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      Longitudinal Relationships Among Visual Acuity, Daily Functional Status, and Mortality : The Salisbury Eye Evaluation Study

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          Abstract

          IMPORTANCE

          Determination of the mechanisms by which visual loss increases mortality risk is important for developing interventional strategies.

          OBJECTIVE

          To evaluate the direct and indirect effects of loss of visual acuity (VA) on mortality risk through functional status changes among aging adults.

          DESIGN, SETTING, AND PARTICIPANTS

          Prospective longitudinal study of a population-based sample of 2520 noninstitutionalized adults aged 65 to 84 years from September 16, 1993, through July 26, 2003, in the greater Salisbury area of Maryland. Participants underwent reassessment 2, 6, and 8 years after baseline. Mortality status was ascertained from linkage with the National Death Index through 2009.

          EXPOSURES

          Results of VA testing and self-reported functional status based on activities of daily living (ADL) and instrumental ADL (IADL).

          MAIN OUTCOMES AND MEASURE

          Mortality.

          RESULTS

          Worse VA levels at baseline were associated with an increased the risk for mortality (hazard ratio [HR], 1.16 [95% CI, 1.04–1.28]; P < .01) through their effect on lower IADL levels at baseline. Declines in VA over time were associated with increased mortality risk (HR, 1.78 [95% CI, 1.27–2.51]; P < .001) by way of decreasing IADL levels over time. Participants experiencing the mean linear decline in VA of 1 letter on the Early Treatment Diabetic Retinopathy Study acuity chart per year are expected to have a 16% increase in mortality risk during the 8-year study exclusively through associated declines in IADL levels.

          CONCLUSIONS AND RELEVANCE

          In this longitudinal study of older adults, VA loss adversely affected IADL levels, which subsequently increased the risk for mortality. Prevention of disabling ocular conditions, treatment of correctable visual impairment, and interventions designed to prevent the effect of visual impairment on IADL declines may all reduce mortality risk in aging adults.

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          Author and article information

          Contributors
          Journal
          101589539
          40866
          JAMA Ophthalmol
          JAMA Ophthalmol
          JAMA ophthalmology
          2168-6165
          2168-6173
          31 January 2021
          December 2014
          19 February 2021
          : 132
          : 12
          : 1400-1406
          Affiliations
          Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana; Department of Statistics, Purdue University, West Lafayette, Indiana
          Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
          Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
          Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
          Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
          Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
          Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
          Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
          Author notes

          Author Contributions: Drs Christ and Zheng had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr West and Ms Muñoz were involved in the original design and collection of Salisbury Eye Evaluation (SEE) data.

          Study concept and design: Christ, West, Tannenbaum, Lee.

          Acquisition, analysis, or interpretation of data: Christ, Zheng, Swenor, Lam, Muñoz, Lee.

          Drafting of the manuscript: Christ, Zheng, Swenor, Lam, Tannenbaum, Lee.

          Critical revision of the manuscript for important intellectual content: Christ, Lam, West, Tannenbaum, Muñoz, Lee.

          Statistical analysis: Christ, Zheng, Swenor.

          Obtained funding: Christ, Lam, West, Lee.

          Administrative, technical, or material support: Lam, West, Muñoz.

          Study supervision: West.

          Corresponding Author: Sharon L. Christ, PhD, Department of Human Development and Family Studies, Purdue University, Fowler Memorial House, 1200 W State St, West Lafayette, IN 47907-2055 ( slchrist@ 123456purdue.edu ).
          Article
          PMC7894742 PMC7894742 7894742 nihpa1660959
          10.1001/jamaophthalmol.2014.2847
          7894742
          25144579
          829121d6-bb74-4986-bdf6-b142a273260e
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