Nonvisual Factors Affect Visual Ability in Elderly Patients

Larry Hand

June 23, 2014

Visual ability is affected by a number of nonvisual factors in elderly patients seeking outpatient low vision rehabilitation (LVR), according to an article published online June 19 in JAMA Ophthalmology.

Walking ability, using a computer, depression, and cognitive function play an important role in setting up an LVR plan for individual patients, write Judith E. Goldstein, OD, from the Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues. The researchers analyzed the records of patients from 28 clinics in the United States.

The researchers recruited 779 patients between April 25, 2008, and May 2, 2011, as part of the Low Vision Rehabilitation Outcomes Study (LVROS). The study population was 67% women and had a mean age of 76.4 years.

To expand their research base for comparison, the researchers added a legacy sample of 2398 patients from the Wilmer Eye Institute LVR service, recruited from April 4, 2001, through September 14, 2007.

The researchers assessed LVR outcomes through an activity inventory (AI) tool, a questionnaire administered at baseline by computer-assisted patient interview. During the interview, patients rated activities in terms of importance of personal goals and personal difficulty in achieving the goals. The LVR targets only items deemed important and difficult. The AI covers 50 goals and 460 tasks within the goals.

After LVR, researchers assessed patients' visual ability, a person's ability to perform tasks dependent on vision, and functional ability, a person's ability to perform tasks with ease.

Among the 779 LVROS patients, visual acuity was the strongest predictor (P < .001) of visual ability. The researchers also found, however, that physical ability was independently associated with overall visual ability (P < .001), mobility, and visual motor function; depression consistently and independently affected overall visual ability (P < .001) and all functional areas; and cognition affected only reading and mobility (P < .001).

Visual acuity, depression, physical ability, and cognition accounted for more than a third of the variance in visual ability, the researchers write, but the remaining unexplained variance needs more study.

"Our findings indicate that the number of comorbidities is not a good predictor of visual ability," they write. "Rather, measures of the patients' ability to perform activities, such as walking and climbing steps, is a significant predictor of visual ability and should be used rather than the number of comorbidities when assessing the effects of physical functioning."

This research was supported by the National Eye Institute and Reader's Digest Partners for Sight Foundation. The authors have disclosed no relevant financial relationships.

JAMA Ophthalmol. Published online June 19, 2014. Abstract

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