Original Articles
Influence of age-related maculopathy on visual functioning and health-related quality of life

https://doi.org/10.1016/S0002-9394(99)00169-5Get rights and content

Abstract

PURPOSE: To describe the influence of age-related maculopathy on visual functioning and health-related quality of life.

METHODS: A prospective, cross-sectional, observational cohort sample of 201 persons with various stages of age-related maculopathy was recruited from the Massachusetts Eye and Ear Infirmary as part of a longitudinal study of age-related macular degeneration. Persons were considered to have age-related maculopathy if one or more of the following clinical characteristics were present: drusen, retinal pigment epithelial changes, geographic atrophy, or evidence of exudative disease. Median corrected visual acuity for this sample was 20/25 in the better eye, with all subjects having 20/200 or better visual acuity in at least one eye at baseline. All participants underwent a comprehensive ophthalmologic examination with a dilated pupil. In addition to the usual clinical data collection, severity of age-related maculopathy was graded by an ophthalmologist who used standard clinical criteria and was masked to the participants’ descriptions of visual functioning and health-related quality of life. All participants completed an interview that included the Activities of Daily Vision Scale, a survey designed to assess difficulties with routine daily activities that require vision, and the Short Form-36 Health Survey, a generic measure of multidimensional health-related quality of life.

RESULTS: Severity of age-related maculopathy was associated with poorer scores of the Activities of Daily Vision Scale. This association was most significant for near vision and driving activities. In this sample, the SF-36 Health Survey scales were not significantly correlated with severity of age-related maculopathy.

CONCLUSIONS: Reported visual functioning is significantly associated with the clinical severity of age-related maculopathy. However, once visual acuity is taken into consideration, clinical grading of age-related maculopathy did not explain a significant portion of the variation in visual functioning. The lack of significant correlation between severity of age-related maculopathy and the SF-36 Health Survey may have resulted from the small number of participants in our sample with severe bilateral age-related maculopathy.

Section snippets

Methods

This ancillary study prospectively enrolled consecutive patients with age-related maculopathy who were scheduled for vision care by one of the authors (J.M.S.) at the Massachusetts Eye and Ear Infirmary between July 1, 1992, and September 1, 1993, as part of the Age-related Macular Degeneration Progression Study, which began in 1989. This study is an ongoing longitudinal study designed to measure multiple risk factors for progression of maculopathy.

Eligibility criteria at the baseline visit

Results

The 201 patients (63% female; 97% white) had a mean (± SD) age of 71 ± 10 years. The mean number of medical comorbidities was one, with the most common comorbid conditions being hypertension (43%), heart disease (20%), and diabetes mellitus (7%); 41% of the participants had no comorbid medical conditions.

On average, this cohort had well-preserved visual acuity, with a median corrected acuity value of 20/25 in the better eye and 20/40 in the worse eye (Table 1). Patients in this sample reported

Discussion

Our results illustrate the performance of generic health-related quality of life and vision-targeted measures for a sample of patients with age-related maculopathy and the relationship of these measures with standard clinical indicators of severity of age-related maculopathy. The SF-36 had low and nonsignificant correlations with both clinical indicators of age-related maculopathy severity and visual acuity. Similarly, unadjusted mean SF-36 scores were nonsignificant across severity categories

Acknowledgements

The authors thank Elaine Abrams for assisting with the patient interviews and Alex Pedan for assisting with construction of the data set and analyses.

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    This study was supported in part by Clinical Investigator Award 1K08-AG00605 from the National Institute on Aging and a Claude D. Pepper Geriatric Research and Training Center Faculty Development Award, National Institute on Aging, Bethesda, Maryland (Drs Mangione and Gutierrez); and Research to Prevent Blindness, Inc, New York, New York, and the Epidemiology Unit Fund (Dr Seddon). Dr Seddon is a recipient of the Lew R. Wasserman Merit Award from Research to Prevent Blindness, Inc.

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