Association of vision loss in glaucoma and age-related macular degeneration with IADL disability

Abstract

Purpose: To determine if glaucoma and/or age-related macular degeneration (AMD) are associated with disability in instrumental activities of daily living (IADLs).

Methods: Glaucoma subjects (n = 84) with bilateral visual field (VF) loss and AMD subjects (n = 47) with bilateral or severe unilateral visual acuity (VA) loss were compared with 60 subjects with normal vision (controls). Subjects completed a standard IADL disability questionnaire, with disability defined as an inability to perform one or more IADLs unassisted.

Results: Disability in one or more IADLs was present in 18.3% of controls as compared with 25.0% of glaucoma subjects (P = 0.34) and 44.7% of AMD subjects (P = 0.003). The specific IADL disabilities occurring more frequently in both AMD and glaucoma subjects were preparing meals, grocery shopping, and out-of-home travelling (P < 0.05 for both). In multivariate logistic regression models run adjusting for age, sex, mental status, comorbidity, and years of education, AMD (odds ratio [OR] = 3.4, P = 0.02) but not glaucoma (OR = 1.4, P = 0.45) was associated with IADL disability. However, among glaucoma and control patients, the odds of IADL disability increased 1.6-fold with every 5 dB of VF loss in the better-seeing eye (P = 0.001). Additionally, severe glaucoma subjects (better-eye MD worse than -13.5 dB) had higher odds of IADL disability (OR = 4.2, P = 0.02). Among AMD and control subjects, every Early Treatment of Diabetic Retinopathy Study line of worse acuity was associated with a greater likelihood of IADL disability (OR = 1.3).

Conclusions: VA loss in AMD and severe VF loss in glaucoma are associated with self-reported difficulties with IADLs. These limitations become more likely with increasing magnitude of VA or VF loss.

Figure 1.

Association of IADL disability with disease severity. Mean better-eye MD was +0.2 dB (IQR = −0.6 to +0.9 dB) in controls (n = 60), −3.8 dB (IQR = −4.8 to −3.2 dB) in the mild glaucoma group (n = 28), −8.0 dB (IQR = −11.1 to −6.9 dB) in the moderate glaucoma group (n = 28), and −19.5 dB (IQR = −16.7 to −25.5 dB) in the severe glaucoma group (n = 28). Mean logMAR better-eye VA was +0.08 (IQR = 0 to +0.16) for controls (n = 60), 0.18 (IQR = 0.1 to 0.28) for the better VA AMD group (n = 23) and 0.65 (IQR = 0.52 to 0.76) for the worse VA AMD group (n = 24). *OR = 4.2 (95% CI 1.3 – 13.9) vs. controls after adjustment for health and demographic covariates. **OR = 3.7 (95% CI 1.1 – 13.0) vs. controls after adjustment for health and demographic covariates.

Figure 2.

Modeled probability of IADL disability by severity of vision loss. Circles reflect outcomes for individual patients, who either had IADL disability (probability = 1) or did not have IADL disability (probability = 0). Models reflect probability adjusted for age, education, sex, comorbidity, and MMSE score. *Glaucoma and control subjects only. **AMD and control subjects only.