity, and limited capacity to manage other comorbidities ( 11 ). Factors influencing VI include socioeconomic and cultural status, age, gender, chronic non-communicable diseases such as HTN, obesity, diabetes mellitus, lifestyle behaviors, and educational attainment ( 11 , 16 – 20 ). In resource-limited settings such as Ethiopia, eye care services are often fragmented, and routine visual screening is not systematically integrated into hypertension management. Consequently, many cases of visual impairment remain undetected until advanced or irreversible stages. Integrating regular ophthalmic screening into chronic disease care pathways could play a critical role in reducing the burden of preventable visual impairment. Despite some studies in northern Ethiopia, no research has addressed the prevalence, severity, and types of VI among hypertensive patients in the southern region, which features diverse socioeconomic and cultural backgrounds. This study aims to fill this gap by assessing the visual impairment among hypertensive patients in resource-limited settings: evidence from Southern Ethiopia. The findings are expected to raise awareness among patients, families, healthcare providers, and policymakers, facilitate early diagnosis, and provide a foundation for future research in the region. Methods Study Area and Period This multicenter cross-sectional study was conducted in the Southern region of Ethiopia at Bonga Gebretsadik Shawo Memorial Hospital, Mizan Teppi University Teaching Hospital, Teppi, and Tarcha General Hospital from September 2021 to January 2023. Sample Size Determination and Study Subjects A total of 423 hypertensive patients aged 18 years and above, attending follow-up at the four hospitals, were included using a single-proportion formula with a 10% non-response adjustment. Diabetic, critically ill, and mentally ill patients were excluded. Participants were selected via systematic random sampling, with proportional allocation across hospitals. Data Collection Tools and Techniques Sociodemographic data were collected through structured questionnaires prepared for this study. Anthropometric measurements and blood pressure (BP) were measured using standard techniques after 15 minutes of rest, with a sphygmomanometer (XMEQSPHYRIAC14, 54.5 cm length × 14 cm width). Visual acuity was assessed using the Snellen illiterate “E” chart at a 6-meter distance. Color vision was tested with the Ishihara 24-plate test, with participants reading numbers from 75 cm away. A slit-lamp examination diagnosed cataracts. Intraocular pressure (IOP) measurements and perimetry assessed glaucoma. Fundus examinations using an ophthalmoscope, combined with pupil dilation via tropicamide, determined retinal health and refractive errors. Data Analysis Data were entered and analyzed in SPSS version 26. Binary logistic regression identified factors associated with VI among hypertensive patients. Statistical significance was set at p < 0.05. Results Sociodemographic Characteristics Participants’ ages ranged from 25 to 80 years, with a median of 57 ± 11 years. Females comprised 51.54% (n = 218) of the sample. Most participants were married (n = 359; 84.87%) and illiterate (n = 260; 61.47%). Farmers represented 33.10% (n = 140), and 55.79% (n = 236) had a monthly income < 2000 Ethiopian birr ( Table 1 ). Table 1: Socio-Demographic Characteristics of Study Participants (n=423) n (%) Variables Variable n (%) Age(years) 64 20 (4.73) 233 (55.08) 170 (40.19) Occupation Farmer Merchant Civil Servant Unemployed Retired 140 (33.10) 98(23.17) 105(24.82) 23 (5.44) 57 (13.48) Sex Male Female 205 (48.46) 218 (51.54) Monthly Income (Birr) 5000 236 (55.79) 86(20.33) 101 (23.88) Marital status Married Single Divorced Widowed 359 (84.87) 13 (3.07) 25 (5.91) 26 (6.15) Educational level Illiterate Primary and Junior Secondary and College University and above 260 (61.47) 75 (17.73) 35 (8.27) 53 12.53) Clinical Characteristics Half of the participants (50.35%, n = 213) had hypertension for <5 years; 87.94% (n = 372) had no comorbid diseases. Most had no ocular trauma (88.89%), no ocular infection (91.02%), and no family history of eye problems (97.64%). The majority (70.92%) had a BMI of 18.5–24.99 kg/m² ( Table 2 ). Table 2: Clinical Characteristics of Study Participants (n=423) Variables n (%) Variables n (%) Duration of HTN < 5 years ≥ 5 years 213 (50.35) 210 (49.65) Family history of eye problems Yes No 10 (2.36) 413 (97.64) Disease other than HTN Yes No 51 (12.06) 372 (87.94) BMI (kg/m²) <18.5 18.5-24.99 25-29.99 ≥30 12 (2.84) 300 (70.92) 10 1(23.88) 10 (2.36) History of ocular trauma Yes No 47 (11.11) 376 (88.89) sBP (mmHg) < 140 ≥ 140 146 (34.52) 277 (65.48) History of ocular infection Yes No 38 (8.98) 385 (91.02) dBP (mmHg) <90 ≥90 224 (52.96) 199 (47.04) BMI: Body mass index, dBP: Diastolic blood pressure, sBP: Systolic blood pressure Behavioral Characteristics Sleep duration was 5–8 hours in 64.3% of participants. Exposure to television was reported by 43.97%, with most viewing from >2 meters. Mobile phone use was rare in 38.53%. Smoking and chewing were negligible. Alcohol intake was reported by 84.4%, with 12.32% reporting intake in the last 30 days ( Table 3 ). Table 3: Behavioral Characteristics of Study Participants (n=423) Variables n (%) Variables n (%) Duration of sleep (Hours) 9 10 (2.36) 272 (64.30) 141 (33.33) Ever alcohol intake Yes No 357 (84.40) 66 (15.60) Exposure for TV Yes No 186 (43.97) 237 (56.03) Current alcohol intake Yes No 44 (12.32) 313 (87.68) Exposure distance (Meter) <2 ≥2 62 (33.33) 124 (66.67) Type of alcohol in the last 30 days Beer Tej/Tela 25 (56.82) 19 (43.18) Mobile phone use Always Frequently Sometimes Rarely Never 40 (9.46) 62 (14.66) 60 (14.18) 163 (38.53) 98 (23.17) Cigarette smoking Yes No 1 (0.24) 422 (99.76) Chat chewing Yes No 4 (0.95) 419 (99.05) Visual Impairments Overall, 39.7% (n = 168) of participants were visually impaired ( Figure 1a ). Among these, 38.7% had mild, 44.1% moderate, 11.9% severe VI, and 5.4% were blind ( Figure 1b ). Cataract (36.3%) and glaucoma (25%) were the most frequent types, followed by uncorrected refractive error (16.7%), color blindness (9.5%), optic neuropathy (7.1%), and hypertensive retinopathy (5.4%) ( Figure 2 ). Factors Associated with Visual Impairment Multiple logistic regression revealed that duration of HTN, history of ocular trauma, and alcohol intake were significantly associated with VI. Hypertensive patients with ≥5 years of HTN were 3.73 times more likely to have VI (AOR: 3.73, 95% CI: 2.32–5.99). History of ocular trauma increased the odds by 3.84 (AOR: 3.84, 95% CI: 1.7–8.71), and alcohol intake increased the odds by 2.27 (AOR: 2.27, 95% CI: 1.12–4.59) ( Table 4 ). Table 4: Bivariable and multivariable binary logistic regression analysis (n=423) Visual impairment Variables Yes (%) No (%) COR AOR (95%CI) P-Value Age (years) 64 4(20) 16(80) 73(31.33) 160(68.67) 91(53.53) 79(46.47) 1.00 1.83 4.61 1.00 0.75(0.17-3.25) 2.51(0.58-10.79) 0.699 0.216 Occupation Farmer Merchant Civil Servant Unemployed Retired 65(46.43) 75(53.57) 33(33.67) 65(66.33) 35(33.33) 70(66.67) 8(34.78) 15(65.22) 27(47.37) 30(52.63) 1.73 1.02 1.00 1.07 1.80 1.25(0.59-2.65) 0.78(0.37-1.61) 1.00 0.96(0.29-3.22) 0.8(0.36-1.76) 0.566 0.494 0.946 0.578 Monthly Income (Birr) 5000 104(44.07) 132(55.93) 23(26.74) 63(73.26) 41(40.59) 60(59.41) 1.15 0.53 1.00 1.51(0.78-2.91) 0.61(0.29-1.3) 1.00 0.217 0.201 Duration of HTN < 5 years ≥ 5 years 53(24.88) 160(75.12) 115(54.76) 95(45.24) 1.00 3.65 1.00 3.73(2.32-5.99) 0.001** History of ocular trauma Yes No 28(59.57) 19(40.43) 140(37.23) 236(62.77) 2.48 1.00 3.84(1.7-8.71) 1.00 0.001** Duration of sleep (Hours) 9 4(40) 6(60) 91(33.46) 181(66.54) 73(51.77) 68(48.23) 1.33 1.00 2.14 2.14(0.45-10.13) 1.00 1.45(0.84-2.51) 0.338 0.182 Exposure for TV Yes No 61(32.8) 125(67.2) 107(45.15) 130(54.85) 0.59 1.00 0.72(0.36-1.47) 1.00 0.370 Mobile phone use Always Frequently Sometimes Rarely Never 12(30) 28(70) 20(32.26) 42(67.74) 21(35) 39(65) 72(44.17) 91(55.83) 43(43.88) 55(56.12) 0.55 0.61 0.69 1.01 1.00 0.59(0.21-1.68) 1.17(0.47-2.93) 0.90(0.35-2.29) 1.17(0.65-2.11) 1.00 0.323 0.742 0.820 0.604 Alcohol intake Yes No 152(42.58) 205(57.42) 16(24.24) 50(75.76) 2.32 1.00 2.27(1.12-4.59) 1.00 0.023 * COR: Crude odds ratio, AOR: Adjusted odds ratio, CI = Confidence Interval. *, and ** indicates statistically significant difference at p< 0.05 and p<0.01, respectively. Discussion In this study, the prevalence of visual impairment (VI) among hypertensive patients was 39.72% (95% CI: 27.1–37.1), which is considerably higher than previous reports from Taiwan (11%) ( 12 ), India (30.1%) ( 13 ), Sri Lanka (21.3%) ( 14 ), Afghanistan (22.6%) ( 17 ), and Saudi Arabia (13.9%) ( 22 ). Several factors could explain this higher prevalence observed in our study. Firstly, the definition of VI differed between studies. In the present study, VI was defined as a presenting visual acuity of less than 6/12 in the better eye, whereas in the aforementioned studies, VI was commonly defined as visual acuity less than 6/18. This stricter cut-off in our study likely contributed to a higher observed prevalence. Secondly, the method of assessment differed; we used the visual acuity of the better eye, which tends to yield higher prevalence rates compared with best-corrected visual acuity used in studies from India ( 13 ), Sri Lanka ( 14 ), and Saudi Arabia ( 22 ). Other plausible explanations include differences in socioeconomic status, educational level, and quality of life. In Taiwan ( 12 ), India ( 13 ), and Sri Lanka ( 14 ), the studied populations were more educated or employed in professional roles, whereas most participants in our study were illiterate farmers, a factor that may exacerbate the impact of hypertension on visual health. Age differences also play a role: prior studies often involved narrower age ranges, whereas our participants ranged from 18 to 80 years, increasing the likelihood of age-related ocular complications. Conversely, the prevalence of VI in our study was lower than that reported in Nigeria (56%) ( 2 ), Malaysia (46%) ( 15 ), and the Central African Republic (70.8%) ( 23 ). Differences in participant age could partially explain these discrepancies, as the prior studies included older populations (≥ 60 years), whereas our study involved adults aged 18 years and above. Age-related deterioration in ocular tissues can increase susceptibility to VI. Additionally, previous studies were population-based, while our study was hospital-based, which may yield relatively lower prevalence estimates. Notably, our prevalence closely aligns with that reported in South Africa (36.1%) ( 24 ), indicating some consistency in sub-Saharan African hospital-based settings. Consistent with global evidence, cataracts were identified as the leading cause of VI in this study, accounting for 36.3% of cases. Similar findings were reported in Nigeria (37.6%) ( 2 ), Eastern Taiwan (45%) ( 12 ), China ( 4 , 5 ), India ( 13 ), and Afghanistan ( 17 ). The slightly lower prevalence in our study may reflect the inclusion of younger participants (18 + years) compared to other studies that focused on individuals aged 60 years and above. Advancing age likely exacerbates both hypertension-related ocular complications and cataract formation. Glaucoma emerged as the second leading cause of VI (25%), consistent with studies in Nigeria (32.8%) ( 2 ) and China ( 4 ), highlighting its global relevance among hypertensive populations. Uncorrected refractive error accounted for 16.7% of VI cases, in agreement with findings from China (14.5%) ( 4 ) and India (27%) ( 13 ), though lower than the 36% reported in Saudi Arabia ( 22 ). This discrepancy may reflect differences in the relative contribution of other ocular pathologies such as cataracts and glaucoma. Hypermetropia was the most frequent refractive error (60.7%), followed by myopia (32.1%) and astigmatism (7.2%), consistent with Saudi Arabian data ( 22 ). Color blindness affected 9.5% of visually impaired participants and 3.8% overall. Few studies examine color blindness in conjunction with other VI types, limiting comparative analysis. However, similar prevalence has been reported in Japan (4.37%) ( 25 ), the USA (4.2%) ( 26 ), and Greece (3%) ( 27 ), with slightly higher rates in Iraq (8.47%) ( 28 ). Differences may be influenced by racial and genetic factors. Hypertensive retinopathy, a direct consequence of sustained hypertension, accounted for 5.1% of VI, comparable to findings in Nigeria (3.4%) ( 2 ) and Canada (8.6%) ( 29 ). Optic neuropathy was observed in 7.1% of participants, closely aligning with Nigerian data (6.8%) ( 2 ). Our study demonstrated a significant association between ocular trauma and VI, with affected participants being 3.84 times more likely to develop VI. This is consistent with studies in China ( 30 ), Malawi ( 31 ), and Saudi Arabia ( 22 ), emphasizing that even non-disease-related eye injuries contribute to long-term visual impairment. Trauma may result in corneal ulcers, eyelid injury, or structural damage to the eye, leading to permanent vision loss or blindness ( 32 , 33 ). Additionally, participants with a hypertension duration of five or more years had a 3.73-fold higher likelihood of VI, consistent with findings from Eastern Taiwan ( 12 ), Bangladesh ( 34 ), India ( 35 ), and Pakistan ( 36 ). Prolonged hypertension leads to retinal vascular remodeling, arteriosclerosis, and changes in precapillary sphincter size, reducing perfusion and choroidal blood flow, increasing intraocular pressure, and ultimately contributing to irreversible vision loss ( 37 ). Alcohol intake was another independent predictor of VI, with a 2.27-fold increased risk among users. This relationship aligns with studies from China ( 38 , 40 ) and Turkey ( 39 ). Alcohol may impair visual processing by modulating neurotransmitter systems, particularly GABAergic pathways, across retinal cells, the lateral geniculate nucleus, superior colliculus, and visual cortex. By hyperpolarizing neurons and slowing transmission of visual information, alcohol can diminish visual acuity and disrupt ocular motor control, affecting saccades and fixations, and contributing to color perception deficits and contrast sensitivity reduction ( 41 , 42 ). Overall, this study provides critical insight into the burden of visual impairment among hypertensive patients in southern Ethiopia. It highlights the need for early screening, preventive interventions, and awareness programs, especially in developing countries where access to eye care may be limited. By documenting the prevalence, causes, and risk factors of VI in this population, the study contributes valuable baseline data to the global literature and underscores the intersection of chronic non-communicable diseases and visual health in resource-limited settings. Strength of the study Strengths of the Study This study has several important strengths. It was conducted across multiple hospitals in southern Ethiopia, which enhances the representativeness of the findings compared to single-center studies. In addition, comprehensive ophthalmic examinations, including visual acuity assessment, slit-lamp evaluation, intraocular pressure measurement, and fundus examination, were performed, improving the accuracy of visual impairment diagnosis. By focusing on hypertensive patients, a high-risk population, the study provides clinically relevant evidence that can inform integrated management of chronic diseases. Furthermore, the identification of modifiable risk factors such as alcohol intake and ocular trauma offers practical implications for prevention strategies. The study also contributes valuable context-specific data from a resource-limited setting where evidence on visual impairment among hypertensive patients is scarce. Limitations of the Study The study was cross-sectional, which doesn’t establish the causal relationships between hypertension and visual impairments. As the study was hospital-based, the results may not be generalizable to the broader community and may overestimate the true prevalence due to selection bias. In addition, visual impairments were assessed using presenting visual acuity rather than best-corrected visual acuity, which may have led to an overestimation of prevalence due to uncorrected refractive errors. Finally, although multivariable analysis was conducted, residual confounding from unmeasured factors such as dietary habits and access to eye care services cannot be ruled out. Despite these limitations, the study provides valuable insight into the burden and determinants of visual impairment among hypertensive patients in a resource-limited setting. Thus, these limitations identified in this study will be addressed in future large-scale studies. Strengths of the Study This study has several important strengths. It was conducted across multiple hospitals in southern Ethiopia, which enhances the representativeness of the findings compared to single-center studies. In addition, comprehensive ophthalmic examinations, including visual acuity assessment, slit-lamp evaluation, intraocular pressure measurement, and fundus examination, were performed, improving the accuracy of visual impairment diagnosis. By focusing on hypertensive patients, a high-risk population, the study provides clinically relevant evidence that can inform integrated management of chronic diseases. Furthermore, the identification of modifiable risk factors such as alcohol intake and ocular trauma offers practical implications for prevention strategies. The study also contributes valuable context-specific data from a resource-limited setting where evidence on visual impairment among hypertensive patients is scarce. Limitations of the Study The study was cross-sectional, which doesn’t establish the causal relationships between hypertension and visual impairments. As the study was hospital-based, the results may not be generalizable to the broader community and may overestimate the true prevalence due to selection bias. In addition, visual impairments were assessed using presenting visual acuity rather than best-corrected visual acuity, which may have led to an overestimation of prevalence due to uncorrected refractive errors. Finally, although multivariable analysis was conducted, residual confounding from unmeasured factors such as dietary habits and access to eye care services cannot be ruled out. Despite these limitations, the study provides valuable insight into the burden and determinants of visual impairment among hypertensive patients in a resource-limited setting. Thus, these limitations identified in this study will be addressed in future large-scale studies. Conclusion Nearly two-fifths of hypertensive patients in southern Ethiopia were visually impaired. Cataract and glaucoma were the leading causes. Duration of hypertension, history of ocular trauma, and alcohol intake were significant risk factors. This study contributes to the literature by providing region-specific evidence from southern Ethiopia, highlighting modifiable and non-modifiable risk factors for VI among hypertensive patients, and emphasizing the public health relevance in resource-limited settings. Recommendations Government and stakeholders should prioritize interventions addressing hypertension-induced VI. Healthcare providers should educate hypertensive patients on eye care and facilitate early detection. Future research should explore disease mechanisms and conduct community-based studies to inform preventive strategies. Abbreviations BP Blood Pressure BMI Body Mass Index DM Diabetes Mellitus CI Confidence interval HTN Hypertension GABA Gamma-aminobutyric acid IOP Intraocular pressure LGN Lateral geniculate nucleus LMIC s Low and middle-income countries SES Socioeconomic status SC Superior colliculus URE Uncorrected refractive error VI Visual impairment WHO World Health Organization. Statements and Declarations Funding There was no funding or sponsoring organization for this study. Competing interests The authors declare that they have no competing interests and have agreed to submit the manuscript to this journal Ethics approval and consent to participate The study was carried out after ethical clearance and approval were obtained from the Research and Ethical Review Committee of the Department of Physiology, College of Health Sciences, and Addis Ababa University. Official letters from the department were sent to hospitals to get permission. The study was performed per the Declaration of Helsinki, ethical principles for medical research involving human subjects. The study participants were also informed that they had the right to withdraw from the study at any time. The participants’ privacy was maintained by interviewing in a private place, and they were informed that there would not be any incentive or harm for their participation in the study. Participants’ identity was kept confidential throughout the data collection and analysis process, while the information was used only for the objectives of the study. All study participants who had VI after examinations were linked to the ophthalmology unit for the appropriate management and follow-up. Consent to participate Written informed consent was obtained from each patient after she/ he was informed about the study. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Authors’ Contributions Daniel Assefa Adasho conceived and designed the study, participated in data collection, analysis, and interpretation, and drafted the initial manuscript. Abebaye Aragaw Leminie contributed to the study design, supervised the research process, interpreted results, performed critical revision of the manuscript for important intellectual content, and approved the final version for publication. Both authors read and approved the final manuscript and agree to be accountable for all aspects of the work. Acknowledgements The authors would like to thank Addis Ababa University and Dilla University for their institutional support. 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Prevalence of congenital red-green color vision defects among various ethnic groups of students in Erbil City. Jordan J Biol Sci. 2013;6(3):235–7. Foster BJ, Ali H, Mamber S, Polomeno RC, Mackie AS. Prevalence and severity of hypertensive retinopathy in children. Clin Pediatr (Phila). 2009;48(9):926–30. Xu C, Teng C, Chow J, Liu J, Li L, Maslin J. Risk factors for visual impairment associated with corneal disease in Southern China. Clin Ophthalmol. 2016;10:777–83. Zungu T, Mdala S, Manda C, Twabi HS, Kayange P. Characteristics and visual outcome of ocular trauma patients at Queen Elizabeth Central Hospital in Malawi. PLoS One. 2021;16(3):e024xxxx. Pradhan E. Ocular trauma prevention. Nepal J Ophthalmol. 2017;8:107–10. Aghadoost D. Ocular trauma overview. Arch Trauma Res. 2014;3(2):e21639. Mondal R, Matin M, Rani M, Hossain M, Shaha A, Singh R. Prevalence and risk factors of hypertensive retinopathy in hypertensive patients. J Hypertens Open Access. 2017;6:1–5. AsMK Team. Hypertensive retinopathy. 2020. Bahoo LA, Khalid MS, Haq M. Relationship between duration of hypertension and vision problem in hypertensive patients: a cross-sectional survey. Med Forum Mon. 2019;30:103–7. Katsi V, Marketou M, Vlachopoulos C, Tousoulis D, Souretis G, Papageorgiou N, et al. Impact of arterial hypertension on the eye. Curr Hypertens Rep. 2012;14(6):581–90. Li Z, Xu K, Wu S, Sun Y, Song Z, Jin D. Alcohol consumption and visual impairment in a rural northern Chinese population. Ophthalmic Epidemiol. 2014;21(6):384–90. Ozgonul C, Sertoglu E, Mumcuoglu T. Determination of visual impairment associated with alcohol consumption. Ophthalmic Epidemiol. 2015;22(2):142–3. Li Z, Xu K, Wu S, Sun Y, Song Z, Jin D, et al. Alcohol consumption and visual impairment in a rural northern Chinese population. Ophthalmic Epidemiol. 2014;21(6):384–90. Karimi S, Arabi A, Shahraki T. Alcohol and the eye. J Ophthalmic Vis Res. 2021;16(2):260–70. Silva JBS, Cristino ED, Almeida NL, Medeiros PC, Santos NAD. Effects of acute alcohol ingestion on eye movements and cognition: a double-blind, placebo-controlled study. PLoS One. 2017;12(10):e0186061. Additional Declarations No competing interests reported. Supplementary Files QuestionarieEnglishversion.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 23 Apr, 2026 Editor assigned by journal 23 Apr, 2026 Editor invited by journal 23 Apr, 2026 Submission checks completed at journal 23 Apr, 2026 First submitted to journal 23 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9482890","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":628430810,"identity":"868e910f-6d7d-4abe-b7f0-5d7011ce1877","order_by":0,"name":"Daniel Assefa Adasho¹","email":"","orcid":"","institution":"Dilla University","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"Assefa","lastName":"Adasho¹","suffix":""},{"id":628430811,"identity":"2eeb90d6-1915-4a96-8c44-fffea24bcaaf","order_by":1,"name":"Abebaye Aragaw Leminie","email":"data:image/png;base64,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","orcid":"","institution":"Addis Ababa University","correspondingAuthor":true,"prefix":"","firstName":"Abebaye","middleName":"Aragaw","lastName":"Leminie","suffix":""}],"badges":[],"createdAt":"2026-04-21 10:40:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9482890/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9482890/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108735414,"identity":"7fa8cac8-fa39-4300-8069-26e83605a394","added_by":"auto","created_at":"2026-05-07 20:07:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":15480,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence (a) and Level (b) of Visual Impairment among Hypertensive Patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9482890/v1/fee8a5375cfda7a879f3f5ea.png"},{"id":108806122,"identity":"042fd9a9-82d0-411f-91cc-7f1c128d61c8","added_by":"auto","created_at":"2026-05-08 15:27:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":24862,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTypes of Visual Impairment among Hypertensive Patients (n=168).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9482890/v1/ae5842b168a83829d1438d60.png"},{"id":108979500,"identity":"f2725edb-01e7-4ec3-935b-06ed390d9686","added_by":"auto","created_at":"2026-05-11 11:59:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":409701,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9482890/v1/235c12de-b30b-4576-bf28-b1a74cd869c6.pdf"},{"id":108976673,"identity":"8a5a9af8-e7a6-4161-9580-2122a8ac9300","added_by":"auto","created_at":"2026-05-11 11:27:44","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19293,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionarieEnglishversion.docx","url":"https://assets-eu.researchsquare.com/files/rs-9482890/v1/64b2f82605995c4f0aab977f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Visual impairment among hypertensive patients in resource-limited settings: evidence from Southern Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eVisual impairment (VI), ranging from mild loss to complete blindness, is defined as a presenting distance visual acuity of the better eye worse than 6/12 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The leading causes of VI include uncorrected refractive errors, cataract, age-related macular degeneration, glaucoma, diabetic retinopathy, corneal opacity, and trachoma, many of which are associated with hypertension (HTN) (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Hypertensive retinopathy, characterized by retinal vascular damage, develops in the later stages of hypertension (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Arteriolar constriction, vascular wall changes, cotton-wool spots, yellow hard exudates, and optic disc edema, identifiable by fundoscopic examination, are common manifestations that may result in VI.\u003c/p\u003e \u003cp\u003eGlobally, at least 2.2\u0026nbsp;billion people are affected by VI, with 26.3\u0026nbsp;million in Africa alone, and up to half of these cases are preventable (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Ethiopia ranks among countries with the highest rates of blindness (1.6%) and low vision (3.7%), of which approximately 80% are preventable or treatable (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Studies in China (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), Taiwan (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), India (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Sri Lanka (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), Malaysia (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and Nigeria (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) have consistently identified hypertension as a leading diagnosis among visually impaired populations.\u003c/p\u003e \u003cp\u003eVI significantly impacts individuals\u0026rsquo; quality of life, causing disability, cognitive decline, poor mental health, reduced productivity, and limited capacity to manage other comorbidities (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Factors influencing VI include socioeconomic and cultural status, age, gender, chronic non-communicable diseases such as HTN, obesity, diabetes mellitus, lifestyle behaviors, and educational attainment (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn resource-limited settings such as Ethiopia, eye care services are often fragmented, and routine visual screening is not systematically integrated into hypertension management. Consequently, many cases of visual impairment remain undetected until advanced or irreversible stages. Integrating regular ophthalmic screening into chronic disease care pathways could play a critical role in reducing the burden of preventable visual impairment.\u003c/p\u003e \u003cp\u003eDespite some studies in northern Ethiopia, no research has addressed the prevalence, severity, and types of VI among hypertensive patients in the southern region, which features diverse socioeconomic and cultural backgrounds. This study aims to fill this gap by assessing the visual impairment among hypertensive patients in resource-limited settings: evidence from Southern Ethiopia. The findings are expected to raise awareness among patients, families, healthcare providers, and policymakers, facilitate early diagnosis, and provide a foundation for future research in the region.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area and Period\u003c/h2\u003e \u003cp\u003eThis multicenter cross-sectional study was conducted in the Southern region of Ethiopia at Bonga Gebretsadik Shawo Memorial Hospital, Mizan Teppi University Teaching Hospital, Teppi, and Tarcha General Hospital from September 2021 to January 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample Size Determination and Study Subjects\u003c/h3\u003e\n\u003cp\u003eA total of 423 hypertensive patients aged 18 years and above, attending follow-up at the four hospitals, were included using a single-proportion formula with a 10% non-response adjustment. Diabetic, critically ill, and mentally ill patients were excluded. Participants were selected via systematic random sampling, with proportional allocation across hospitals.\u003c/p\u003e\n\u003ch3\u003eData Collection Tools and Techniques\u003c/h3\u003e\n\u003cp\u003eSociodemographic data were collected through structured questionnaires prepared for this study. Anthropometric measurements and blood pressure (BP) were measured using standard techniques after 15 minutes of rest, with a sphygmomanometer (XMEQSPHYRIAC14, 54.5 cm length \u0026times; 14 cm width).\u003c/p\u003e \u003cp\u003eVisual acuity was assessed using the Snellen illiterate \u0026ldquo;E\u0026rdquo; chart at a 6-meter distance. Color vision was tested with the Ishihara 24-plate test, with participants reading numbers from 75 cm away. A slit-lamp examination diagnosed cataracts. Intraocular pressure (IOP) measurements and perimetry assessed glaucoma. Fundus examinations using an ophthalmoscope, combined with pupil dilation via tropicamide, determined retinal health and refractive errors.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were entered and analyzed in SPSS version 26. Binary logistic regression identified factors associated with VI among hypertensive patients. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants\u0026rsquo; ages ranged from 25 to 80 years, with a median of 57 \u0026plusmn; 11 years. Females comprised 51.54% (n = 218) of the sample. Most participants were married (n = 359; 84.87%) and illiterate (n = 260; 61.47%). Farmers represented 33.10% (n = 140), and 55.79% (n = 236) had a monthly income \u0026lt; 2000 Ethiopian birr (\u003cstrong\u003eTable 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Socio-Demographic Characteristics of Study Participants (n=423)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003cp\u003e\u0026lt;40\u003c/p\u003e\n \u003cp\u003e40-64\u003c/p\u003e\n \u003cp\u003e\u0026gt;64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;20 (4.73)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;233 (55.08)\u003c/p\u003e\n \u003cp\u003e170 (40.19) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003cp\u003eCivil Servant\u003c/p\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e140 (33.10)\u003c/p\u003e\n \u003cp\u003e98(23.17) \u0026nbsp; \u0026nbsp; \u0026nbsp;105(24.82) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;23 (5.44)\u003c/p\u003e\n \u003cp\u003e57 (13.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e205 (48.46)\u003c/p\u003e\n \u003cp\u003e218 (51.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eMonthly Income (Birr)\u003c/p\u003e\n \u003cp\u003e\u0026lt;2000\u003c/p\u003e\n \u003cp\u003e2000-5000\u003c/p\u003e\n \u003cp\u003e\u0026gt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e236 (55.79)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;86(20.33) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;101 (23.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e359 (84.87)\u003c/p\u003e\n \u003cp\u003e13 (3.07)\u003c/p\u003e\n \u003cp\u003e25 (5.91)\u003c/p\u003e\n \u003cp\u003e26 (6.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003cp\u003ePrimary and Junior\u003c/p\u003e\n \u003cp\u003eSecondary and College\u003c/p\u003e\n \u003cp\u003eUniversity and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e260 (61.47)\u003c/p\u003e\n \u003cp\u003e75 (17.73)\u003c/p\u003e\n \u003cp\u003e35 (8.27)\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e53 \u0026nbsp; \u0026nbsp;12.53)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHalf of the participants (50.35%, n = 213) had hypertension for \u0026lt;5 years; 87.94% (n = 372) had no comorbid diseases. Most had no ocular trauma (88.89%), no ocular infection (91.02%), and no family history of eye problems (97.64%). The majority (70.92%) had a BMI of 18.5\u0026ndash;24.99 kg/m\u0026sup2; (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Clinical Characteristics of Study Participants (n=423)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"95%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eDuration of HTN\u003c/p\u003e\n \u003cp\u003e\u0026lt; 5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge; 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e213 (50.35) \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e210 (49.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eFamily history of eye problems\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (2.36) \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e413 (97.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eDisease other than HTN\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51 (12.06) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e372 (87.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\n \u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n \u003cp\u003e18.5-24.99\u003c/p\u003e\n \u003cp\u003e25-29.99\u003c/p\u003e\n \u003cp\u003e\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (2.84) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e300 (70.92) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 1(23.88) \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (2.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eHistory of ocular trauma\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47 (11.11) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e376 (88.89) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003esBP (mmHg)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 140\u003c/p\u003e\n \u003cp\u003e\u0026ge; 140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e146 (34.52)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e277 (65.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eHistory of ocular infection\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38 (8.98) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e385 (91.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003edBP (mmHg)\u003c/p\u003e\n \u003cp\u003e\u0026lt;90\u003c/p\u003e\n \u003cp\u003e\u0026ge;90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e224 (52.96)\u003c/p\u003e\n \u003cp\u003e199 (47.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI: Body mass index, dBP: Diastolic blood pressure, sBP: Systolic blood pressure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBehavioral Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSleep duration was 5\u0026ndash;8 hours in 64.3% of participants. Exposure to television was reported by 43.97%, with most viewing from \u0026gt;2 meters. Mobile phone use was rare in 38.53%. Smoking and chewing were negligible. Alcohol intake was reported by 84.4%, with 12.32% reporting intake in the last 30 days (\u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Behavioral Characteristics of Study Participants (n=423)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eDuration of sleep (Hours)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 5\u003c/p\u003e\n \u003cp\u003e5-8\u003c/p\u003e\n \u003cp\u003e\u0026gt;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (2.36)\u003c/p\u003e\n \u003cp\u003e272 (64.30)\u003c/p\u003e\n \u003cp\u003e141 (33.33)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003eEver alcohol intake\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e357 (84.40)\u003c/p\u003e\n \u003cp\u003e66 (15.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eExposure for TV\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;186 (43.97)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;237 (56.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003eCurrent alcohol intake\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (12.32)\u003c/p\u003e\n \u003cp\u003e313 (87.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eExposure distance (Meter)\u003c/p\u003e\n \u003cp\u003e\u0026lt;2\u003c/p\u003e\n \u003cp\u003e\u0026ge;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62 (33.33)\u003c/p\u003e\n \u003cp\u003e124 (66.67) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003eType of alcohol in the last 30 days\u003c/p\u003e\n \u003cp\u003eBeer\u003c/p\u003e\n \u003cp\u003eTej/Tela\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 (56.82)\u003c/p\u003e\n \u003cp\u003e19 (43.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eMobile phone use\u003c/p\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003cp\u003eFrequently\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (9.46)\u003c/p\u003e\n \u003cp\u003e62 (14.66)\u003c/p\u003e\n \u003cp\u003e60 (14.18)\u003c/p\u003e\n \u003cp\u003e163 (38.53)\u003c/p\u003e\n \u003cp\u003e98 (23.17) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003eCigarette smoking\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.24)\u003c/p\u003e\n \u003cp\u003e422 (99.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003eChat chewing\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (0.95)\u003c/p\u003e\n \u003cp\u003e419 \u0026nbsp;(99.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eVisual Impairments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 39.7% (n = 168) of participants were visually impaired (\u003cstrong\u003eFigure 1a\u003c/strong\u003e). Among these, 38.7% had mild, 44.1% moderate, 11.9% severe VI, and 5.4% were blind (\u003cstrong\u003eFigure 1b\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCataract (36.3%) and glaucoma (25%) were the most frequent types, followed by uncorrected refractive error (16.7%), color blindness (9.5%), optic neuropathy (7.1%), and hypertensive retinopathy (5.4%) (\u003cstrong\u003eFigure 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors Associated with Visual Impairment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiple logistic regression revealed that duration of HTN, history of ocular trauma, and alcohol intake were significantly associated with VI. Hypertensive patients with \u0026ge;5 years of HTN were 3.73 times more likely to have VI (AOR: 3.73, 95% CI: 2.32\u0026ndash;5.99). History of ocular trauma increased the odds by 3.84 (AOR: 3.84, 95% CI: 1.7\u0026ndash;8.71), and alcohol intake increased the odds by 2.27 (AOR: 2.27, 95% CI: 1.12\u0026ndash;4.59) (\u003cstrong\u003eTable 4\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eTable 4: Bivariable and multivariable binary logistic regression analysis (n=423)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eVisual impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eYes (%) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eCOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eAOR (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e\u0026lt;40\u003c/p\u003e\n \u003cp\u003e40-64\u003c/p\u003e\n \u003cp\u003e\u0026gt;64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(20) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;16(80)\u003c/p\u003e\n \u003cp\u003e73(31.33) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 160(68.67)\u003c/p\u003e\n \u003cp\u003e91(53.53) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 79(46.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.83\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.75(0.17-3.25)\u003c/p\u003e\n \u003cp\u003e2.51(0.58-10.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.699 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.216\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003cp\u003eCivil Servant\u003c/p\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e65(46.43) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 75(53.57)\u003c/p\u003e\n \u003cp\u003e33(33.67) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 65(66.33)\u003c/p\u003e\n \u003cp\u003e35(33.33) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 70(66.67)\u003c/p\u003e\n \u003cp\u003e8(34.78) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 15(65.22)\u003c/p\u003e\n \u003cp\u003e27(47.37) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30(52.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.73\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.02\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.07\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1.25(0.59-2.65)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.78(0.37-1.61)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.96(0.29-3.22)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 0.8(0.36-1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003cp\u003e0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eMonthly Income (Birr)\u003c/p\u003e\n \u003cp\u003e\u0026lt;2000\u003c/p\u003e\n \u003cp\u003e2000-5000\u003c/p\u003e\n \u003cp\u003e\u0026gt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e104(44.07) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 132(55.93)\u003c/p\u003e\n \u003cp\u003e23(26.74) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 63(73.26)\u003c/p\u003e\n \u003cp\u003e41(40.59) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 60(59.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.15\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.53\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1.51(0.78-2.91)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.61(0.29-1.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003cp\u003e0.201\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eDuration of HTN\u003c/p\u003e\n \u003cp\u003e\u0026lt; 5 years\u003c/p\u003e\n \u003cp\u003e\u0026ge; 5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53(24.88) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 160(75.12)\u003c/p\u003e\n \u003cp\u003e115(54.76) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 95(45.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;1.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3.73(2.32-5.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eHistory of ocular trauma\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28(59.57) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 19(40.43)\u003c/p\u003e\n \u003cp\u003e140(37.23) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 236(62.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2.48\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3.84(1.7-8.71)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eDuration of sleep (Hours)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 5\u003c/p\u003e\n \u003cp\u003e5-8\u003c/p\u003e\n \u003cp\u003e\u0026gt;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(40) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 6(60)\u003c/p\u003e\n \u003cp\u003e91(33.46) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 181(66.54)\u003c/p\u003e\n \u003cp\u003e73(51.77) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 68(48.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.33\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.14(0.45-10.13)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1.00\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1.45(0.84-2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.338 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eExposure for TV\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61(32.8) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 125(67.2)\u003c/p\u003e\n \u003cp\u003e107(45.15) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 130(54.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.59\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.72(0.36-1.47)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.370 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eMobile phone use\u003c/p\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003cp\u003eFrequently\u003c/p\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12(30) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 28(70)\u003c/p\u003e\n \u003cp\u003e20(32.26) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 42(67.74)\u003c/p\u003e\n \u003cp\u003e21(35) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 39(65)\u003c/p\u003e\n \u003cp\u003e72(44.17) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 91(55.83)\u003c/p\u003e\n \u003cp\u003e43(43.88) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 55(56.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.55\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.61\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.69\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.01\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.59(0.21-1.68)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1.17(0.47-2.93)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.90(0.35-2.29)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1.17(0.65-2.11)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003cp\u003e0.742\u003c/p\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003cp\u003e0.604 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 193px;\"\u003e\n \u003cp\u003eAlcohol intake\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e152(42.58) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 205(57.42)\u003c/p\u003e\n \u003cp\u003e16(24.24) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 50(75.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 2.32\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2.27(1.12-4.59)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.023 *\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCOR: Crude odds ratio, AOR: Adjusted odds ratio, CI = Confidence Interval. *, and ** indicates statistically significant difference at p\u0026lt; 0.05 and p\u0026lt;0.01, respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, the prevalence of visual impairment (VI) among hypertensive patients was 39.72% (95% CI: 27.1\u0026ndash;37.1), which is considerably higher than previous reports from Taiwan (11%) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), India (30.1%) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Sri Lanka (21.3%) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), Afghanistan (22.6%) (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and Saudi Arabia (13.9%) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Several factors could explain this higher prevalence observed in our study. Firstly, the definition of VI differed between studies. In the present study, VI was defined as a presenting visual acuity of less than 6/12 in the better eye, whereas in the aforementioned studies, VI was commonly defined as visual acuity less than 6/18. This stricter cut-off in our study likely contributed to a higher observed prevalence. Secondly, the method of assessment differed; we used the visual acuity of the better eye, which tends to yield higher prevalence rates compared with best-corrected visual acuity used in studies from India (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), Sri Lanka (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and Saudi Arabia (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOther plausible explanations include differences in socioeconomic status, educational level, and quality of life. In Taiwan (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), India (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), and Sri Lanka (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), the studied populations were more educated or employed in professional roles, whereas most participants in our study were illiterate farmers, a factor that may exacerbate the impact of hypertension on visual health. Age differences also play a role: prior studies often involved narrower age ranges, whereas our participants ranged from 18 to 80 years, increasing the likelihood of age-related ocular complications.\u003c/p\u003e \u003cp\u003eConversely, the prevalence of VI in our study was lower than that reported in Nigeria (56%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), Malaysia (46%) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and the Central African Republic (70.8%) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Differences in participant age could partially explain these discrepancies, as the prior studies included older populations (\u0026ge;\u0026thinsp;60 years), whereas our study involved adults aged 18 years and above. Age-related deterioration in ocular tissues can increase susceptibility to VI. Additionally, previous studies were population-based, while our study was hospital-based, which may yield relatively lower prevalence estimates. Notably, our prevalence closely aligns with that reported in South Africa (36.1%) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), indicating some consistency in sub-Saharan African hospital-based settings.\u003c/p\u003e \u003cp\u003eConsistent with global evidence, cataracts were identified as the leading cause of VI in this study, accounting for 36.3% of cases. Similar findings were reported in Nigeria (37.6%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), Eastern Taiwan (45%) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), China (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), India (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), and Afghanistan (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The slightly lower prevalence in our study may reflect the inclusion of younger participants (18\u0026thinsp;+\u0026thinsp;years) compared to other studies that focused on individuals aged 60 years and above. Advancing age likely exacerbates both hypertension-related ocular complications and cataract formation.\u003c/p\u003e \u003cp\u003eGlaucoma emerged as the second leading cause of VI (25%), consistent with studies in Nigeria (32.8%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and China (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), highlighting its global relevance among hypertensive populations. Uncorrected refractive error accounted for 16.7% of VI cases, in agreement with findings from China (14.5%) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and India (27%) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), though lower than the 36% reported in Saudi Arabia (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This discrepancy may reflect differences in the relative contribution of other ocular pathologies such as cataracts and glaucoma. Hypermetropia was the most frequent refractive error (60.7%), followed by myopia (32.1%) and astigmatism (7.2%), consistent with Saudi Arabian data (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eColor blindness affected 9.5% of visually impaired participants and 3.8% overall. Few studies examine color blindness in conjunction with other VI types, limiting comparative analysis. However, similar prevalence has been reported in Japan (4.37%) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), the USA (4.2%) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and Greece (3%) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), with slightly higher rates in Iraq (8.47%) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Differences may be influenced by racial and genetic factors.\u003c/p\u003e \u003cp\u003eHypertensive retinopathy, a direct consequence of sustained hypertension, accounted for 5.1% of VI, comparable to findings in Nigeria (3.4%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and Canada (8.6%) (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Optic neuropathy was observed in 7.1% of participants, closely aligning with Nigerian data (6.8%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study demonstrated a significant association between ocular trauma and VI, with affected participants being 3.84 times more likely to develop VI. This is consistent with studies in China (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), Malawi (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and Saudi Arabia (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), emphasizing that even non-disease-related eye injuries contribute to long-term visual impairment. Trauma may result in corneal ulcers, eyelid injury, or structural damage to the eye, leading to permanent vision loss or blindness (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, participants with a hypertension duration of five or more years had a 3.73-fold higher likelihood of VI, consistent with findings from Eastern Taiwan (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), Bangladesh (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), India (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), and Pakistan (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Prolonged hypertension leads to retinal vascular remodeling, arteriosclerosis, and changes in precapillary sphincter size, reducing perfusion and choroidal blood flow, increasing intraocular pressure, and ultimately contributing to irreversible vision loss (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlcohol intake was another independent predictor of VI, with a 2.27-fold increased risk among users. This relationship aligns with studies from China (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) and Turkey (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Alcohol may impair visual processing by modulating neurotransmitter systems, particularly GABAergic pathways, across retinal cells, the lateral geniculate nucleus, superior colliculus, and visual cortex. By hyperpolarizing neurons and slowing transmission of visual information, alcohol can diminish visual acuity and disrupt ocular motor control, affecting saccades and fixations, and contributing to color perception deficits and contrast sensitivity reduction (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, this study provides critical insight into the burden of visual impairment among hypertensive patients in southern Ethiopia. It highlights the need for early screening, preventive interventions, and awareness programs, especially in developing countries where access to eye care may be limited. By documenting the prevalence, causes, and risk factors of VI in this population, the study contributes valuable baseline data to the global literature and underscores the intersection of chronic non-communicable diseases and visual health in resource-limited settings.\u003c/p\u003e \u003cp\u003eStrength of the study\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths of the Study\u003c/h2\u003e \u003cp\u003eThis study has several important strengths. It was conducted across multiple hospitals in southern Ethiopia, which enhances the representativeness of the findings compared to single-center studies. In addition, comprehensive ophthalmic examinations, including visual acuity assessment, slit-lamp evaluation, intraocular pressure measurement, and fundus examination, were performed, improving the accuracy of visual impairment diagnosis. By focusing on hypertensive patients, a high-risk population, the study provides clinically relevant evidence that can inform integrated management of chronic diseases. Furthermore, the identification of modifiable risk factors such as alcohol intake and ocular trauma offers practical implications for prevention strategies. The study also contributes valuable context-specific data from a resource-limited setting where evidence on visual impairment among hypertensive patients is scarce.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eThe study was cross-sectional, which doesn\u0026rsquo;t establish the causal relationships between hypertension and visual impairments. As the study was hospital-based, the results may not be generalizable to the broader community and may overestimate the true prevalence due to selection bias. In addition, visual impairments were assessed using presenting visual acuity rather than best-corrected visual acuity, which may have led to an overestimation of prevalence due to uncorrected refractive errors. Finally, although multivariable analysis was conducted, residual confounding from unmeasured factors such as dietary habits and access to eye care services cannot be ruled out. Despite these limitations, the study provides valuable insight into the burden and determinants of visual impairment among hypertensive patients in a resource-limited setting. Thus, these limitations identified in this study will be addressed in future large-scale studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths of the Study\u003c/h2\u003e \u003cp\u003eThis study has several important strengths. It was conducted across multiple hospitals in southern Ethiopia, which enhances the representativeness of the findings compared to single-center studies. In addition, comprehensive ophthalmic examinations, including visual acuity assessment, slit-lamp evaluation, intraocular pressure measurement, and fundus examination, were performed, improving the accuracy of visual impairment diagnosis. By focusing on hypertensive patients, a high-risk population, the study provides clinically relevant evidence that can inform integrated management of chronic diseases. Furthermore, the identification of modifiable risk factors such as alcohol intake and ocular trauma offers practical implications for prevention strategies. The study also contributes valuable context-specific data from a resource-limited setting where evidence on visual impairment among hypertensive patients is scarce.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the Study\u003c/h2\u003e \u003cp\u003eThe study was cross-sectional, which doesn\u0026rsquo;t establish the causal relationships between hypertension and visual impairments. As the study was hospital-based, the results may not be generalizable to the broader community and may overestimate the true prevalence due to selection bias. In addition, visual impairments were assessed using presenting visual acuity rather than best-corrected visual acuity, which may have led to an overestimation of prevalence due to uncorrected refractive errors. Finally, although multivariable analysis was conducted, residual confounding from unmeasured factors such as dietary habits and access to eye care services cannot be ruled out. Despite these limitations, the study provides valuable insight into the burden and determinants of visual impairment among hypertensive patients in a resource-limited setting. Thus, these limitations identified in this study will be addressed in future large-scale studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNearly two-fifths of hypertensive patients in southern Ethiopia were visually impaired. Cataract and glaucoma were the leading causes. Duration of hypertension, history of ocular trauma, and alcohol intake were significant risk factors. This study contributes to the literature by providing region-specific evidence from southern Ethiopia, highlighting modifiable and non-modifiable risk factors for VI among hypertensive patients, and emphasizing the public health relevance in resource-limited settings.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eGovernment and stakeholders should prioritize interventions addressing hypertension-induced VI. Healthcare providers should educate hypertensive patients on eye care and facilitate early detection. Future research should explore disease mechanisms and conduct community-based studies to inform preventive strategies.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBlood Pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHTN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGABA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGamma-aminobutyric acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntraocular pressure\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLateral geniculate nucleus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMIC\u003cb\u003es\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow and middle-income countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSES\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSocioeconomic status\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSuperior colliculus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eURE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUncorrected refractive error\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVisual impairment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":" Statements and Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;There was no funding or sponsoring organization for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare that they have no competing interests and have agreed to submit the manuscript to this journal\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The study was carried out after ethical clearance and approval were obtained from the Research and Ethical Review Committee of the Department of Physiology, College of Health Sciences, and Addis Ababa University. Official letters from the department were sent to hospitals to get permission. The study was performed per the Declaration of Helsinki, ethical principles for medical research involving human subjects. The study participants were also informed that they had the right to withdraw from the study at any time. The participants\u0026rsquo; privacy was maintained by interviewing in a private place, and they were informed that there would not be any incentive or harm for their participation in the study. Participants\u0026rsquo; identity was kept confidential throughout the data collection and analysis process, while the information was used only for the objectives of the study. All study participants who had VI after examinations were linked to the ophthalmology unit for the appropriate management and follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from each patient after she/ he was informed about the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDaniel Assefa Adasho conceived and designed the study, participated in data collection, analysis, and interpretation, and drafted the initial manuscript. Abebaye Aragaw Leminie contributed to the study design, supervised the research process, interpreted results, performed critical revision of the manuscript for important intellectual content, and approved the final version for publication. Both authors read and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Addis Ababa University and Dilla University for their institutional support. We are also grateful to the administrative staff and healthcare professionals at Bonga Gebretsadik Shawo Memorial Hospital, Mizan Teppi University Teaching Hospital, and Tarcha General Hospital for their cooperation during data collection. Our sincere appreciation goes to the data collectors and study participants for their valuable time and willingness to participate.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Blindness and vision impairment [Internet]. 2021 [cited 2026 Apr 9]. Available from: https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment \u003c/li\u003e\n\u003cli\u003eYoung Azuamah AN, Esenwah EC. Visual acuity and impairment among hypertensive adults in Okagwe Ohafia, Abia State, Nigeria. Int J Adv Med Sci Appl Res. 2011;1:1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eCongdon N, O\u0026apos;Colmain B, Klaver CC, Klein R, Mu\u0026ntilde;oz B. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004;122:477\u0026ndash;85. \u003c/li\u003e\n\u003cli\u003eHe Y, Nie A, Pei J, Ji Z, Jia J, Liu H, et al. Prevalence and causes of visual impairment in population more than 50 years old: the Shaanxi Eye Study. Medicine (Baltimore). 2020;99(20):e20109. \u003c/li\u003e\n\u003cli\u003eHu JY, Yan L, Chen YD, Du XH, Li TT, Liu DA, et al. Population-based survey of prevalence, causes, and risk factors for blindness and visual impairment in an aging Chinese metropolitan population. Int J Ophthalmol. 2017;10(1):140\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKahloun R, Jelliti B, Zaouali S, Attia S, Ben Yahia S, Resnikoff S, et al. Prevalence and causes of visual impairment in diabetic patients in Tunisia, North Africa. Eye (Lond). 2014;28(8):986\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eMaake MM, Oduntan OA. Prevalence and causes of visual impairment in patients seen at Nkhensani Hospital Eye Clinic, South Africa. Afr J Prim Health Care Fam Med. 2015;7(1):728. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization Regional Office for Africa. Eye health [Internet]. 2021 [cited 2026 Apr 9]. Available from: https://www.afro.who.int/health-topics/eye-health \u003c/li\u003e\n\u003cli\u003eGashaw M, Janakiraman B, Minyihun A, Jember G, Sany K. Self-reported fall and associated factors among adult people with visual impairment in Gondar, Ethiopia: a cross-sectional study. BMC Public Health. 2020;20(1):498. \u003c/li\u003e\n\u003cli\u003eCherinet FM, Tekalign SY, Anbesse DH, Bizuneh ZY. Prevalence and associated factors of low vision and blindness among patients attending St. Paul\u0026apos;s Hospital Millennium Medical College, Addis Ababa, Ethiopia. BMC Ophthalmol. 2018;18(1):232. \u003c/li\u003e\n\u003cli\u003eYan X, Chen L, Yan H. Socio-economic status, visual impairment and the mediating role of lifestyles in developed rural areas of China. PLoS One. 2019;14(4):e0215329. \u003c/li\u003e\n\u003cli\u003eWang WL, Chen N, Sheu MM, Wang JH, Hsu WL, Hu YJ. The prevalence and risk factors of visual impairment among the elderly in Eastern Taiwan. Kaohsiung J Med Sci. 2016;32(9):475\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eMarmamula S, Barrenakala NR, Challa R, Kumbham TR, Modepalli SB, Yellapragada R, et al. Prevalence and risk factors for visual impairment among elderly residents in homes for the aged in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES). Br J Ophthalmol. 2021;105(1):32\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eAbeysena C. Prevalence of visual impairment among adults aged forty years and above in a medical officer of health area in Sri Lanka: cross-sectional study. Int Arch Public Health Community Med. 2018;2:1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eFalahaty K. Disability among elderly people with visual impairment in two welfare homes in Malaysia. Biomed Pharmacol J. 2015;8(2):1369\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eMerrie YA, Tegegne MM, Munaw MB, Alemu HW. Prevalence and associated factors of visual impairment among school-age children in Bahir Dar City, Northwest Ethiopia. Clin Optom (Auckl). 2019;11:135\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eAbdianwall MH, Dogan BG. Prevalence of visual impairment and related factors in Nangarhar Province of Afghanistan: a cross-sectional study. Int J Ophthalmol. 2018;11(12):1968\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eAddo EK, Akuffo KO, Sewpaul R, Dukhi N, Agyei-Manu E, Asare AK, et al. Prevalence and associated factors of vision loss in the South African National Health and Nutrition Examination Survey (SANHANES-1). BMC Ophthalmol. 2021;21(1):1. \u003c/li\u003e\n\u003cli\u003eAn Y, Joo CK. The U-shaped association between self-reported sleep duration and visual impairment in Korean adults: a population-based study. Sleep Med. 2016;26:306\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eNuertey BD, Amissah-Arthur KN, Addai J, Adongo V, Nuertey AD, Kabutey C, et al. Prevalence, causes, and factors associated with visual impairment and blindness among registered pensioners in Ghana. J Ophthalmol. 2019;2019:1717464. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global data on visual impairments [Internet]. 2012 [cited 2026 Apr 9]. Available from: https://www.who.int \u003c/li\u003e\n\u003cli\u003eAl-Shaaln FF, Bakrman MA, Ibrahim AM, Aljoudi AS. Prevalence and causes of visual impairment among Saudi adults attending primary health care centers in northern Saudi Arabia. Ann Saudi Med. 2011;31(5):473\u0026ndash;80. \u003c/li\u003e\n\u003cli\u003eGbessemehlan A, Helmer C, Delcourt C, Boumediene F, Ndamba-Bandzouzi B, Melissa P. Cardiovascular health and near visual impairment among older adults in the Republic of Congo: a population-based study. J Gerontol A Biol Sci Med Sci. 2020;76(5):842\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eMabaso RG, Oduntan OA. Risk factors for visual impairment and blindness among black adult diabetics receiving treatment at government healthcare facilities in Mopani District, Limpopo province, South Africa. Afr J Prim Health Care Fam Med. 2014;6(1):E1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eShoji T, Sato H, Chihara E, Sakurai Y. Are middle-age blood pressure levels related to color vision impairment? The Okubo Color Study. Am J Hypertens. 2015;28(1):1\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eMorton WE. Hypertension and color blindness in young men. Arch Intern Med. 2015;175:1\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003ePapaconstantinou D, Georgalas I, Kalantzis G, Karmiris E, Koutsandrea C, Diagourtas A, et al. Acquired color vision and visual field defects in patients with ocular hypertension and early glaucoma. Clin Ophthalmol. 2009;3:251\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKarim JK, Salem MA. Prevalence of congenital red-green color vision defects among various ethnic groups of students in Erbil City. Jordan J Biol Sci. 2013;6(3):235\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eFoster BJ, Ali H, Mamber S, Polomeno RC, Mackie AS. Prevalence and severity of hypertensive retinopathy in children. Clin Pediatr (Phila). 2009;48(9):926\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eXu C, Teng C, Chow J, Liu J, Li L, Maslin J. Risk factors for visual impairment associated with corneal disease in Southern China. Clin Ophthalmol. 2016;10:777\u0026ndash;83. \u003c/li\u003e\n\u003cli\u003eZungu T, Mdala S, Manda C, Twabi HS, Kayange P. Characteristics and visual outcome of ocular trauma patients at Queen Elizabeth Central Hospital in Malawi. PLoS One. 2021;16(3):e024xxxx. \u003c/li\u003e\n\u003cli\u003ePradhan E. Ocular trauma prevention. Nepal J Ophthalmol. 2017;8:107\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eAghadoost D. Ocular trauma overview. Arch Trauma Res. 2014;3(2):e21639. \u003c/li\u003e\n\u003cli\u003eMondal R, Matin M, Rani M, Hossain M, Shaha A, Singh R. Prevalence and risk factors of hypertensive retinopathy in hypertensive patients. J Hypertens Open Access. 2017;6:1\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eAsMK Team. Hypertensive retinopathy. 2020. \u003c/li\u003e\n\u003cli\u003eBahoo LA, Khalid MS, Haq M. Relationship between duration of hypertension and vision problem in hypertensive patients: a cross-sectional survey. Med Forum Mon. 2019;30:103\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKatsi V, Marketou M, Vlachopoulos C, Tousoulis D, Souretis G, Papageorgiou N, et al. Impact of arterial hypertension on the eye. Curr Hypertens Rep. 2012;14(6):581\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eLi Z, Xu K, Wu S, Sun Y, Song Z, Jin D. Alcohol consumption and visual impairment in a rural northern Chinese population. Ophthalmic Epidemiol. 2014;21(6):384\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eOzgonul C, Sertoglu E, Mumcuoglu T. Determination of visual impairment associated with alcohol consumption. Ophthalmic Epidemiol. 2015;22(2):142\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eLi Z, Xu K, Wu S, Sun Y, Song Z, Jin D, et al. Alcohol consumption and visual impairment in a rural northern Chinese population. Ophthalmic Epidemiol. 2014;21(6):384\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eKarimi S, Arabi A, Shahraki T. Alcohol and the eye. J Ophthalmic Vis Res. 2021;16(2):260\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eSilva JBS, Cristino ED, Almeida NL, Medeiros PC, Santos NAD. Effects of acute alcohol ingestion on eye movements and cognition: a double-blind, placebo-controlled study. PLoS One. 2017;12(10):e0186061.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Visual impairment, Glaucoma, Cataract, Southern Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-9482890/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9482890/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eVisual impairment (VI) is an emerging global health challenge and is strongly associated with hypertension (HTN). In low- and middle-income countries such as Ethiopia, where visual health problems are increasingly severe, understanding the burden of VI among hypertensive patients is critical to inform prevention and treatment strategies.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to determine visual impairment among hypertensive patients in resource-limited settings: evidence from Southern Ethiopia\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA multicenter, institution-based cross-sectional study was conducted among 423 randomly selected hypertensive patients. Sociodemographic and clinical data, including blood pressure and intraocular pressure, were collected. Comprehensive ocular assessments\u0026mdash;visual acuity, perimetry, color vision testing, slit-lamp evaluation, and fundus examination\u0026mdash;were performed. Data were analyzed using SPSS version 26, with logistic regression identifying factors associated with VI. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall prevalence of VI was 39.7% (n\u0026thinsp;=\u0026thinsp;168; 95% CI: 27.1\u0026ndash;37.1), with 38.7%, 44.1%, and 11.9% of patients showing mild, moderate, and severe impairment, respectively. Complete blindness was observed in 5.4% of participants. Cataract (36.3%) and glaucoma (25%) were the leading causes of VI. Significant predictors included history of ocular trauma (AOR\u0026thinsp;=\u0026thinsp;3.84, 95% CI: 1.7\u0026ndash;8.71, P\u0026thinsp;=\u0026thinsp;0.001), hypertension duration\u0026thinsp;\u0026ge;\u0026thinsp;5 years (AOR\u0026thinsp;=\u0026thinsp;3.73, 95% CI: 2.32\u0026ndash;5.99, P\u0026thinsp;=\u0026thinsp;0.001), and alcohol intake (AOR\u0026thinsp;=\u0026thinsp;2.27, 95% CI: 1.12\u0026ndash;4.59, P\u0026thinsp;=\u0026thinsp;0.023).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNearly two-fifths of hypertensive patients in southern Ethiopia were visually impaired, primarily due to cataract. Ocular trauma, prolonged hypertension, and alcohol use were key predictors, highlighting the need for early detection, integrated eye care, and targeted public health interventions in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Visual impairment among hypertensive patients in resource-limited settings: evidence from Southern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 20:07:29","doi":"10.21203/rs.3.rs-9482890/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-23T13:58:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-23T13:57:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-23T12:20:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-23T11:58:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-04-23T11:06:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e00c73e9-9234-4605-984d-566694783321","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T20:07:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 20:07:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9482890","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9482890","identity":"rs-9482890","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}