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Poorer visual function and limited driving ability are associated with increased mortality among people with age-related macular degeneration (AMD), a new study published in Ophthalmology Retina has found.¹ In the U.S., nearly 20 million persons ages 40 and older have AMD, approximately 1% of whom are at risk for vision loss.²

AMD鈥攁 chronic retinal disease that causes progressive and irreversible vision loss鈥攊s associated with profound burdens.¹ Specifically, patients with AMD are challenged to complete activities of daily living, such as reading, facial recognition, social functioning, and driving.^3,4 Individuals with AMD with vision loss are also at increased risk for depression.⁴

Some studies point to an association between visual impairment and mortality risk, potentially due to impacts of vision loss on falls, accidents, and mental health.¹ However, to date, possible relationships between visual functioning and mortality haven鈥檛 been evaluated specifically among persons with AMD.¹ 

In an interview with 澳门老奇人论坛, Jennifer Patnaik, PhD, MHS, Assistant Professor of Ophthalmology at the University of Colorado School of Medicine, in Aurora, who was involved in the study, was asked about the rationale for the new research. 鈥淲e鈥檝e found that visual functioning gives a wide perspective on each patient鈥檚 experience with their ocular health. Because AMD has a large impact on visual functioning, we were curious as to what aspects of visual functioning might potentially predict mortality.鈥�

How the study was conducted

Individuals ages 55 years or older with a diagnosis of AMD, who were enrolled in the University of Colorado AMD registry between 2014 and 2021, were eligible for the study. At registry enrollment, a total of 876 participants were assessed for habitual visual acuity using the Snellen chart and completed the National Eye Institute Visual Function Questionnaire 25 (VFQ-25), which measures the impact of vision-affecting diseases on near-vision activities, distance-vision activities, mental health symptoms, and social functioning. 

At enrollment, the mean age of participants was 78.7 years, and 60.2% were female. A participant survey and electronic medical records were used to verify the presence of several comorbidities that were examined as covariates in the study: diabetes, treated hypertension, kidney disease, stroke, peripheral vascular disease, atrial fibrillation, skin cancer, lung disease, heart disease, and a history of cancer treatment.

The study鈥檚 primary outcome of all-cause mortality was assessed through a collaboration with the Colorado Department of Public Health and Environment.

Lower visual function increases mortality

Over the course of the study, 180 participants (20.6%) died. The mean follow-up time for the cohort was 52.5 months, and the mean time to death for those who died during the study period was 42.6 months.

Factors associated with time to mortality included age, AMD category, marital status, and smoking history. Comorbidities associated with time to mortality included several of those mentioned earlier: diabetes, treated hypertension, kidney disease, stroke, peripheral vascular disease, atrial fibrillation, lung disease, and heart disease.

With respect to vision, lower visual acuity in both the better-seeing and the worse-seeing eyes was significantly associated with time to mortality. For each 10-point increase in the VFQ-25 composite score, the risk of death decreased by 19% (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.75 to 0.87; P<.0001). VFQ-25 subscales, except for ocular pain, were each associated with time to mortality as well. In a multivariable analysis, each 10-point increase in VFQ-25 scores for general health and driving was associated with a 15% (HR 0.85, 95% CI 0.80 to 0.91; P<.0001) and 8% lower risk of death (HR 0.92, 95% CI 0.87 to 0.97; P=.005), respectively.

Those who died during the study period were more likely to have reported not currently driving for non-eyesight reasons or eyesight plus non-eyesight reasons. The driving rate at enrollment was higher for those who did not die during the study period (73.5%) compared with those who did (46.1%). Adjusted models showed that current drivers had a 48% reduced risk of death compared with non-drivers (HR 0.52, 95% CI 0.36 to 0.76; P=.0008).

What are the implications of these findings?

鈥淥ur results demonstrated that low scores on the VFQ-25 were associated with higher mortality rates,鈥� says Dr. Patnaik. These results add to those previously published by Dr. Patnaik and her colleagues regarding factors associated with current driving and experiencing challenges while driving.⁵

鈥淚t鈥檚 clear that driving is an important piece of a person鈥檚 emotional and physical well-being,鈥� Dr. Patnaik emphasized.

With respect to the role of clinicians, Dr. Patnaik explains that 鈥渢he decision to stop driving is a multidimensional process in which clinicians can help to provide guidance. Referral to low-vision care may help delay the loss of visual functioning and critical activities such as driving.鈥�

Looking ahead, Dr. Patnaik says that the current research team plans to explore specific causes of mortality in patients with AMD.

Published: September 12, 2023